To examine the role that ambient air pollution plays in exacerbating cardiovascular disease hospitalization in Windsor, Ontario.
The number of daily cardiac hospital admissions was obtained from all Windsor hospitals from April 1, 1995 to December 31, 2000 and linked to concentrations of ambient air pollutants and weather variables. The logarithm of daily counts of hospitalization was regressed on the levels of pollutants, after adjusting for seasonal, weekly cycles, and weather variables using time series analysis with natural splines as smoothing functions.
Of all the pollutants considered, sulphur dioxide (SO2) had the strongest effect on cardiac hospitalization among the > or = 65 age group. The percentage increase in daily admission was 2.6% for current day sulphur dioxide level (95% CI: 0.5-6.4), 4.0% for 2-day mean level (95% CI: 0.1-6.9), and 5.6% (95% CI: 1.5-9.9) for 3-day mean level for an increase in interquartile range of 19.3 ppb. When particulate PM10 was included in the model, the contributing effect of sulphur dioxide remained significant for the > or = 65 age group for all three levels.
Short-term effects of sulphur dioxide are associated significantly to daily cardiac hospital admissions for people > or = 65 years of age living in Windsor. Since Windsor is a border city, additional monitoring and assessment is recommended to determine if air quality and resultant health effects have deteriorated since traffic congestion at the border has increased following the events of September 11, 2001.
Cites: J Air Waste Manag Assoc. 2000 Jul;50(7):1199-20610939212
Cites: Eur Respir J. 2001 Apr;17(4):604-811401052
Cites: Circulation. 2001 Jun 12;103(23):2810-511401937
Cites: Epidemiology. 2001 Jul;12(4):413-911416779
Cites: Environ Health Perspect. 2001 Aug;109 Suppl 4:523-711544157
Cites: Environ Health Perspect. 2001 Dec;109 Suppl 6:827-4311744501
Cites: Epidemiology. 2003 Jan;14(1):18-2312500041
Cites: Environ Res. 2003 Jan;91(1):8-2012550083
Cites: Eur Heart J. 2003 Apr;24(8):752-6012713769
Cites: Am J Epidemiol. 2003 Jun 15;157(12):1055-6512796040
Cites: Circulation. 2004 Jan 6;109(1):71-714676145
Cites: Lancet. 1995 Jan 21;345(8943):176-87741860
Cites: Am J Epidemiol. 1995 Jul 1;142(1):15-227785669
Cites: Am J Epidemiol. 1995 Jul 1;142(1):23-357785670
Cites: Am J Public Health. 1995 Oct;85(10):1361-57573618
Cites: Am J Public Health. 1996 Sep;86(9):1273-808806380
Cites: Epidemiology. 1997 Jul;8(4):371-79209849
Cites: Epidemiology. 1997 Mar;8(2):162-79229208
Cites: Occup Environ Med. 1997 Aug;54(8):535-409326156
Cites: Environ Health Perspect. 1998 Oct;106(10):649-539755140
Cites: J Toxicol Environ Health A. 1998 Oct 9;55(3):185-969772102
Cites: Epidemiology. 1999 Jan;10(1):17-229888275
Cites: Arch Environ Health. 1999 Mar-Apr;54(2):130-910094292
Structured diagnostic inter- views include items that evaluate physical etiologies for mood and anxiety disorders. The objective of this article was to assess the impact of such items.
A mental health survey in Canada collected data from n = 36,984 household residents. The lifetime prevalence of mood and anxiety disorders was calculated with and without exclusions due to physical causes.
Approximately 10% of subjects with a lifetime depressive disorder reported that all of their episodes were due to one or more physical cause. Many of the reported etiologies were implausible given the DSM-IV requirement that the disturbance be a "direct physiological consequence" of the physical cause. The results were similar for manic episodes and anxiety disorders.
Structured diagnostic interviews assess physical etiologies in ways that are subject to inconsistency and inaccuracy. Physical etiology items may bias estimates by introducing etiological opinions into the assessment of disorder frequency.
The association between cigarette smoking and cervical cancer has been demonstrated in numerous prior studies. As part of population-based case-control studies of cancers of the vulva, vagina, cervix, anus, and penis in relation to infection with human papillomavirus, conducted in western Washington State and the province of British Columbia from the mid 1980s until the present time, the authors have collected detailed information on smoking history. The proportion of subjects who were current smokers of cigarettes ranged from slightly over 40% among incident cases of vaginal and cervical cancer to 60% among cases of vulvar and anal cancer. In contrast, only about 25% of controls were current smokers. The adjusted odds ratios (OR) associated with current smoking were substantially elevated (OR = 1.9-14.6) for all cancer sites except cancer of the vagina (OR = 1.3). The risks tended to increase in proportion to the number of cigarettes smoked. For most cancer sites, the odds ratios associated with former smoking were substantially less than those associated with current smoking and diminished with increasing time since cessation of smoking. The authors' data and those of other investigators suggest that cigarette smoking plays a role in the etiology of anogenital cancers and that smoking has a late-stage or promotional effect.
Data from the Norwegian part of the WHO/EURO Multicenter Study on Suicidal Behavior were used to investigate gender differences in the communicative aspect of nonfatal suicidal behavior by means of analyzing precipitating factors, intentions involved in and effects of the suicidal act within the frame of Qvortrup's interpretation of speech-act theory. Eighty-nine patients (48 women and 41 men) were included in the analyses, virtually no gender differences were found. Thus, in general, the results did not support the view that persons engaging in nonfatal suicidal behavior should receive different treatment or follow-up as a group based on their gender. The results gave some support to Qvortrup's speech-act theory and his four categories of suicidal behavior, emotional toward others, regulative toward others, emotional toward oneself and regulative toward oneself.
