OBJECTIVE: To evaluate whether the use of salmeterol is associated with an increased risk of an asthma-related hospitalization or emergency care among asthma patients. METHODS: The data for this study were extracted from the Medstat MarketScan® claims databases occurring between 01/01/00 and 12/31/01. A nested case-control study design was employed. A cohort representing asthma patients was identified in 2000. Among the study cohort, hospitalized cases were identified as those who had the firsttime asthma-related hospitalization in 2001, and were matched to select controls by age (± 5 years), sex, and the number of ambulatory visits for asthma (5:1 control to case ratio). A similar process was applied to evaluating an asthma-related emergency department (ED) visit. The odds of prior salmeterol exposure among cases compared to controls were estimated using conditional multiple logistic regressions. The covariates of interest comprised age, prior hospital admission or ED visit for asthma, number of canisters of inhaled short-acting β₂ agonists and use of other asthma medications. RESULTS: A total of 35,312 subjects were eligible to be the study cohort. In addition, 285 and 640 subjects were identified as hospitalized and ED cases, respectively. The non-significant association was found when the prior salmeterol exposure was treated as a dichotomized variable. However, it was found that one unit increase in the number of canisters of salmeterol was associated with a seven percent decrease in the risk of a hospital admission for asthma (p <0.001). Additionally, current use of salmeterol was associated with a 48 percent decrease in the risk of an asthma-related hospitalization (OR = 0.52; p <0.001). The protective effect of salmeterol did not exist for those with recent or past use of salmeterol. Similar findings were observed for the ED visit outcome. CONCLUSIONS: The use of salmeterol was not found to be associated with an increased risk of an asthma-related hospital admission or ED visit. Conversely, one unit increase in the number of canisters of salmeterol and current use of salmeterol, respectively, were found to decrease the risk in an asthma-related hospitalization or ED visit among asthma patients.

No description available.

Postpartum depression is by definition a major depression with an onset during the first weeks after delivery. In practice, however, the term, postpartum depression is used to characterize all kinds of depressive symptoms after childbirth. The aims of this thesis were to investigate the prevalence of depressive symptoms during late pregnancy, in the puerperium and four years after delivery, and to analyze the mothers’ estimation of personal health and their children’s behavior at the age of four. Additional goals were to test the predictive power of potential associated factors of postpartum depression during pregnancy and the puerperium and finally, to elucidate possible genetic or neuropeptidergic explanatory variables behind the development of postpartum depression. A population-based sample of 1489 women was screened with the Edinburgh Postnatal Depression Scale and the prevalence of depressive symptoms was 17% in late pregnancy and 13% postpartum. Antenatal depressed mood was related to postpartum depression. In a cross-sectional study we later found that postpartum depression was associated with subsequent depressive symptoms and current health problems four years after childbirth. Four-year-old boys of postpartum depressed mothers and children of mothers with a subsequent depressive status had more behavior problems than children of non-symptomatic mothers did, according to the mothers’ opinion. The strongest associated factors for postpartum depression, in a case-control study, were sick leave during pregnancy mainly due to pregnancy complications, e.g. hyperemesis and premature contractions and a high number of visits to the antenatal care clinic. There was no association between delivery complications or complications in the perinatal period and postpartum depression. The theory that depressive symptoms in late pregnancy or postpartum are connected with CYP2D6 genotype could not be confirmed. In a rat model, we found that pregnancy and parturition influence the concentrations of neuropeptide Y, cholecystokinin, substance P and galanin in the rat brain. This result supports the hypothesis that neuropeptidergic systems in the brain influence the mood changes around childbirth. In conclusion, postpartum depression is a common feature with influence on both maternal and child well being. / Pages 26 and 57 containing illustrations are removed from the electronic version. On the day of the public defence the status of article IV was: Accepted for publication.

