Stress in Parents of Children With Genetically Determined Leukoencephalopathies: A Pilot Study.

Genetically determined leukoencephalopathies comprise a group of rare inherited white matter disorders. The majority are progressive diseases resulting in early death. We performed a cross-sectional pilot study including 55 parents from 36 families to assess the level of stress experienced by parents of patients with genetically determined leukoencephalopathies, aged 1 month to 12 years. Thirty-four mothers and 21 fathers completed the Parenting Stress Index-4th Edition. One demographic questionnaire was completed per family. Detailed clinical data was gathered on all patients. Statistical analysis was performed with total stress percentile score as the primary outcome. Mothers and fathers had significantly higher stress levels compared with the normative sample; 20% of parents had high levels of stress whereas 11% had clinically significant levels of stress. Mothers and fathers had comparable total stress percentile scores. We identified pediatric behavioral difficulties and gross motor function to be factors influencing stress in mothers. Our study is the first to examine parental stress in this population and highlights the need for parental support early in the disease course. In this pilot study, we demonstrated that using the Parenting Stress Index-4th Edition to assess stress levels in parents of patients with genetically determined leukoencephalopathies is feasible, leads to valuable and actionable results, and should be used in larger, prospective studies.

Report Summary--Rio Political Declaration on Social Determinants of Health: A Snapshot of Canadian Actions 2015.

In 2012, Canada and other United Nations (UN) Member States endorsed the "Rio Political Declaration on Social Determinants of Health" (Rio Declaration), a non-binding pledge which calls on World Health Organization (WHO) Member States to improve/influence the working and living conditions that affect health and well-being. The Rio Declaration sets out actions to address health inequities in five themes: to adopt better governance for health and development; to promote participation in policy making and implementation; to further reorient the health sector towards reducing health inequities; to strengthen global governance and collaboration; and to monitor and increase accountability. In 2013, following the endorsement of the Rio Declaration, the Government of Canada released a report to begin to document Canadian actions related to its five themes. Building on this first report, and in anticipation of WHO reporting on Member State implementation of the Rio Declaration at the May 2015 World Health Assembly, the Government of Canada developed the report, Rio Political Declaration on Social Determinants of Health: A Snapshot of Canadian Actions 2015, which showcases Canada's recent actions since 2013 contributing to the advancement of the five Rio Declaration themes. The report provides a current picture of the diverse spectrum of activities undertaken across levels of government and sectors to advance health equity and address social determinants of health in Canada, and intends to stimulate global and domestic exchange and uptake of promising practices to advance health equity.

TITRE: Note de synthèse - Déclaration politique de Rio sur les déterminants sociaux de la santé : aperçu des mesures canadiennes de 2015. INTRODUCTION: En 2012, le Canada et d'autres États membres des Nations unies ont adopté la Déclaration politique de Rio sur les déterminants sociaux de la santé (Déclaration de Rio), un engagement non contraignant par lequel les États membres de l'Organisation mondiale de la santé (OMS) promettent d'améliorer les conditions de travail et de vie qui influent sur la santé et le bien-être. La Déclaration de Rio énonce plus précisément cinq engagements visant à réduire les inégalités en santé : adopter une meilleure gouvernance pour la santé et le développement, promouvoir la participation à l'élaboration et à la mise en oeuvre des politiques, réorienter davantage le secteur de la santé pour réduire les inégalités en santé, renforcer la gouvernance et la collaboration mondiales et enfin suivre les progrès et accroître la responsabilisation. En 2013, à la suite de l'adoption de la Déclaration de Rio, le gouvernement du Canada a publié un premier rapport pour rendre compte des mesures prises. En 2015, en prévision de la présentation d'un rapport par l'OMS sur la mise en oeuvre de la Déclaration de Rio par les États membres à l'Assemblée mondiale de la santé en mai et en s'appuyant sur ce premier rapport, le gouvernement du Canada a rédigé le rapport Déclaration politique de Rio sur les déterminants sociaux de la santé : aperçu des mesures canadiennes de 2015, qui présente les mesures relevant des cinq engagements de la Déclaration et prises depuis 2013 par le Canada. Ce rapport donne un aperçu des activités entreprises par les différents ordres de gouvernement et secteurs pour promouvoir l'équité en santé et agir sur les déterminants sociaux de la santé. Il vise de plus à encourager la mise en commun et l'adoption de pratiques prometteuses visant à promouvoir l'équité en santé à l'échelle nationale et internationale.

