Oral contraceptive use.

OBJECTIVES: This article profiles Canadian women aged 15 to 49 who use oral contraceptives (OCs), and compares certain of their characteristics with those of non-users. It also examines associations between OC use and selected characteristics, including cardiovascular risk factors. DATA SOURCE: The data are from the cross-sectional household component of Statistics Canada's 1996/97 National Population Health Survey. The analysis is based on a sample of 21,996 women aged 15 to 49, weighted to represent an estimated 7.6 million women. ANALYTICAL TECHNIQUES: Cross-tabulations were used to estimate the percentage of women aged 15 to 49 who use OCs and to compare selected health behaviours of users and non-users. A multiple logistic regression model was used to model relationships between selected characteristics and OC use. MAIN RESULTS: An estimated 1.3 million women aged 15 to 49, or 18%, reported using OCs in 1996/97. OC use was significantly associated with being young, unmarried, sexually active, and having prescription drug insurance and relatively high education. About one-third of OC users also smoked.

Changes in social support in relation to seniors' use of home care.

OBJECTIVES: This article examines seniors' entry into government-supported home care in relation to changes in levels of social support and in living arrangements. DATA SOURCE: The analysis is based on longitudinal data from the household component of the first two cycles of the National Population Health Survey, conducted by Statistics Canada in 1994/95 and 1996/97. Data from a sample of 2,044 people aged 65 or older who were followed prospectively were weighted to represent 2.7 million household-dwelling seniors. ANALYTICAL TECHNIQUES: Descriptive data were produced using bivariate frequencies. A multiple logistic regression model was used to examine associations between home care entry and changes in levels of social support and in living arrangements, while controlling for demographic and health-related factors. MAIN RESULTS: Among people aged 65 or older who did not receive government-supported home care in 1994/95, an estimated 7% (192,000) were receiving these services in 1996/97. Changes in social support and in living arrangements between 1994/95 and 1996/97 were significantly associated with home care entry.

The National Population Health Survey--its longitudinal nature.

OBJECTIVES: This article discusses some of the benefits and challenges of data from a longitudinal panel as exemplified by the National Population Health Survey (NPHS). DATA SOURCE: The NPHS collects both cross-sectional and longitudinal data from a sample of randomly selected individuals. The longitudinal sample will be reinterviewed every 2 years for up to 20 years. Two NPHS cycles have been completed: cycle 1 in 1994/95 and cycle 2 in 1996/97. SUMMARY: Selected findings from the NPHS are presented to illustrate the benefits of longitudinal data. An overview of questionnaire content, collection methods follows, and sample design is provided. A summary of response rates is followed by a discussion of the methods used to maintain response and to adjust the survey weights in order to reduce nonresponse bias. Confidentiality, dissemination, inconsistencies in reporting, proxy reporting and changes in coding conventions are also discussed.

Characterization of SYBR Gold nucleic acid gel stain: a dye optimized for use with 300-nm ultraviolet transilluminators.

The highest sensitivity nucleic acid gel stains developed to date are optimally excited using short-wavelength ultraviolet or visible light. This is a disadvantage for laboratories equipped only with 306- or 312-nm UV transilluminators. We have developed a new unsymmetrical cyanine dye that overcomes this problem. This new dye, SYBR Gold nucleic acid gel stain, has two fluorescence excitation maxima when bound to DNA, one centered at approximately 300 nm and one at approximately 495 nm. We found that when used with 300-nm transillumination and Polaroid black-and-white photography, SYBR Gold stain is more sensitive than ethidium bromide, SYBR Green I stain, and SYBR Green II stain for detecting double-stranded DNA, single-stranded DNA, and RNA. SYBR Gold stain's superior sensitivity is due to the high fluorescence quantum yield of the dye-nucleic acid complexes ( approximately 0.7), the dye's large fluorescence enhancement upon binding to nucleic acids ( approximately 1000-fold), and its capacity to more fully penetrate gels than do the SYBR Green gel stains. We found that SYBR Gold stain is as sensitive as silver staining for detecting DNA-with a single-step staining procedure. Finally, we found that staining nucleic acids with SYBR Gold stain does not interfere with subsequent molecular biology protocols.

The health of lone mothers.

OBJECTIVES: This article focuses on differences in the health status and health care utilization patterns of mothers in two-parent families, women who recently became lone parents, and women who had been lone parents for a longer period. Changes in the health of these women and their health care use over time are also explored. DATA SOURCE: The findings are based on the longitudinal component of the first two cycles (1994/95 and 1996/97) of the National Population Health Survey (NPHS). The sample analyzed consisted of 1,805 women in the 10 provinces who had at least one child younger than 18 at home. ANALYTICAL TECHNIQUES: Measures of self-reported health status and health care use for the three types of mothers were compared, using unadjusted and adjusted means. Multiple regression models were used to determine if lone motherhood was significantly associated with measures of health status and health care utilization after accounting for selected factors. MAIN RESULTS: Lone mothers generally had poorer health status than mothers in two-parent families, as measured by self-reported health, happiness, and distress scores. Between the first two cycles of the NPHS, the health status of longer-term lone mothers did not improve significantly. No differences were found on measures of health care utilization.

