This study was designed to test the hypothesis that fetal exposure to corticosteroids in the antenatal period is an independent risk factor for the development of asthma in early childhood with little or no effect in later childhood. A population-based cohort study of all pregnant women who resided in Nova Scotia, Canada, and gave birth to a singleton fetus between 1989 and 1998 was undertaken. After a priori specified exclusions, 80,448 infants were available for analysis. Using linked health care utilization records, incident asthma cases developed after 36 months of age were identified. Extended Cox proportional hazards models were used to estimate hazard ratios while controlling for confounders. Exposure to corticosteroids during pregnancy was associated with a risk of asthma in childhood between 3-5 years of age: adjusted hazard ratio of 1.19 (95% confidence interval: 1.03, 1.39), with no association noted after 5 years of age: adjusted hazard ratio for 5-7 years was 1.06 (95% confidence interval: 0.86, 1.30) and for 8 or greater years was 0.74 (95% confidence interval: 0.54, 1.03). Antenatal steroid therapy appears to be an independent risk factor for the development of asthma between 3 and 5 years of age.
This study was designed to test the hypothesis that fetal exposure to corticosteroids in the antenatal period is an independent risk factor for the development of asthma in childhood.
A population-based cohort study was conducted of all pregnant women who resided in Nova Scotia, Canada, and gave birth to a singleton fetus between January 1989 and December 1998 and lived to discharge. After exclusions, 79,395 infants were available for analysis. Using linked health care utilization records, incident asthma cases between 36 to 72 months of age were identified. Generalized Estimating Equations were used to estimate the odds ratio of the association between exposure to corticosteroids and asthma while controlling for confounders.
Over the 10 years of the study corticosteroid therapy increased by threefold. Exposure to corticosteroids during pregnancy was associated with a risk of asthma in childhood: adjusted odds ratio of 1.23 (95% confidence interval: 1.06, 1.44).
Antenatal steroid therapy appears to be an independent risk factor for the development of asthma between 36 and 72 months of age. Further research into the smallest possible steroid dose required to achieve the desired post-natal effect is needed to reduce the risk of developing childhood asthma.
Adolescents and young adults who are out of school are at elevated risk for a work injury.
To obtain more information on this "high risk" group of young workers, young people at youth employment centers across Ontario were asked through an online survey about training, unsafe work conditions, work injuries and safety knowledge.
The 1,886 youth who completed the survey reported a medically attended work injury rate of 14.45 per 100 FTEs. Also, the most common unsafe work conditions were dust/particles, trip hazards and heavy lifting. In addition, many young workers reported using much of their income for living essentials (e.g., rent).
Though not a representative sample, it appears that youth using employment centers experience many unsafe work conditions and work injuries. While many report safety training, the nature and effectiveness of this training remains to be determined. The large portion of young workers out of school and working for living essentials included in this sample suggest that youth employment centers should be considered in future prevention efforts targeting this vulnerable subgroup of workers.
To describe the incidence of avoidable mortality for causes amenable to medical care among occupation groups in Canada.
A cohort study over an 11-year period among a representative 15% sample of the non-institutionalized population of Canada aged 30-69 at cohort inception. Age-standardized mortality rates for causes amenable to medical care and all other causes of death were calculated for occupationally-active men and women in five categories of skill level and 80 specific occupational groups as well as for persons not occupationally active.
Age-standardized mortality rates per 100,000 person-years at risk for causes amenable to medical care and for all other causes were 132.3 and 218.6, respectively, for occupationally-active women, and 216.6 and 449.3 for occupationally-active men. For causes amenable to medical care and for all other causes, for both sexes, there was a gradient in mortality relative to the five-level ranking by occupational skill level, but the gradient was less strong for women than for men. Across the 80 occupation minor groups, for both men and women, there was a linear relationship between the rates for causes amenable to medical care and the rates for all other causes.
For occupationally-active adults, this study found similar gradients in mortality for causes amenable to medical care and for all other causes of mortality over the period 1991-2001. Avoidable mortality is a valuable indicator of population health, providing information on outcomes pertinent to the organization and delivery of health care services.
There is convincing evidence that several distinct wheezing syndromes exist in childhood. The purpose of this research was to assess the potential of using healthcare utilization profiles to identify wheezing syndromes in children which are distinct from asthma. Using population-based healthcare administrative data, a cohort of children, aged 5-15 years, with bronchitis diagnoses from time of birth to 1995, but no physician diagnoses of asthma, was followed over the period January 1996-March 1998. In this follow-up period, 13% had subsequent healthcare utilization for asthma, 23% had continued healthcare utilization for bronchitis, and 64% had no further healthcare utilization. The likelihood of bronchitis vs. asthma outcomes was determined for a variety of asthma risk factors. In a cohort of 11,043 children with initial healthcare contact for bronchitis but not asthma, two potentially distinct entities of bronchitis emerged from our data: 1) transient bronchitis, similar to transient wheezing of early childhood, which was associated with winter-only healthcare utilization and absence of allergy, and 2) recurrent bronchitis which differed from asthma on the basis of winter-only healthcare utilization, prematurity at birth, absence of allergy, and low socioeconomic status. Healthcare administrative records can be used to describe the natural history of wheezing in children and to identify markers which may discriminate asthma from other syndromes.