Patterns of health services utilization in rural Canada.

CONTEXT OF THIS STUDY: Canadians value ease of access to their health services. Although many studies have focused on accessibility to health services in Canada, few have examined rural-urban differences in this aspect, particularly from a national perspective. Yet disparities in access to health services exist between rural and urban populations, as do the challenges of delivering health care to more remote areas or to those with small populations. "Canada's Rural Communities: Understanding Rural Health and Its Determinants" is a three-year research project co-funded by the Canadian Population Health Initiative (CPHI) of the Canadian Institute for Health Information (CIHI) and the Public Health Agency of Canada (PHAC). It involves investigators from the Public Health Agency of Canada, the Centre for Rural and Northern Health Research (CRaNHR) at Laurentian University, and other researchers. The first publication of the research project was How Healthy Are Rural Canadians? An Assessment of Their Health Status and Health Determinants; this, the second publication, is a descriptive analysis of the utilization patterns of a broad range of health services by rural residents compared to their urban counterparts.

Induced sputum markers of fibrosis and decline in pulmonary function in asbestosis and silicosis: a pilot study.

OBJECTIVE: To evaluate the usefulness of fibrogenic cytokines and mediators in the analysis of induced sputum and determine if their levels correlated with previous decline in lung function in asbestosis and silicosis. DESIGN: In a pilot study for the evaluation of 19 workers with asbestosis and 15 with silicosis, all workers had chart reviews and records of previous lung function tests. Fourteen healthy control subjects were also included in the study. All subjects attended the laboratory for a clinical evaluation, pulmonary function tests and induced sputum sampling. Differential cell counts were performed and the following mediators and cytokines were measured: matrix metalloproteinase 9 (MMP-9), tissue inhibitor of metalloproteinases 1 (TIMP-1), fibronectin, interleukin 1 beta (IL-1beta), IL-6, IL-8, IL-12, transforming growth factor beta (TGF-beta) and tumor necrosis factor-alpha (TNF-alpha). RESULTS: Levels of IL-1beta were higher in the sputum of subjects with asbestosis and silicosis than in controls. Eosinophils, neutrophils and IL-1beta levels were significantly correlated with the rate of decline in pulmonary function. CONCLUSION: The induced sputum levels of certain inflammatory cells and IL-1beta correlate with the decline in pulmonary function associated with asbestosis and silicosis. It remains to be established if these markers can help predict the clinical outcome of workers exposed to these mineral particles or fibers in a prospective study.

Trends in childhood injury mortality in Canada, 1979-2002.

OBJECTIVE: To examine national trends in mortality rates for injuries among Canadian children younger than 15 years in 1979-2002. METHODS: Data on injury deaths were obtained from the Canadian Vital Statistics system at Statistics Canada. Injuries were classified using the codes for external cause of injury and poisoning (E-codes) by intent and by mechanism. Mortality rates were age adjusted to the 1990 world standard population. Negative binomial regression was used to estimate the secular trends. RESULTS: Annual mortality rates for total and unintentional injuries declined substantially (from 23.8 and 21.7 in 1979 to 7.2 and 5.8 in 2002, respectively), whereas suicide deaths among children aged 10-14 showed an increasing trend. All Canadian provinces and territories showed a decreasing trend in mortality rates of total injuries. Motor vehicle related injuries were the most common cause of injury deaths (accounted for an average of 36.4% of total injury deaths), followed by suffocation (14.3%), drowning (13.5%), and burning (11.1%); however, suffocation was the leading cause for infants. The number of potential years of life lost due to injury before age 75 decreased from 89 343 in 1979 to 27 948 in 2002 for children aged 0-14 years. CONCLUSIONS: During the period 1979-2002, there were dramatic decreases in childhood mortality for total injuries and unintentional injuries as well as various degrees of reduction for all causes of injury except suffocation in children aged 10-14 years and drowning in infants. The reason for the reduction in injury mortality might be multifactoral.

Sources of data for rural health research: development of an inventory of Canadian databases.