Work stress and health.

OBJECTIVES: This article describes work stress experienced by the employed population. It examines associations between job strain, job insecurity, physical demands, low co-worker support and low supervisor support, and four health outcomes: migraine, work injury, high blood pressure and psychological distress. DATA SOURCE: The data are from the household component of the 1994/95 National Population Health Survey conducted by Statistics Canada. Results are based on a sample of 9,023 employed Canadians aged 18 to 64. ANALYTICAL TECHNIQUES: Multivariate analyses were used to estimate associations between work stress and health problems, while controlling for other potential stressors. MAIN RESULTS: Among men, job strain was associated with migraine and psychological distress, and among women, with work injury. Job insecurity was associated with migraine among women. High physical demands were related to work injury in both sexes. Low co-worker support was related to migraine among men, and to work injury and psychological distress among women.

Impact of radiation therapy fraction size on local control of early glottic carcinoma.

PURPOSE: Different radiotherapy fractionation schedules were used over a 10-year period to treat patients with early squamous cell carcinoma of the vocal cords at McGill University. A retrospective analysis was performed to study the effect of fraction size on local control in this group of patients. METHODS AND MATERIALS: A total of 126 previously untreated patients with T1 invasive squamous cell carcinoma of the true vocal cords were irradiated between January 1978 and December 1988 in the Department of Radiation Oncology at McGill University. All patients received megavoltage irradiation, 94 patients received daily fractions > 2 Gy (64 patients received 50 Gy with once-daily 2.5-Gy fractions, and 30 received 65.25 Gy in 29 fractions of 2.25 Gy each), and 32 patients were treated to a dose of 66 Gy in 33 fractions with 2 Gy/fraction. Patients' characteristics of prognostic importance were equally distributed between the two fractionation groups. RESULTS: At a median follow-up of 84 months, the 10-year disease-free survival and overall survival were 76% and 93%, respectively. Local control for patients treated with > 2 Gy fraction was 84%, compared to 65.6% for those treated with 2-Gy fractions (p = 0.026). Among the prognostic factors tested, such as gender, age, stage, anterior and posterior commissure involvement, smoking history, and fraction size, the latter was the only significant predictor of local control for the whole group of patients in univariate (p = 0.041) and multivariate (p = 0.023) analysis. There was no observed difference in the incidence of complications between the two fractionation groups. CONCLUSIONS: From the results of this retrospective review of patients treated with radiotherapy for T1 true vocal cord cancer, and within the range of total doses and overall treatment times used in our patients, it was found that fractionation schedules using daily fraction size > 2 Gy are associated with a better local control than schedules delivering 2 Gy/fraction, with no increase in toxicity.

The impact of ibuprofen on the efficacy of antihypertensive treatment with hydrochlorothiazide in elderly persons.

BACKGROUND: Nonsteroidal antiinflammatory drugs (NSAIDs) may alter blood pressure through their inhibitory effects on prostaglandin biosynthesis. Such potential hypertensive effects of NSAIDs have not been adequately examined in the elderly, who are the largest group of NSAID users. METHODS: We performed a randomized, double-blind, two-period crossover trial of ibuprofen (1800 mg per day) vs placebo treatment in patients older than 60 years of age with hypertension controlled with hydrochlorothiazide. While continuing their usual thiazide dosage, subjects were randomized to a 4-week treatment period (ibuprofen or placebo) followed by a 2-week placebo wash-out period and a second 4-week treatment period with the alternative therapy. Supine and standing systolic and diastolic blood pressures were measured weekly. RESULTS: Of 25 randomized subjects, 22 completed the study protocol (mean age = 73 +/- 6.7 years). Supine systolic blood pressure and standing systolic blood pressure were increased significantly with ibuprofen treatment, compared with placebo. Mean supine systolic blood pressures were 143.8 +/- 21.0 and 139.6 +/- 15.9 mmHg on ibuprofen and placebo, respectively (p = .004). Mean standing systolic blood pressures were 148.1 +/- 19.9 and 143.4 +/- 17.9 mmHg on ibuprofen and placebo, respectively (p = .002). CONCLUSION: We conclude that 1800 mg per day of ibuprofen does induce a significant increase in systolic blood pressure in older hypertensive patients treated with hydrochlorothiazide. NSAID therapy may negatively impact the control of hypertension in elderly patients.

Do consensus conferences influence their participants?

