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Biomedical subjects

B Postl

Publications and source records attributed to B Postl.

At least 19 recordsLinked to original sources
PubMed1996

Continuity of pediatric ambulatory care in a universally insured population.

OBJECTIVE: To describe the prevalence of continuity of care over a 5-year period in a complete cohort of urban children universally insured for medical care provided under fee-for-service reimbursement. METHOD: All children enrolled in the study were born to women living in metropolitan Winnipeg between July 1, 1987 and December 31, 1988 (N = 12,590). All ambulatory physician services for this group were enumerated from computerized administrative databases for the period from birth through 60 months. Continuity of care, defined as the proportion of total care provided by the most frequently seen physician or physician practice over time, was calculated for each child. Descriptive analyses include an examination of maternal and household characteristics associated with children receiving 80% or more of total ambulatory care from a single provider source. RESULTS: From birth to 24 months, 51% of children received at least 80% of ambulatory visits from a single provider practice. This proportion of the children declined to 28% at 25 through 60 months. Children living in low-income neighborhoods had poorer continuity profiles. Other household factors associated with poor continuity included young maternal age, single maternal marital status, residential mobility, and inadequate maternal use of prenatal medical care. Households affiliated with pediatric practices had better continuity profiles than households affiliated with general medical practices. CONCLUSION: Despite universal medical insurance, barriers to a longitudinally continuous relationship with a primary care provider remain in this setting. Although this study has emphasized the description of those barriers associated with household characteristics, there is evidence that factors related to the organization and delivery of medical care are also relevant.

Adult↗
PubMed1995

Epidemiology of juvenile rheumatoid arthritis in Manitoba, Canada, 1975-92: cycles in incidence.

OBJECTIVE: To determine the yearly incidence of juvenile rheumatoid arthritis (JRA) and to seek correlations between this and cyclic infections occurring in the province of Manitoba, Canada, during the same period. METHODS: An estimate of the incidence of JRA in Manitoba was determined from a disease registry of the Pediatric Rheumatology Clinic, Children's Hospital, Winnipeg. The numbers of confirmed Mycoplasma pneumoniae and viral respiratory infections were determined from annual reports of Cadham Provincial Laboratory. Both facilities provide centralized services for the province. RESULTS: Between 1975 and 1992 the onset of JRA occurred in 261 patients (136 with pauciarticular, 91 polyarticular, and 34 systemic onset). The average annual incidence of JRA for this period was 5.34/100,000. However, a cyclic incidence was apparent with peaks in 1979, 1982, 1986, and 1990-91. Increases in confirmed M. pneumoniae infections were concurrent with peaks in the incidence of JRA. A significant correlation was found between the incidence of JRA and the number of M. pneumoniae infections detected in the province between 1985 and 1992 (R = 0.76, p = 0.044). In contrast, there was no consistent variation in the incidence of seronegative spondyloarthropathies in children (n = 103 patients). CONCLUSION: These data suggest the need for further study of a possible infectious etiology for JRA.

Adolescent↗
PubMed1990

Group A streptococcal pharyngeal carriage, pharyngitis, and impetigo in two northern Canadian native communities.

The prevalence of pharyngeal carriage of group A streptococci, streptococcal pharyngitis, and impetigo was determined in schoolchildren in two northern communities, one Inuit (mean number of schoolchildren surveyed, 233) and one native Indian (mean number of schoolchildren surveyed, 349). At three surveys from November 1984 to May 1985, pharyngeal group A streptococcal carriage was 5.3%, 22%, and 34% in the Inuit community and 5.3%, 5.1% and 10% in the native Indian, with impetigo prevalence 1.6%, 3.8% and 1.0%, and 2.4%, 4.2% and 0.6%, respectively. Increased pharyngeal carriage correlated with the increasing number of household residents and the lower school grade. In 12 months of observation the incidence of group A streptococcal pharyngitis was 49/100 schoolchildren for the Inuit and 9.4/100 for the native Indian community, with impetigo 13/100 and 11/100 respectively. The maximal incidence of pharyngitis was late winter in the Inuit community and midsummer in the native Indian. The incidence of impetigo peaked in January for both communities. M and T typing showed consecutive outbreaks of different serotypes in the Inuit community, but a persistent low level of endemic infection in the Indian community. These observations suggest a seasonal prevalence of group A streptococcal pharyngeal carriage consistent with other North American populations, but marked inter-community variation in pharyngeal carriage and disease. The midwinter peak of impetigo appears unique to these populations.