Secondary data sources can often be used to help address questions about the health status, health behavior, health resources allocation, and utilization of health services of rural Canadians. But the task of deciding which Canadian databases are amenable to rural health research remains a challenge. As part of a larger research project titled "Canada's Rural Communities: Understanding Rural Health and Its Determinants," an inventory of 51 Canadian databases that have the potential of being used for rural health research was compiled, and it continues to be maintained and updated. The websites maintained by two of Canada's leading statistical data centers were systematically searched, along with other published articles and national reports, to produce this inventory. The criteria used to determine which data sources to include in this inventory are: (1) databases containing data at the national level that can be accessed by researchers, (2) databases containing data that are relevant to a variety of rural health issues, and (3) databases containing data that could be partitioned into rural and non-rural geographies. Detailed information is available by searching the inventory of national rural health research-related databases through the internet (www.cranhr.ca) or by contacting the lead author of this article. This article examines some of the issues in developing this resource and demonstrates the usefulness of its contents to Canadian and other rural health researchers.

Effects of oxygen on lower limb blood flow and O2 uptake during exercise in COPD.

PURPOSE: To quantify the effects of acute oxygen supplementation on lower limb blood flow (QLEG), O2 delivery (QO2LEG), and O2 uptake (VO2LEG) during exercise and to determine whether the metabolic capacity of the lower limb is exhausted at peak exercise during room air breathing in patients with COPD. METHODS: Oxygen (FIO2 = 0.75) and air were randomly administered to 14 patients with COPD (FEV1: 35 +/- 2% pred, mean +/- SEM) during two symptom-limited incremental cycle exercise tests. Before exercise, a cannula was installed in a radial artery and a thermodilution catheter inserted in the right femoral vein. At each exercise step, five-breath averages of respiratory rate, tidal volume, and ventilation (VE), dyspnea and leg fatigue scores, arterial and venous blood gases, and QLEG were obtained. From these measurements, VO2LEG was calculated. RESULTS: Peak exercise capacity increased from 46 +/- 3 W in room air to 59 +/- 5 W when supplemental oxygen was used (P < 0.001). QLEG, QO2LEG, and VO2LEG were greater at peak exercise with O2 than with air (P < 0.05). During submaximal exercise, dyspnea score and VE were significantly reduced with O2 (P < 0.05), whereas QLEG, VO2LEG, and leg fatigue were similar under both experimental conditions. The improvement in peak exercise work rate correlated with the increase in peak QO2LEG (r = 0.66, P < 0.01), peak VO2LEG (r = 0.53, P < 0.05), and reduction in dyspnea at iso-exercise intensity (r = 0.56, P < 0.05). CONCLUSION: The improvement in peak exercise capacity with oxygen supplementation could be explained by the reduction in dyspnea at submaximal exercise and the increases in QO2LEG and VO2LEG, which enabled the exercising muscles to perform more external work. These data indicate that the metabolic capacity of the lower limb muscles was not exhausted at peak exercise during room air breathing in these patients with COPD.

Limitation of lower limb VO(2) during cycling exercise in COPD patients.

Patients with chronic obstructive pulmonary disease (COPD) usually stop exercise before reaching physiological limits in terms of O(2) delivery and extraction. A plateau in lower limb O(2) uptake (VO(2)) and blood flow occurs despite progression of the imposed workload during cycling in some patients with COPD, suggesting that maximal capacity to transport O(2) had been reached and that it had been extracted in the peripheral exercising muscles. This study addresses this observation. Symptom-limited incremental cycle exercise was performed by 14 men [62 +/- 11 (SD) yr] with severe COPD (forced expiratory volume in 1 s = 35 +/- 7% of predicted value). Leg blood flow was measured at each exercise step with a thermodilution catheter inserted in the femoral vein. This value was multiplied by two to account for both working legs (Q(LEGS)). Arterial and femoral venous blood was sampled at each exercise step to measure blood gases. Leg O(2) consumption (VO(2LEGS)) was calculated according to the Fick equation. Total body VO(2) (VO(2TOT)) was measured from expired gas analysis, and tidal volume (VT) and minute ventilation (VE) were derived from the flow signal. In eight patients, VO(2LEGS) kept increasing in parallel with VO(2TOT) as external work rate was increasing. In six subjects, a plateau in VO(2LEGS) and Q(LEGS) occurred during exercise (increment of <3% between 2 consecutive increasing workloads) despite the increase in workload and VO(2TOT) [corresponding mean was 110 +/- 38 ml (11 +/- 4%)]. These six patients also exhibited a plateau in O(2) extraction during exercise. Peak exercise work rate was higher in the eight patients without a plateau than in the six with a plateau (51 +/- 10 vs. 40 +/- 13 W, P = 0.043). VT, VE, and dyspnea were significantly greater at submaximal exercise in patients of the plateau group compared with those of the nonplateau group. These results show that, in some patients with COPD, blood flow directed to peripheral muscles and O(2) extraction during exercise may be limited. We speculate that redistribution of cardiac output and O(2) from the lower limb exercising muscles to the ventilatory muscles is a possible mechanism.