Background: Moderate-to-vigourous intensity physical activity (MVPA) is among the few modifiable factors known to reduce breast cancer risk. However, the independent effects of leisure-time, household, and occupational MPVA by age period across the life course remain poorly understood. Whether these effects differ by menopausal status and by tumour subtypes defined by the estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor-2 (HER2) is unknown. An understanding of these issues will help advance policy and public health action targeting breast cancer prevention through physical activity. Methods: A case-control study of 1,011 incident breast cancer cases and 1,014 cancer-free controls aged 40-80 years was conducted from 2006-2010 in Vancouver, British Columbia (BC). Lifetime leisure-time, household, and occupational MVPA were assessed by questionnaire and mean MET-hrs/week of each were calculated for age periods 12-17, 18-34, 35-49, and ≥50 years and the total lifetime. Odds ratios for pre- and post-menopausal breast cancer risk associated with each activity domain across age periods were estimated using unconditional logistic regression, and odds ratios for risks of ER/PR-defined and ER/PR/HER2-defined breast tumours were estimated using unconditional polytomous logistic regression. Results: Among post-menopausal women, lifetime leisure-time and household MVPA reduced breast cancer risk by approximately 50% at volumes equal to 3 hours per week of running and 21 hours per week of active household work. MVPA reduced risk at all age periods across the life course, particularly during adulthood. Effects of leisure-time MVPA appeared restricted to HER2- tumours. Household MVPA reduced risk for ER/PR+ tumours, regardless of HER2 status. MVPA was not associated with pre-menopausal breast cancer risk, except occupational MVPA performed during ages 18-34 was associated with a doubling in risk. Conclusions: MVPA is a lifestyle factor women may engage in to reduce post-menopausal breast cancer risk. Results suggest HER2 may be implicated in anti-breast carcinogenic effects of leisure-time MVPA. Increased risk associated with occupational MVPA may be due to occupational exposures related to job intensity. Further research on specific aspects of weekly MVPA energy expenditure dose required to reduce breast cancer risk will aid in refining physical activity recommendations for breast cancer prevention. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2012-06-29 10:01:45.535

We investigated the association of Bell's palsy (BP) with the subsequent risk of Parkinson's disease (PD) using a case-control study design. We matched 196 incident cases of PD in Olmsted County, MN, to 196 general population controls with same age (±1 year) and sex, and we reviewed the complete medical records of cases and controls in a medical records-linkage system to detect BP. Six of the 196 patients with PD and none of the 196 controls were diagnosed with BP before PD (exact binomial probability, P = 0.02). The median age at occurrence of BP was 49.5 years (range, 15-84 years) and the median time between BP and the onset of PD was 27.5 years (range, 2-54 years). The findings were similar using a standardized incidence ratio (SIR) approach, but were not statistically significant. This initial association between BP and PD awaits replication.

Controlling norovirus transmission in units with immunocompromised patients is challenging. We present a cluster of norovirus cases that occurred on a stem-cell transplant unit and the prevention efforts that were implemented to limit the outbreak. Protocols developed to control this cluster may provide a model for other facilities. / National Institutes of Health / Revisión por pares

No description available.

The aims of the studies underlying this thesis were to assess the exposure to quartz in Swedish iron foundries and to determine the cancer morbidity for Swedish foundry workers. A cohort of 3,045 foundry workers and a final measurement database of 2,333 number of samples was established. The exposure measurements showed high levels of respirable quartz, in particular for fettlers and furnace and ladle repair workers with individual 8 hr TWA (GM=0.041 and 0.052 mg/m3; range 0.004-2.1 and 0.0098-0.83 mg/m3). In our database, the quartz concentrations as 8hr TWAs of current and historical data varied between 0.0018 and 4.9 mg/m3, averaging 0.083 mg/m3, with the highest exposures for fettlers (0.087 mg/m3) and furnace and ladle repair workers (0.42 mg/m3). The exposure for workers using respirators assuming full effect when used were assessed quantitatively, revealing workers with actual exposure exceeding the occupational exposure limits. Overall cancer morbidity was not increased, but the incidence of lung cancer was significantly elevated (SIR 1.61; 95 % CI 1.20-2.12). In the cohort study, significant associations between lung cancer and cumulative quartz exposure were detected for quartz doses of 1-2 mg/m3 * year (SIR 2.88; 95 % CI 1.44-5.16) and &gt;2 mg/m3 * year (SIR 1.68; 95 % CI 1.07- 2.52). These findings were not confirmed in the case-control analysis. The agreement between the estimated exposure in our early historical model and the development model showed a regression coefficient of 2.42, implying an underestimation of the historical exposure when using the development model data. The corresponding comparison between the development and the validation model based on our survey data showed a B of 0.31, implying an overestimation of present exposures when using data from the validation model. The main conclusions of the thesis are that certain foundry workers are still exposed to high levels of quartz, and the overall excess lung cancer could not be confirmed in the exposure-response analysis.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

