Over an 18-month period, we observed 759 children attending eight day care centres in the Quebec City area to determine the rate of absenteeism due to illness in day care centres. 481 children were absent for a mean duration of 4.1 days. The absenteeism rate was 5.6 days out of a possible 1 000 days of attendance and did not vary with day care centre or age.
This article describes the prevalence of the four international body mass index (BMI) categories--underweight (18.5 or less), acceptable weight (18.6 to 24.9), overweight (25 to 29.9) and obese (30 or more)--by selected socio-demographic and lifestyle characteristics. It also examines the association between BMI and selected health problems.
The data are from the household component of the 1996/97 National Population Health Survey, conducted by Statistics Canada. Results are based on a sample of 50,347 respondents aged 20 to 64.
Prevalence estimates of BMI categories were calculated. Multivariate analyses were used to examine associations between BMI and various health conditions by smoking status, while controlling for age and sex.
In 1996/97, about half of Canadian adults were in the acceptable weight range; 34% were overweight; 12%, obese; and 2%, underweight. Being overweight or obese was associated with asthma, arthritis, back problems, high blood pressure, diabetes and thyroid disorders, although this varied with smoking status. Underweight smokers had high odds of reporting cancer, bowel disorders, ulcers, and migraine.
Calcium antagonists, particularly the newer, longer-acting agents, are clearly effective in reducing elevated blood pressure with minimal to modest adverse effect profiles, and are therefore used extensively. The goal of antihypertensive therapy, however, is not simply to reduce blood pressure, but also to reduce vascular injury due to hypertension. Prospective controlled clinical trials evaluating cardiovascular morbidity and mortality are needed to test calcium antagonists in patients with hypertension. This review summarises the design and, in some cases, the results of 7 trials (5 of them still ongoing) that have provided insight into the effects of moderate- to long-acting calcium antagonists on mortality and target-organ damage in patients with hypertension. The Systolic Hypertension in Europe (Syst-Eur) trial studied 4695 elderly patients with isolated systolic hypertension, and demonstrated significant reductions in stroke and all fatal and nonfatal cardiac end-points in patients randomised to nitrendipine versus placebo. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) compares the effects of standard diuretic treatment with 3 alternatives (amlodipine, lisinopril, and doxazosin) on the incidence of fatal coronary artery disease and nonfatal myocardial infarction in more than 42,000 hypertensive patients with additional cardiovascular risk factors. The Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) compares the effects of amlodipine +/- perindopril with atenolol +/- bendrofluazide on fatal coronary artery disease and nonfatal myocardial infarction in 18,000 high risk patients. The Controlled ONset Verapamil INvestigation of Cardiovascular End-points (CONVINCE) study is assessing the incidence of fatal or nonfatal myocardial infarction and stroke, and cardiovascular disease-related death in patients on controlled-onset extended-release verapamil compared with a standard regimen of hydrochlorothiazide or atenolol. The Nordic Diltiazem Study (NORDIL) also compares a calcium antagonist (diltiazem) with conventional antihypertensive drug treatment (diuretics or beta-blockers) with add-on therapy as needed, in preventing cardiovascular mortality or morbidity. The Prospective Randomized Evaluation of the Vascular Effects of Norvasc Trial (PREVENT) tests a similar hypothesis, examining the effects of amlodipine on atherosclerotic lesions. The African-American Study of Kidney Disease (AASK) trial is evaluating the effects of amlodipine in hypertensive patients with renal disease. These important clinical trials of different classes of antihypertensive agents are critical for optimising the treatment of hypertensive patients in order to prevent coronary artery disease and other vascular diseases in this new millennium. Importantly, these randomised trials are free of the major problems of observational studies, i.e., confounding by indication, and should fully address the concerns raised by observational studies and small, under-powered, randomised trials that calcium antagonists may have adverse effects on myocardial infarction, bleeding and cancer. To date, these trials in progress have provided no evidence to support these concerns.
This article describes trends in the prevalence of asthma among children aged 0 to 14 from 1978/79 to 1994/95, and in hospital separations for asthma from 1974/75 to 1994/95. It also examines factors associated with childhood asthma.
Information on asthma among children aged 0 to 11 is from the 1994/95 National Longitudinal Survey of Children and Youth (NLSCY), and among children aged 12 to 14, from the 1994/95 National Population Health Survey (NPHS). Hospital separation data are from the Hospital Morbidity File. Mortality data are from the Canadian Vital Statistics Data Base.
Prevalence estimates of asthma were calculated based on a sample of 22,831 children aged 0 to 11 from the NLSCY and 637 children aged 12 to 14 from the NPHS. Logistic regression was used to estimate the odds of asthma among children aged 0 to 11 by selected characteristics.
The prevalence of childhood asthma and hospital separations rates for asthma have increased sharply. A history of bronchitis and allergies, parental asthma, and residence in the Atlantic provinces and Quebec are associated with higher rates of asthma in children.
Empyema is a suppurative infection of the pleural space. Without prompt treatment, it can result in significant hospital stays, more invasive treatments as it progresses, and substantial morbidity and mortality.
The primary objective of the present study was to evaluate whether there has been an increasing incidence of empyema in Canada. A secondary objective was to investigate whether this increase disproportionately affects any age group.
The Discharge Abstract Database of the Canadian Institute for Health Information was used to evaluate national empyema data.
There were 11,294 patients identified with empyema over the nine-year period of the present study, of whom 31% were women. The mean (+/- SD) length of stay was stable throughout the study at 21.82+/-33.88 days, and 63.4% were discharged home. The incidence rate ratio (IRR) was defined as the ratio of the incidence rate of medical empyema in 2003 divided by the incidence rate in 1995. Medical empyema increased significantly (IRR 1.30, 95% CI 1.20 to 1.41; P
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Pertussis remains present in the industrialized world, although the widespread use of whole-cell pertussis vaccine has led to a dramatic decline of the disease. Great differences in immunization policies and coverage explain the uneven epidemiological pattern across the developed world. Different situations can be described. In some countries such as Japan, UK and Italy, concerns about the occurrence of severe adverse events following pertussis vaccination in the 70's led to a reduced acceptance and thus, to a significant decrease in immunization coverage. In Sweden, the protective efficacy of pertussis vaccine was questioned and vaccination was discontinued in 1979. In all these countries, severe epidemics of pertussis were observed in the following years, and immunization was then reinforced in some (UK). In Japan, considerable efforts were made to develop new and safer pertussis acellular vaccines which have replaced the whole-cell vaccine since 1981. In other countries such as the USA and France, despite a continuous immunization programme maintaining a sustained and high coverage, a resurgence of the disease was observed in association with a modification of the age-distribution. Vaccinated adults became susceptible to the infection because of progressive waning, vaccine-induced immunity. These patients contaminated very young and thus, unvaccinated infants. These observations underline the need for early immunization in infants as well as the importance of late booster doses to be given to older children or adults.(ABSTRACT TRUNCATED AT 250 WORDS)