End-stage renal disease in Canada: prevalence projections to 2005.

BACKGROUND: The incidence and prevalence of end-stage renal disease (ESRD) have increased greatly in Canada over the last 2 decades. Because of the high cost of therapy, predicting numbers of patients who will require dialysis and transplantation is necessary for nephrologists and health care planners. METHODS: The authors projected ESRD incidence rates and therapy-specific prevalence by province to the year 2005 using 1981-1996 data obtained from the Canadian Organ Replacement Register. The model incorporated Poisson regression to project incidence rates, and a Markov model for patient follow-up. RESULTS: Continued large increases in ESRD incidence and prevalence were projected, particularly among people with diabetes mellitus. As of Dec. 31, 1996, there were 17,807 patients receiving renal replacement therapy in Canada. This number was projected to climb to 32,952 by the end of 2005, for a relative increase of 85% and a mean annual increase of 5.8%. The increased prevalence was projected to be greatest for peritoneal dialysis (6.0% annually), followed by hemodialysis (5.9%) and functioning kidney transplant (5.7%). The projected annual increases in prevalence by province ranged from 4.4%, in Saskatchewan, to 7.5%, in Alberta. INTERPRETATION: The projected increases are plausible when one considers that the incidence of ESRD per million population in the United States and other countries far exceeds that in Canada. The authors predict a continued and increasing short-fall in resources to accommodate the expected increased in ESRD prevalence.

Mutual concurrent validity of the child health questionnaire and the health utilities index: an exploratory analysis using survivors of childhood cancer.

Mutual concurrent validity of 2 generic measures of health-related quality of life (HRQL), the Child Health Questionnaire (CHQ) and the Health Utilities Index Mark 2 (HUI2) and HUI3, was assessed. Data were from 3 centers participating in a Canadian multi-center retrospective cohort study currently in progress to assess psycho-social and physical late effects in children surviving >/=5 years after cancer diagnosis between 1981 and 1990. Exploratory results are from 244 parent reports on HRQL in children <16 years old when studied. Spearman rank-order correlations between sub-scale scores for the CHQ and single-attribute utility scores for the corresponding attribute from the HUI2 and HUI3 were used. As predicted, the correlation between CHQ bodily pain and HUI2 and HUI3 pain was strong, 0.58 and 0.60, respectively, while correlations between CHQ physical functioning and HUI2 mobility and HUI3 ambulation were moderate, both 0.45. Correlations between CHQ mental health and HUI2 and HUI3 emotion were strong, 0.64 and 0.54, respectively, rather than moderate, as predicted. Both the CHQ general health scale and the general health single item were moderately correlated with the HUI2 and HUI3 global utility scores rather than weakly, as predicted (CHQ general health scale and HUI2 and HUI3 global utility were 0.43 and 0.44, respectively; CHQ general health single item and HUI2 and HUI3 global utility were 0. 38 and 0.42, respectively). The CHQ and HUI, which are based on different methodologies (summative Likert scaling and utility analysis, respectively), appear to capture similar constructs in childhood cancer survivors.

Metabolic and hemodynamic responses of lower limb during exercise in patients with COPD.