Introdução: A prevalência de nascimento pré-termo vem aumentando nos últimos anos e é atualmente um problema de saúde pública mundial, sendo responsável por significante mortalidade neonatal e morbidades infantil e na vida adulta. As causas são multifatoriais e estão relacionadas às dimensões socioeconômica, psicossocial e biológica que se interrelacionam e se sobrepõem. Os fatores de risco diferem entre as populações e grupos étnicos, no entanto, ainda não estão claros quais e como os determinantes etiológicos estão envolvidos. As estratégias de cuidado pré-natal desenvolvidas tem sido insuficientes para a prevenção. Objetivo: estudar os fatores de risco para o nascimento pré-termo em crianças nascidas de partos hospitalares de mães residentes no município de Campina Grande/PB, Brasil. Métodos: O desenho foi um caso-controle de base populacional, que foi realizado no período de junho de 2008 a maio de 2009. Os casos foram nascidos com menos de 37 semanas gestacionais e os controles os nascidos com 37 semanas ou mais. A idade gestacional foi definida em semanas utilizando-se critérios de seleção baseados na acurácia da estimativa. Foram realizadas entrevistas com as mães e coleta de registros hospitalares. Foram selecionados 341 casos e 424 controles. A análise foi baseada em modelo de regressão múltipla hierarquizada. Resultados: os fatores de risco para nascimento pré-termo foram: filho anterior pré-termo (OR=2,32; IC 95%: 1,25-4,29), assistência pré-natal inadequada (categoria II três ou mais prérequisitos negativos) (OR=2,15; IC 95%: 1,40-3,27), ganho ponderal materno insuficiente (OR=2,33; IC 95%: 1,45-3,75), dano físico materno durante a gestação (OR=2,10; IC 95%: 1,22-3,60), hipertensão arterial na gestação com eclâmpsia (OR=17,08; IC 95%: 3,67-79,43) e sem eclâmpsia (OR=6,42; IC 95%: 3,50-11,76), internação durante a gestação (OR=5,64; IC 95%: 3,47-9,15), alteração do volume amniótico (OR=2,28; IC 95%: 1,32-3,95); sangramento vaginal (OR=1,54; IC 95%: 1,01-2,34) e gestação múltipla (OR=22,65; IC 95%: 6,22-82,46). Segundo o mesmo modelo, a renda familiar per capita menor que um salário mínimo foi fator protetor (OR=0,63; IC 95%: 0,39-0,99). Conclusão: Os fatores de risco foram semelhantes ao observado em outros estudos nacionais e internacionais, a não ser para o resultado da variável do nível socioeconômico. A elevada prevalência da pobreza e baixa escolaridade, maior que em estudos realizados na Região Sul, tanto nos casos como nos controles, pode ter contribuído para esse resultado. Estudos adicionais são necessários para o aprofundamento do conhecimento sobre a complexidade das cadeias causais no parto pré-termo, em diferentes contextos e a diferenciação pelos subtipos, espontâneo e indicado / Introduction: The prevalence of preterm birth has increased in recent years and it is currently a worldwide public health problem, being responsible for significant neonatal mortality and morbidity in childhood and adulthood. The causes are multifactorial and related to socioeconomic, psychosocial and biological factors that interrelate and overlap. Risk factors differ between ethnic groups and populations, however, it is not yet clear which are and how the etiological determinants are involved. Strategies for prenatal care have been developed enough for prevention. Objective: To study the risk factors for preterm birth in newborn of hospital deliveries by mothers, residents in the city of Campina Grande/PB, Brazil. Methods: The study design was a case-control population-based, which was conducted from June 2008 to May 2009. Cases were born at less than 37 weeks of gestation and controls, at 37 weeks or more. Gestational age in weeks was defined using selection criteria based on the accuracy of the estimate. Interviews were conducted with mothers and collection of hospital records. It was selected 341 cases and 424 controls. The analysis was based a logistic multiple regression model, based on a hierarchized conceptual modelling approach. Results: The risk factors for preterm birth were: previous preterm birth (OR=2,32; 95%CI: 1,25-4,29), inadequate prenatal care (category II three or more negative prerequisites) (OR=2,15; 95%CI: 1,40- 3,27), inadequate maternal weight gain (OR=2,33; 95%CI: 1,45-3,75), physical damage to the mother during pregnancy (OR=2,10; 95%CI: 1,22-3,60), hypertension pressure (OR=17,08; 95%CI: 3,67-79,43), hospitalization during pregnancy (OR=5,64; 95%CI: 3,47-9,15), amniotic fluid volume changes (OR=2,28; 95%CI: 1,32-3,95), vaginal bleeding (OR=1,54; 95%CI: 1,01-2,34) and multiple gestation (OR=22,65; 95%CI: 6,22-82,46). According to the model, the per capita income less than the minimum wage was a protective factor (OR=0,63; 95%CI: 0,39-0,99). Conclusion: The risk factors were similar to those observed in other national and international studies, except for the result of varying socioeconomic level. The high prevalence of poverty and low educational level, higher than in studies in the South in both outcomes, may have contributed to this result. Further studies are needed on the complexity of causal chains in preterm delivery in different contexts and differentiation by subtypes, spontaneous and indicated