The objectives of this thesis were: (i) to examine the relationship and the nature of the link of socioeconomic status (SES) to an objective indicator of childhood asthma; (ii) to quantify the agreement between area-based SES measures and SES assessed at the level of the individual; and (iii) to compare the test characteristics of asthma as evidenced by questionnaire, exercise and methacholine challenges without assuming a gold standard. We carried out a cross-sectional study of 989 Montreal elementary school children in an area where there is universal access to medical care through state-funded health insurance. A questionnaire was completed by parents, and the children performed spirometry before and after a free-running exercise challenge. Street address information and parental occupation were used to establish neighborhood and individual-level SES indicators respectively. A sub-sample of 332 children underwent allergy skin and methacholine bronchoprovocation tests, and indoor home measurements of NO$ sb2$, PM$ sb{10}$, dust-mites and various types of moulds were performed. / Low SES was associated with an increased likelihood of exercise-induced bronchospasm (EIB), lower FEV$ sb1$ and FVC, but not with FEV$ sb1$/FVC, a measure of airway calibre. With lower SES the likelihood of positive allergy skin tests decreased for cat, trees and grasses but increased for cockroach and moulds. / Of the host factors examined, birthweight was positively associated with FVC and FEV$ sb1$ while airway responsiveness to methacholine increased as birthweight decreased. Pre-term birth independent of birthweight was associated with a lower FEV$ sb1$/FVC. Of the environmental factors, increasing exposure to household tobacco smoke and smoking during pregnancy were found to be associated with larger FVC and lower FEV$ sb1$/FVC. The current presence of a cat and lower respiratory infection prior to the age of 2 years (LRI) were associated with EIB. Increasing usual dietary salt intake was also found to be associated with higher methacholine responsiveness. Part of the observed relationship between SES and indicators of asthma was mediated by the indoor environmental pollutants. / There was poor agreement between the area-based and the individual-level SES measures even when used to classify children into broad SES categories. Using a Bayesian approach, comparison of the three tests for measuring asthma revealed exercise challenge to perform least well compared to a questionnaire or methacholine provocation in terms of the test characteristics when the purpose was to chose a single test for identifying asthma in community based studies. / The results provide evidence suggesting that SES is an important risk factor for childhood asthma. This further suggests that excess morbidity and mortality from asthma in inner city areas of large American cities is not only due to differential access to health care but that under-utilization of health care as well as host, dietary and environmental factors associated with social disadvantage are also important.

In this study, the feasibility and reliability of health-related quality of life and health preference measurements among patients with tuberculous infection or disease have been evaluated. Cronbach's correlation coefficients were all higher than 0.70 for the different dimensions and interviews. In fact, for interview 1 to 3, the mean (SD) for the SF-36 PCS ranged from 53.0 (7.5) to 53.5 (6.5), for the SF-36 MCS from 49.5 (10.2) to 52.4 (10.4), for the EQ5D 81.7 (22.3) to 86.9 (18.6), for the VAS from 83.5 (15.6) to 86.9 (10.3) and for the SG 87.8 (19.6) to 89.7 (17.7). For both the VAS and SG, health states of active TB subjects ranked lower than those of other subjects (p-value ranging from 0.002 to 0.11 for each instruments and interviews, Wilcoxon rank-sum test). These measures of health-related quality of life and health utilities appeared feasible and reliable in this subject population. (Abstract shortened by UMI.)