OBJECTIVE: To determine whether participation in a consensus conference on the assessment of dementia would influence conference participants with respect to their recommendations to primary care physicians for the assessment of dementia. DESIGN: Questionnaire before and after the conference. SETTING: Canadian Consensus Conference on the Assessment of Dementia, held in Montreal, Oct. 5 and 6, 1989. PARTICIPANTS: All 38 experts representing relevant health disciplines who participated in the consensus conference; 36 completed both questionnaires. OUTCOME MEASURES: Participants' opinion before and after the conference as to how frequently each of 28 manoeuvres (12 blood tests, 4 neurologic imaging procedures, 4 types of consultation and 8 "other" tests) should be ordered by primary care physicians as part of an assessment of a patient with dementia suspected in clinical grounds. RESULTS: For 18 (64%) of the 28 manoeuvres (10 of the 12 blood tests, 3 of the 4 neurologic imaging procedures and 5 of the 8 "other" tests), there was a shift in opinion after the conference toward recommending that primary care physicians order them less often; for 10 of these 18 (5 blood tests and 5 "other" tests) the shift was statistically significant. For the remaining 10 manoeuvres (36%) the shift in opinion was toward a recommendation that primary care physicians order them more often; the shift was not statistically significant for any of these 10 manoeuvres. CONCLUSION: Expert members of a consensus conference are influenced by the process of having participated in such a conference and are capable and willing to chance their initial recommendations when confronted with relevant data.

Depression.

According to the 1994-95 National Population Health Survey, close to 6% of Canadians aged 18 and over had experienced a major depressive episode in the previous 12 months. Univariate analysis shows that the prevalence of depression was higher among women than among men, but tended to decline at older ages both sexes. The prevalence of depression was also related to a number of socioeconomic characteristics such as marital status, education, and household income, and to several measures of stress, psychological resources and social support. However, multivariate analysis shows that not all of these variables were significantly associated with the odds of experiencing depression. In some instances, factors that increased the risk differed for men and women. For both sexes, chronic strain, recent negative events, lack of closeness, and low self-esteem increased the odds of depression. Traumatic events in childhood or young adulthood and a low sense of mastery were associated with a higher risk of depression for women, but not men. For men, being single and having moderate self-esteem heightened the risk of depression. A substantial proportion of both men and women who had suffered depression reported using drugs. As well, a notable share of people who had been depressed sought professional health care for emotional or mental problems.

A healthy outlook.

The sense of coherence-a healthy outlook-can be thought of as a measure of positive health, that is, a factor promoting resilience which enables an individual to remain healthy. Based on National Population Health Survey (NPHS) data, three health measures were analyzed in relation to sense of coherence. The sense of coherence accounted for a substantial proportion of the total variance for two of the three measures. Theoretically, people with a healthy outlook are more able to cope successfully with trauma and stress. According to NPHS data, on average, those who reported at least one traumatic event had a lower sense of coherence than those who did not. For people who experienced trauma during childhood and young adulthood, yet had a strong sense of coherence, the impact of that trauma on their health was diminished.

Risk assessment for pressure ulcers: an adaptation of the National Pressure Ulcer Advisory Panel risk factors to spinal cord injured patients.

To estimate risk factors for pressure ulcers, we developed quantitative definitions for each of the nine general areas of risk outlined by the 1989 National Pressure Ulcer Advisory Panel (NPUAP) and evaluated each of these factors in a group of spinal cord injured patients by means of a retrospective chart review at a spinal cord injury referral center serving the New England area. All patients (n = 364) admitted to the spinal cord injury service between January 1, 1989 and December 31, 1990 were studied. We identified a pressure ulcer in 81 of 364 patients (22.3 percent). In the univariate analyses, pressure ulcers were associated with Frankel groups A to B with an odds ratio (OR) of 5.7 (95 percent confidence interval 2.8 to 11.9), low albumin with an OR of 4.9 (95 percent confidence interval 2.8 to 8.6), low hemoglobin with an OR of 2.5 (95 percent confidence interval 1.5 to 4.1), age > or = 60 years with an OR of 1.9 (95 percent confidence interval 1.2 to 3.2) and three independent measures of co-morbidity: Cumulative Illness Rating Scale (CIRS) with an OR of 3.7 (95 percent confidence interval 2.1 to 6.3), Charlson Index with an OR of 2.2 (95 percent confidence interval 1.3 to 3.8), and International Classification of Diseases, Ninth Revision, Clinical Modification count with an OR of 4.2 (95 percent confidence interval 2.4 to 7.2). In the logistic regression model, low albumin, CIRS and Frankel grade A to B and history of pressure ulcers were predictors.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent chemical dependency treatment in an HMO.

HMOs are under increasing pressure to expand benefits and services for treatment of adolescents who abuse alcohol and drugs. Little information exists, however, on these programs. This article describes a comprehensive adolescent chemical dependency treatment program within an HMO and presents data on use, costs, and results. Characteristics of clients were similar to adolescents seen in community treatment programs. Less than 1% of the HMO adolescent population sought treatment, and the mean number of outpatient treatment visits was 9.7. The median was between two and three visits, and the mode was one visit. Thirty-four percent of the adolescents required residential treatment, and 65% of the adolescents completed the recommended 28-day stay. The additional premium cost per member per month for adolescent chemical dependency treatment was approximately $0.28. A telephone follow-up survey of a random sample of treated adolescents found that most adolescents had reduced their use of alcohol and drugs and had made improvements in other areas of their lives. Few adolescents, however, met the program's goal of total abstinence.