Subtle developmental (motor, emotional, cognitive, and behavioral) abnormalities are often present in apparently healthy individuals who later develop psychosis, suggesting that some aspects of causation are established before overt psychosis. These impairments may restrict information processing and social achievements years before manifesting psychosis. The main known risk factors in the development of schizophrenic psychosis are genetic factors, pregnancy and delivery complications, slow neuromotor development, and deviant cognitive and academic performance. However, their effect size and predictive power are small. Developmental precursors are not necessarily specific to schizophrenia, but also common to other psychotic disorders. No powerful risk factor, premorbid sign, or risk indicator has been identified that is useful for prediction of psychoses in the general population.
The association between treatment with Selective serotonin reuptake inhibitors (SSRIs) and suicide in children and adolescents on the individual and ecological level were examined in a nationwide Danish pharmacoepidemiological register-linkage study including all persons aged 10-17 years treated with antidepressants during the period 1995-1999 (n=2,569) and a randomly selected control population (n=50,000). A tripartite approach was used. In Part 1, changes in youth suicide and use of antidepressants were examined. In Part 2, we made an assessment of youth suicide characteristics. In Part 3, we analysed the relative risk (RR) of suicide according to antidepressant treatment corrected for psychiatric hospital contact to minimize the problem of confounding by indication. The use of SSRIs among children and adolescents increased substantially during the study period, but the suicide rate remained stable (Part 1). Among 42 suicides nationally aged 10-17 years at death, none was treated with SSRIs within 2 weeks prior to suicide (Part 2). There was an increased rate of suicide associated with SSRIs (RR=4.47), however, not quite significant (95% CI: 0.95-20.96), when adjusted for severity of illness (Part 3). Conclusively, we were not able to identify an association between treatment with SSRIs and completed suicide among children and adolescents.
The objective was to study explanatory factors for help-seeking among incontinent women, and what was the outcome of the treatment. A questionnaire was mailed to all 2366 women aged 20 or over in the rural community of Rissa, Norway. Women confirming incontinence gave information about duration, precipitating factors, frequency, amount of leakage, and impact. Questions about doctor consultation or planned consultation, treatment and results were included. Women with incontinence which had resolved without treatment were also recorded. A total of 77% answered the questionnaire. Twenty per cent of women with incontinence (n = 535) had consulted a doctor, 18% had planned to consult. Increasing age and duration, and urge/mixed type of incontinence were determinative factors for doctor consultation, while increasing severity and impact were determinative for planned consultation. Drugs, exercises, pads, and electrostimulation were all important treatment options: 21% were cured, 40% much better after treatment. Of all the women, 8% reported that they had been incontinent in the past, and only 18% of these had consulted a doctor.
To assess the impact of surgically placed feeding tubes on children with severe cerebral palsy (CP) and their families and to determine the survival of these children after initiation of tube feeding (TF).
Virtually all children from Nova Scotia who had gastrostomy or jejunostomy procedures between the years 1980 and 1998 and who had been diagnosed with CP were identified. Caretakers of those children who had TF initiated in the last 8 years were evaluated by using a semi-structured interview. Names of children who had not had recent follow-up visits were submitted to the provincial Vital Statistics office to determine whether they had died. Data from patients who were tube-fed between 1980 and 1989 were then used in combination with data from the more recent cases to create a survival curve.
A total of 61 children were identified; 16 had died. Forty of 45 eligible families were interviewed; 90% were pleased with the effect of TF on their child and family life. Negative reports were associated with increased stress related to feeding. Survival rates after gastrostomy and/or jejunostomy were 83% after 2 years and 75% after 7 years.
In children with severe CF, initiation of TF improved the quality of life for both the child and family in 90% despite frequent minor complications.
Acute myocardial infarction (AMI) is a highly dynamic event, which is associated with marked neuroendocrinological dysfunction in addition to cardiac damage. The immediate trigger for AMI is not precisely known. Studies conducted by Lown, Braunwald, Halberg, Otsuka and our group have demonstrated a marked increase in sympathetic activity, oxidative stress, and magnesium and potassium deficiency during AMI. Clinical studies have reported an increased incidence of AMI, sudden death and ischemia during first quarter of the day when there is a rapid withdrawal of vagal activity and increase in sympathetic tone. In one case-control study of 202 patients with AMI, there was a significant (P
Delirium is common and serious acute syndrome among older people precipitated by multiple external factors such as acute illnesses, trauma, surgery, and drugs. The aim of this study was to find possible stressors and causative triggers for acute delirium and compare patients with or without dementia in this respect.
193 delirious patients from two separate delirium studies including settings of nursing homes and geriatric wards were thoroughly assessed for precipitating factors of delirium. Patients with and without dementia were compared for their clinical status, symptoms and signs, prognosis, and the profile of precipitating factors of delirium.
The patients with dementia (n=98) and without dementia (n=95) did not differ in their demographic factors, mean number of drugs, or their psychiatric symptoms. The patients with dementia had higher number of comorbidities, poorer cognition, and they were more often restrained than those without dementia. The mean number of precipitators for delirium was 2.6 among those without dementia and 2.0 among those with dementia (p=0.0019). Infections, metabolic conditions, trauma, and surgery were more common precipitating factors for delirium in those without than those with dementia. There was no difference in mortality between the groups.
Most patients had multiple precipitating factors for delirium irrespective of prior dementia. Those with dementia and decreased cognitive reserves needed lower number of etiologies to develop delirium. The profile of causative agents differed among patients with and without dementia.