Background. Evidence to date remains equivocal regarding the association between tattooing and various transfusion-transmitted diseases (TTDs). / Objectives. To determine whether there is an association between the presence or specific characteristics of ornamental tattoos and one or more of the following infections: HBV, HCV, HIV, Chagas' disease, and syphilis. / Methods. Type of study: Hospital-based cross-sectional pair-matched study. Setting: Teaching hospital and blood bank in a Brazilian town. Study population: Adults 18 years of age and over who were admitted to the hospital, attended the outpatient clinic or volunteered to donate blood. Exclusion criteria: medical conditions causing transitory or permanent intellectual impairment; physical impossibility to provide blood specimens or information. Exposure of interest: Having at least one permanent ornamental tattoo. Covariates: Several socio-demographic and behavioral characteristics. Outcomes of interest: Presence of serological markers for one or more of the following infections: HIV, HBV, HCV, Chagas' disease and syphilis. Matching variables: Individuals with tattoos (exposed group) were pair-matched to individuals without tattoos (unexposed group) on age, sex, and main clinical complaint. Assessment of the exposure: Interview and inspection of the tattoo(s). Assessment of the outcomes: Positive or negative laboratory findings as follows for each infection: HBV - HBsAg and anti-HBc (ELISA); HCV - anti-HCV (ELISA); HIV - anti-HIV (ELISA); Chagas' disease - anti-Trypanosoma cruzi (IFA, ELISA and/or IHA); syphilis - VDRL. / Results. 345 subjects were included in the study, 182 with tattoos and 163 without tattoos. Having a tattoo was associated with HCV (adjusted OR: 6.41; 95% CI: 1.29, 31.84), and with having at least one positive test for any TTD (adjusted OR: 2.05; 95% CI: 1.11, 3.81). Among the subjects with tattoos associations were found between an increasing number of tattoos and HBV infection (adjusted OR: 2.04 (95% CI: 1.80, 9.97) for two tattoos and 3.48 (95% CI: 1.41, 8.58) for three or more tattoos), having a nonprofessional tattoo and testing positive for at least one TTD (adjusted OR: 3.25; 95% CI: 1.39, 7.59), and having three or more tattoos and testing positive for at least one TTD (adjusted OR: 2.98; 1.03, 8.64). / Conclusion. The presence of tattoo(s) may be useful in certain settings for the screening of blood donors, mostly because tattoos are associated with good indicators of TTD such as intravenous drug use.

Introduction: Evidence suggests that neighbourhood characteristics are associated with health; however, this association has not been fully explored in regards to Traumatic Dental Injury (TDI) in Quebec. Objectives: To assess the prevalence and factors associated with TDI to permanent anterior teeth in children participating in the QUALITY cohort. Methods: Study participants (N=279) include children 8-10 years of age at risk of obesity, and their families. TDI was clinically evaluated using the same criteria of the Children's Dental Health Survey’s questionnaire, UK. Questionnaires completed by children and their parents collected data on socio-demographic, behavioural and environmental factors. Results: The prevalence of TDI was 12.9%. Children with incisal overjet greater than 5mm, from high socioeconomic backgrounds, and residing in neighbourhoods with high levels of social capital were more likely to have TDI. Conclusion: Neighbourhood characteristics, such as social capital and socioeconomic status may be associated with TDI experience. / Introduction: Des études ont démontré que les caractéristiques des quartiers étaient associées à la santé; toutefois, cette association n'a pas été complètement explorée en regard du trauma dentaire (TD) au Québec. Objectifs: Évaluer la prévalence de TD ainsi que les facteurs associés au TD sur les dents antérieures chez les enfants participants à la cohorte QUALITY. Méthodes: Les participants (N=279) étaient des enfants, âgés de 8 à 10 ans et ayant un risque élevé de développer l'obésité, ainsi que leurs familles. TD a été cliniquement évalué en utilisant les mêmes critères du questionnaire de l'Enquête de Santé Dentaire des Enfants du Royaume-Uni. Les questionnaires complétés par les enfants et leurs parents ont permis de recueillir des données sociodémographiques, comportement mentales et environnementales. Résultats: La prédominance de TD s’élevait à 12.9 %. Les enfants ayant un surjet incisal plus grand que 5 millimètres, une position socioéconomique élevée et résidant dans les quartiers avec un niveau de capital social élevé étaient plus à risque de TD. Conclusion: Les caractéristiques des quartiers tels que le capital social et le statut socioéconomique pourraient être associées avec le TD.