Hypertension is an increasingly important health concern in Canada. This paper examines the risks associated with psychosocial working conditions compared to health behaviours on the risk of hypertension over a 9-year period in Ontario, Canada.
We used data from Ontario respondents to the 2000-01 Canadian Community Health Survey linked to the Ontario Health Information Plan database covering physician services and the Canadian Institute for Health Information database for hospital admissions. We focused on labour market participants aged 35 to 60, who had not been previously diagnosed with hypertension, were not self-employed, and were working more than 10 hours per week, more than 20 weeks in the previous 12 months (N = 6,611). Subjects were followed for a nine-year period to ascertain incidence of hypertension.
Low job control was associated with an increased risk of hypertension among men, but not among women. The population attributable fraction associated with low job control among males was 11.8% in our fully adjusted model. There was no consistent pattern of increased risk of hypertension across different levels of health behaviours.
Primary prevention efforts to reduce the incidence of hypertension predominantly target modifiable health behaviours. Evidence from this longitudinal cohort suggests that modifiable characteristics of the work environment should also be considered in the design of cardiovascular disease prevention programs, in particular for male labour market participants.
The objective of this study was to compare the incidence of work-related injury and illness presenting to Ontario emergency departments to the incidence of worker's compensation claims reported to the Ontario Workplace Safety & Insurance Board over the period 2004-2008.
Records of work-related injury were obtained from two administrative data sources in Ontario for the period 2004-2008: workers' compensation lost-time claims (N=435,336) and records of non-scheduled emergency department visits where the main problem was attributed to a work-related exposure (N=707,963). Denominator information required to compute the risk of work injury per 2,000,000 work hours, stratified by age and gender was estimated from labour force surveys conducted by Statistics Canada.
The frequency of emergency department visits for all work-related conditions was approximately 60% greater than the incidence of accepted lost-time compensation claims. When restricted to injuries resulting in fracture or concussion, gender-specific age differences in injury incidence were similar in the two data sources. Between 2004 and 2008, there was a 14.5% reduction in emergency department visits attributed to work-related causes and a 17.8% reduction in lost-time compensation claims. There was evidence that younger workers were more likely than older workers to seek treatment in an emergency department for work-related injury.
In this setting, emergency department records available for the complete population of Ontario residents are a valid source of surveillance information on the incidence of work-related disorders. Occupational health and safety authorities should give priority to incorporating emergency department records in the routine surveillance of the health of workers.
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The objective of this article is to examine the factors associated with differences in access to income replacement benefits for workers experiencing a work-related injury or illness of 1-week or longer in the Canadian labor force.
This study utilized data from the Survey of Labour and Income Dynamics, a representative longitudinal survey conducted by Statistics Canada. A total of 3,352 work-related absences were identified. Logistic regression models examined factors at the individual, occupational, and geographic level that were associated with the probability of receiving compensation.
The probability of not receiving employer or workers' compensation benefits was higher among women, immigrants in their first 10 years in Canada, younger workers, respondents who were in their first year of a job, those who were not members of a union or collective bargaining agreement, and part-time workers.
More research is required to understand why almost 50% of respondents with 1-week or longer work-related absences did not report receiving workers' compensation payments following their absence. More importantly, research is required to understand why particular groups of workers are more likely to be excluded from any type of compensation for lost earnings after a work-related injury and illness in Canada.
To examine the potential effectiveness and efficiency of different guidelines for statin treatment to reduce deaths from coronary heart disease in the Canadian population.
Modelled outcomes of screening and treatment recommendations of six national or international guidelines--from Canada, Australia, New Zealand, the United States, joint British societies, and European societies.
Details for 6760 men and women aged 20-74 years from the Canadian Heart Health Survey (weighted sample of 12,300,000 people) that included physical measurements including a lipid profile.
The number of people recommended for treatment with statins, the potential number of deaths from coronary heart disease avoided, and the number needed to treat to avoid one coronary heart disease death with five years of statin treatment if the recommendations from each guideline were fully implemented.
When applied to the Canadian population, the Australian and British guidelines were the most effective, potentially avoiding the most deaths over five years (> 15,000 deaths). The New Zealand guideline was the most efficient, potentially avoiding almost as many deaths (14,700) while recommending treatment to the fewest number of people (12.9% of people v 17.3% with the Australian and British guidelines). If their "optional" recommendations are included, the US guidelines recommended treating about twice as many people as the New Zealand guidelines (24.5% of the population, an additional 1.4 million people) with almost no increase in the number of deaths avoided.
By focusing recommendations on people with the highest risk of coronary heart disease, the Canadian, US, and European societies guidelines could improve either their effectiveness (in terms of hundreds of avoided deaths) or efficiency (in terms of thousands of fewer people recommended treatment) in the Canadian population.
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