Premature lactic acidosis during exercise in patients with chronic obstructive pulmonary disease (COPD) may play a role in exercise intolerance. In this study, we evaluated whether the early exercise-induced lactic acidosis in these individuals can be explained by changes in peripheral O2 delivery (O2). Measurements of leg blood flow by thermodilution and of arterial and femoral venous blood gases, pH, and lactate were obtained during a standard incremental exercise test to capacity in eight patients with severe COPD and in eight age-matched controls. No significant difference was found between the two groups in leg blood flow at rest or during exercise at the same power outputs. Blood lactate concentrations and lactate release from the lower limb were greater in COPD patients at all submaximal exercise levels (all P < 0.05). Leg D02 at a given power output was not significantly different between the two groups, and no significant correlation was found between this parameter and blood lactate concentrations. COPD patients had lower arterial and venous pH at submaximal exercise, and there was a significant positive correlation between venous pH at 40 W and the peak O2 uptake (r = 0.91, P < 0.0001). The correlation between venous pH and peak O2 uptake suggests that early muscle acidosis may be involved in early exercise termination in COPD patients. The early lactate release from the lower limb during exercise could not be accounted for by changes in peripheral O2. The present results point to skeletal muscle dysfunction as being responsible for the early onset of lactic acidosis in COPD.

End-stage renal disease projections for Canada to 2005 using Poisson and Markov models.

BACKGROUND: End-stage renal disease (ESRD) incidence and prevalence are increasing in many countries worldwide. Due to the high cost of therapy, predicting future numbers of patients requiring dialysis and transplantation is necessary for health care planners. Projecting therapy-specific chronic disease prevalence is inherently problematic, and examples of suitable models and their application are sparse. When applied, rarely was the adequacy of such models evaluated. METHODS: We describe and illustrate a method for projecting therapy-specific ESRD prevalence in Canada for 1995-2005 using data obtained from the Canadian Organ Replacement Register. The projections combine the Poisson model for incidence rates and a Markov model for patient follow-up. Model adequacy is empirically validated by data-splitting. RESULTS: Large increases in ESRD prevalence are expected in Canada, with an average annual increase of 6.9% projected for 1995-2005. Upon validation, the projection model based on 1981-1987 data was able to predict 1994 prevalence within 1%, while projected therapy-specific prevalences closely approximated those observed. CONCLUSIONS: Therapy-specific ESRD prevalence was successfully projected using Poisson and Markov models. Where multistate prevalence forecasts are required, the method could be augmented for application to various other chronic diseases.

[Quebec spirometry reference values]. / Valeurs de références spirométriques québécoises.

Lung volumes forced expiratory flow rates and carbon monoxide diffusing capacity (apnea) were measured in 397 non-smoking, nonatopic, asymptomatic subjects (219 women, 178 men). The equipments and methods for measurements met the ATS criteria. The linear regression of the different variables according to age and height allowed the elaboration of a new set of predictive equations (Quebec). When comparing the different reference values used in North America and Europe, it is found that those of Miller and associates as well as those recommended by the CECA provide the best description of the Quebec situation. However, we would eventually prefer the reference values of Miller and associates over those of the CECA, because they better fit the current ATS criteria and also provide references for smokers. Lung volumes and forced expiratory flow rates of 97 non-smoking, nonatopic, asymptomatic manual workers were measured in the same conditions and submitted to the same comparisons. Quebec predictive values as well as those of Miller and associates isolated the same individuals in the so called abnormal zone. We therefore conclude that Quebec's standards should be preferred in the Province of Quebec pulmonary function laboratories.

[Hard-to-reach young mothers: study of the implementation of a pre and postnatal intervention for a clientele at risk]. / Les jeunes mères difficiles à rejoindre: étude d'implantation d'une intervention pré et postnatale auprès d'une clientèle à risque.

This paper describes the implementation of a project to prevent the negative biopsychosocial outcomes of teenage pregnancy. The purposes of this project were 1) to reach, as early as possible, young women under 20 years, either pregnant or already young mothers, living in the downtown area of Quebec city on the fringe of society, and perceived to be at risk, and 2) to develop their capacities to take care of themselves and their children, by helping them to recognize their needs, to use adequately the available resources, and to break out of their isolation. A team from Le Centre jeunesse de Québec worked with 25 young pregnant women and 3 young mothers, over a period of 21 months. This team provided the women and their children with a continued and individualized follow-up, which allowed them to develop their autonomy.