The main objective of this research is to identify risk factors for severe playground injuries among children aged 1 to 14 years who visited the emergency room of a paediatric hospital in Montreal, during the summer of 1991. Secondary objectives are to study determinants of the occurrence of playground injuries, to estimate injury rates adjusted for exposure, and to do recommendations for prevention. To document circumstances of each injury, telephone interviews were completed with parents of children and a response rate of 90% was obtained. / The objectives of this research required different study designs. The principal objective was achieved through a case-control study. In this study, logistic regressions were performed to study risk factors of serious (AIS3, n = 88) and moderate injuries (AIS2, n = 203), using minor injuries (AIS1, n = 348) as the reference category. One of our secondary objectives was to analyze risk factors for injury occurrence. For this, two additional case-control studies were performed. In the first study, cases related to playgrounds (n = 639) were compared with control children who had visited the emergency room for another type of injury (n = 1064). In the second study, characteristics of playgrounds where an injury occurred were compared with playgrounds with no injuries. Finally, qualitative analyses were conducted to describe the scenarios of the injury incidents. To prevent future incidents, the Canadian Standards on Children's Playspaces and Equipment were reviewed to identify playground elements associated with injuries. / As they become older, boys tend to sustain more severe injuries than girls. Children who use playgrounds less frequently are at lower risk of being injured, however, when they are injured, the injuries are more severe. Approximately 75% of all playground injuries resulted from a fall. Injuries from falls are more severe than other types of injuries. Public playgrounds account for 71% of injuries and home playgrounds for 21%. Injuries sustained at public playgrounds are more severe than injuries at home, except among children aged 1 to 4. The rate of injury is higher on modules (combination of several types of equipment including swings, climbers and slides) and swings than on slides and climbers. However, injuries on slides are more severe. The odds of serious injuries are 2.1 times greater for a fall on grass compared to one on sand (CI: 1.08; 3.96). The height of the equipment also appears to be a risk factor for incidence and severity of injury. For all hospitals in Montreal during 1991, the average rate of emergency room visits for playground injuries among children aged 1 to 14 years is 397 per 100,000 children for the period May to September. Injury rates are higher for children under 10 years old and among boys. / In conclusion, the findings regarding playground surfaces are the most important, and suggest that, under equipment, grass should be replaced by sand. This recommendation applies to both public and home playgrounds. Prevention programs should focus on ensuring that playgrounds are in compliance with Canadian Safety Standards and should include both public and home playgrounds.

No description available.

<p> The purpose of this study is to determine whether there is a disparity in the receipt or uptake of the HPV vaccine by race/ethnicity in young females, and whether the sources of information about HPV and the HPV vaccine affects the receipt of the HPV vaccine by race/ethnicity. Data from the California Health Interview Survey was utilized in analyzing these factors related to females who received the HPV vaccine. Although there were significant differences between receipt of the vaccine by race/ethnicity, overall vaccine receipt was low for all groups, which is consistent with other findings. Vaccination rates also varied by age, which likely was the result of better access to the HPV vaccine for younger females and by source of information.</p>

<p> Long-term consequences of environmental lead exposure in Kosovo: Effects of pre and postnatal lead exposure in early adulthood Pashko R. Camaj Between May 1985 and December 1986, a cohort of 1,502 pregnant women was recruited at two government clinics in Kosovo (formerly a province of Yugoslavia) for a study of the relationship between environmental lead (Pb) exposure and birth outcomes. Subsequently, a representative group of 541 of their children were selected for long-term follow up. The children were followed longitudinally at six-month intervals for 12 years to examine the effects of environmental Pb exposure on a variety of health outcomes including cognitive and motor function, anemia, endocrine function and growth. This work produced numerous landmark publications (Popovac et al, 1982; Graziano et al., 1990, 1991, 2004; Murphy et al., 1990; Factor-Litvak et al, 1993, 1996, 1998, 1999; Wasserman et al,. 1992, 1994, 1997, 1998, 2000) that contributed to the modification of environmental policies to reduce Pb exposure worldwide. The long-term study ultimately linked environmental Pb exposure from the Trepca mining and smelting operations in Mitrovica to adverse effects on intelligence, motor function, blood pressure, renal, endocrine and hematological functioning. Follow up rates over time were excellent in that 70% of the total cohort was evaluated at 6 years of age, and 65% were evaluated at 12 years of age, at which point the study was - until now - concluded. For the present study, we located 101 members of the original study cohort and requested their participation in a follow-up study in which participants were evaluated to assess their current blood lead (BPb) levels and health outcomes as follows: a) blood pressure; b) biomarkers of endothelial cell function that are associated with cardiovascular disease; c) and measurements of erythropoietin, a glycoprotein hormone produced in the kidney that regulates the production of red blood cells in the bone marrow. The participants, whose environmental exposure history is very well documented from 12 weeks of gestation through 12 years of age, were between 25-26 years of age during the follow-up study. We found a statistically significant association between BPb and systolic blood pressure (sBP), and a marginally significant association between BPb and diastolic blood pressure (dBP), which is consistent with a multitude of studies and meta-analyses referenced in this dissertation. These results provide further evidence that recent circulating dose, as estimated by BPb, or as estimated by lifetime cumulative exposure, is associated with slight increase in sBP. Furthermore, we detected a suggestive relationship between BPb and levels of circulating serum intercellular adhesion molecules (sICAM-1) and serum intravascular adhesion molecules (sVCAM-1), possibly a mechanism by which Pb may lead to increased BP. These findings support the hypothesis that the exposure to Pb either prenatally or in early adulthood, may lead to increased BP and increased circulating levels of sICAM-1 and sVCAM-1 later in life. Lastly, the results regarding the serum erythropoietin (EPO) production presented here resemble the findings reported in this cohort at 4.5 and 6.5 years of age and in contrast with the findings in this cohort when the study participants were 9.5 and 12 years of age (Graziano et al., 2004). In addition, they also contrast the findings reported in the anemic mothers of this study cohort (Graziano et al., 1991) where serum-EPO levels were lower in those with higher BPb levels.</p>

<p> Since 1988 when the first HIV positive drug user was identified in Poland, for close to two decades, the predominant route of HIV transmission has been through injecting drug use. In mid 2000s, Polish officials reported that injecting drug use no longer contributed to incrasing HIV incidence. The consequences of such a statement are that many of the structural and personal risks associated with HIV infection go unaddressed, that drug users are neglected by HIV prevention efforts, that HIV treatment is not made available to drug users and that the policy environment does not adequately support effective public health initiatives. This case study is based on documentation, archival records, interviews, participant observation, and physical artifacts shows that these assertions were made, and continue to be repeated, in a highly political context. Poland is a post-socialist state with strong neoliberal leanings, and it is highly invested in successful integration with the European Union. Powerful Catholic Church serves as an important backdrop. While people considered "at risk" now have more freedom to conduct their lives, they also have a set of neoliberal expectations and religious pressures placed on them. Country's geographic location adds to this complexity - situated between "Old Europe" where HIV problem has been successfully contained and the former Soviet Union, where the HIV incidence among drug users is the highest in the world, Poland attempts to align itself with the success of the West. Furthermore, examination of the available data suggests that the assertions made by Polish officials omit numerous variables. My research shows that even though Polish leadership in the area of HIV and drug policy wishes to resemble Western Europe, Poland does not meet international standards for the prevention of HIV transmission. The interviews I conducted, as well as the review of the literature on drug and HIV policies and programs suggest that these services are scattered, often unavailable, and that their number is stagnating, at best, and in some cases, even decreasing. This maybe a direct result of lack of engagement of drug users in their design. Excluded from the discussion of risk, drug users are thus not the focus of prevention efforts. Based on gathered data, there are seven crucial issues that require immediate action if Poland is to manage HIV prevention and care for people who use drugs in a manner consistent with the international standards. The areas requiring action are: a change in the drug policy from the current very punitive approach, expansion of needle and syringe programs and other harm reduction services, improved data collection and an increase in the availability of HIV testing, scaled-up substitution treatment, improved quality of other forms of drug treatment, greater investment in civil society organizations, improved access to HIV treatment, and educational and training efforts that encourage greater attention to HIV related matters across disciplines.</p>

No description available.