PIP: Between 1980 and 1993, the pregnancy rate among Quebec teenagers rose from 24.9 to 37.3 per 1000 women aged 15-19 years, a 50% increase. In the heart of the city of Quebec, the rate rose from 43.7/1000 to 74.4/1000 between 1986 and 1994, an increase of 70%. In 1994, 59 young women gave birth to their infants, while 110 opted for abortion. In Quebec during the 1990s, a range of services were offered to pregnant women and young parents, but these services reached out to few disenfranchised women, and still less to pregnant teens and young mothers. This paper describes a project launched in downtown Quebec to prevent the negative biopsychosocial consequences of adolescent pregnancy. The project hoped to reach out to women under age 20 years, who were either pregnant or already mothers, living on the margins of society in downtown Quebec, and help them to develop their capacities to care for themselves and their children. The idea was to make them recognize their needs, use their available resources, and break them out of their isolation. A team from Le Centre jeunesse de Quebec (Quebec Youth Center) worked with 25 young, pregnant women and 3 young mothers from September 1995 to August 1997. The team then provided the young women with an individualized and ongoing follow-up, during which they were helped to become autonomous. One-third of the women were considered to be autonomous by the end of the project.

Hemodialysis versus peritoneal dialysis: a comparison of adjusted mortality rates.

Although kidney transplantation is the preferred treatment method for patients with ESRD, most patients are placed on dialysis either while awaiting transplantation or as their only therapy. The question of which dialytic method provides the best patient survival remains unresolved. Survival analyses comparing hemodialysis and continuous ambulatory peritoneal dialysis/continuous cyclic peritoneal dialysis (CAPD/CCPD), a newer and less costly dialytic modality, have yielded conflicting results. Using data obtained from the Canadian Organ Replacement Register, we compared mortality rates between hemodialysis and CAPD/CCPD among 11,970 ESRD patients who initiated treatment between 1990 and 1994 and were followed-up for a maximum of 5 years. Factors controlled for include age, primary renal diagnosis, center size, and predialysis comorbid conditions. The mortality rate ratio (RR) for CAPD/CCPD relative to hemodialysis, as estimated by Poisson regression, was 0.73 (95% confidence interval: 0.68 to 0.78). No such relationship was found when an intent-to-treat Cox regression model was fit. Decreased covariable-adjusted mortality for CAPD/CCPD held within all subgroups defined by age and diabetes status, although the RRs increased with age and diabetes prevalence. The increased mortality on hemodialysis compared with CAPD/CCPD was concentrated in the first 2 years of follow-up. Although continuous peritoneal dialysis was associated with significantly lower mortality rates relative to hemodialysis after adjusting for known prognostic factors, the potential impact of unmeasured patient characteristics must be considered. Notwithstanding, we present evidence that CAPD/CCPD, a newer and less costly method of renal replacement therapy, is not associated with increased mortality rates relative to hemodialysis.

Effect of contact avoidance or treatment with oral prednisolone on bronchoalveolar lavage surfactant protein A levels in subjects with farmer's lung.

BACKGROUND: Surfactant protein A (SP-A) acts as an immune system modulator in the lungs and may therefore be involved in the pathogenesis of hypersensitivity pneumonitis. METHODS: The levels of SP-A in bronchoalveolar lavage (BAL) fluid were measured in 20 subjects with acute farmer's lung, 16 asymptomatic dairy farmers, and 14 normal controls. Eight patients had a second evaluation after one month of treatment by either contact avoidance (n = 3) or oral prednisolone (20 or 25 mg/day, n = 5). Chest radiographs and lung function measurements were also obtained in all farmers, twice in those re-evaluated after treatment. RESULTS: Patients with acute farmer's lung had significantly higher levels of SP-A than asymptomatic farmers and normal controls (p = 0.005) with mean (SE) values of 1.43 (0.29) micrograms/ml, 0.62 (0.09) microgram/ml, and 0.68 (0.11) microgram/ml, respectively. In eight subjects tested after one month of treatment the level of SP-A was unchanged although all were clinically improved. No correlations were seen between levels of SP-A in BAL fluid and numbers of BAL cells, lung function measurements, or chest radiographic scores. CONCLUSION: Although the level of SP-A is increased in the BAL fluid of patients with acute farmer's lung, it is not correlated with clinical abnormalities of this disease.

Serum folate and risk of fatal coronary heart disease.

OBJECTIVE: To assess the relationship between serum folate level and the risk of fatal coronary heart disease (CHD) among men and women. DESIGN: Retrospective cohort study with serum folate levels measured from September 1970 to December 1972, with follow-up through 1985. SETTING: Participants in the Nutrition Canada Survey. PARTICIPANTS: A total of 5056 Canadian men and women aged 35 to 79 years with no history of self-reported CHD. MAIN OUTCOME MEASURE: Fifteen-year CHD mortality. RESULTS: A total of 165 CHD deaths were observed. We found a statistically significant association between serum folate level and risk of fatal CHD, with rate ratios for individuals in the lowest serum folate level category (<6.8 nmol/L [3 ng/mL]) compared with the highest category (>13.6 nmol/L [6 ng/mL]) of 1.69 (95% confidence interval, 1.10-2.61). CONCLUSIONS: These data indicate that low serum folate levels are associated with an increased risk of fatal CHD.

Neonatal characteristics as risk factors for preschool asthma.

Childhood asthma usually begins early in life. Neonatal characteristics are reportedly predictive of symptom onset. This investigation utilized data from a provincial health organization to evaluate the effect of several birth characteristics on asthma incidence and hospitalization for asthma during age 0-4. Using logistic regression, the odds ratios (OR) for the following variables indicate a significant (p < 0.05) association with physician-diagnosed preschool asthma: male gender (OR = 1.72), birthweight < 1500 g (OR = 2.11), prematurity (OR = 1.34), respiratory distress syndrome (RDS) in the presence (OR = 2.95) or absence (OR = 1.61) of bronchopulmonary dysplasia (BPD), and transient tachypnea of the newborn (TTN; OR = 1.36). Male gender (OR = 1.91), birthweight < 1500 g (OR = 2.56), RDS with and without BPD (OR = 3.35 and 2.50, respectively), TTN (OR = 2.08), and severe birth asphyxia (OR = 1.94) showed an important association with hospitalization due to asthma. Neonatal characteristics are important determinants for the risk of preschool asthma, even after mutual adjustment.

Survival experience among elderly end-stage renal disease patients. A controlled comparison of transplantation and dialysis.

Renal transplantation is a relatively recent treatment option among the elderly with end-stage renal disease (ESRD). Since little is known regarding the clinical benefits of transplantation relative to dialysis in this age group, this study compares transplantation and dialysis among the elderly with respect to patient survival. Data utilized in this investigation were obtained from the Canadian Organ Replacement Register (CORR). The study population consisted of the 6400 patients aged 60 and over at registration, diagnosed between 1987 and 1993, for whom data on comorbid conditions were available. Survival probability, death rates, age-standardized mortality ratios (SMRs) and Cox regression analysis were employed to evaluate the survival experience among the transplant and dialysis groups. Transplant recipients were matched (by age, underlying diagnosis leading to ESRD, and number of comorbid conditions) to 2 randomly selected patients who did not undergo transplantation. Using Cox regression, the time-dependent hazard ratio for transplantation versus dialysis patients was estimated at 0.47 (P < 0.0001), indicating that even after adjusting for other known prognostic factors, elderly patients who received a transplant experienced significantly greater survival probability than those who remained on dialysis. When transplant patients were matched to randomly selected dialysis patients with the constraint that the corresponding dialysis patient have at least as much follow-up time as the transplant patient had waiting time, five-year survival rates were 81% and 51% for the transplant and dialysis groups, respectively (P < 0.0001). These results support the potential advantage of transplantation among the elderly, and may have important implications for renal care in this age group.

Inorganic components of drinking water and microalbuminuria.

Relatively little is known of the chronic effects attributable to the ingestion of inorganic components such as uranium and silicon. Although ingestion of large amounts of U can cause acute renal damage through a chemical effect, studies on humans have typically considered inhalation the route of exposure. We investigated the association between drinking water concentration levels of U and Si, and microalbuminuria, a sensitive biological indicator of renal dysfunction. Linear regression analysis revealed a statistically significant association between U cumulative exposure index and albumin per mmol creatinine (P = 0.03). No such significant relationship appeared for Si, although a positive trend was witnessed. Since normal but increasing levels of microalbuminuria were observed at U concentration levels below the Canadian Maximum Allowable Concentration (MAC), it is suggested that further study be undertaken.