Adolescent↗
PubMed1986

Rheumatic diseases in an Inuit population.

Prevalence and incidence rates for rheumatic diseases were found to be minimal among the Inuit people in the Keewatin District of the Northwest Territories, Canada. Patient identification was achieved by a review of medical records. All identified patients were interviewed and examined by a participating rheumatologist. Among women, the prevalence of rheumatoid arthritis, adjusted for age of the Manitoba population, was 1,822 per 100,000 and was comparable with that observed in other populations; no cases of rheumatoid arthritis in men were confirmed. The age-adjusted prevalence of osteoarthritis, 1,219 per 100,000 in men and 2,144 per 100,000 in women, was apparently low. A moderately high incidence of Reiter's syndrome, 24.9 per 100,000, was found. The findings in children suggested a high frequency of seronegative spondylarthropathies (yearly incidence 60.1 per 100,000), although the adjusted yearly incidence for juvenile rheumatoid arthritis also appeared to be high, 23.6 per 100,000. The frequencies of HLA antigens in patient groups were compared with those found in 19 patients with musculoskeletal complaints but no rheumatic disease. Both HLA-B27 and HLA-DR4 appeared to be common in these controls, 36.8% and 63.2%, respectively. Nevertheless, there was a higher frequency of HLA-B27 in patients with seronegative spondylarthropathies (87%) than in controls (P = 0.001). Because of the small numbers of patients who had rheumatoid arthritis, no associations with HLA were made for this condition. Although the findings suggest differences in the distribution of rheumatic diseases compared with those found in other populations, more complete studies are required to confirm these observations.

Adult↗
PubMed1986

Cross-sectional seroepidemiologic study of the prevalence of cytomegalovirus and herpes simplex virus infection in a Canadian Inuit (Eskimo) community.

The prevalence of antibody to cytomegalovirus (CMV) and herpes simplex virus (HSV) was determined, using enzyme-linked immunosorbent assay techniques, in a cross-sectional serologic survey of an isolated northern Canadian Inuit (Eskimo) community. The population studied included 155 Inuit and 11 Caucasian residents. By 6 years of age, 80% of the Inuit population were seropositive for CMV and 100% for herpes simplex virus. While only 7/63 Inuit greater than 20 years were seronegative for CMV, 5/11 Caucasian residents were seronegative (p = 0.01). For the Inuit population, no association between seropositivity for CMV and seropositivity for hepatitis A or hepatitis B was observed. This prevalence survey shows a serologic profile for infection with CMV and HSV in this northern Inuit community with an early age of acquisition and high prevalence of infection characteristic of socioeconomically deprived populations throughout the world, and is distinct from that observed in many other North American populations.

Adolescent↗
PubMed1985

The changing epidemiology of hepatitis B virus infection in the Canadian north.

Hepatitis B virus infections are common in the Eskimo (Inuit) populations of the world. In this study, serologic markers of hepatitis B infection were measured in 172 inhabitants (78%) of an isolated Canadian Inuit settlement. Evidence of hepatitis B infection was found in 22% of residents. The prevalence increased with age, being uncommon under the age of 20 (7%), yet present in the majority of inhabitants over the age of 40 (64%). Sera from four individuals (2.3%) were hepatitis B surface antigen- (HBsAg) positive. All four HBsAg carriers were negative for immunoglobulin M (IgM) antibody to hepatitis B core antigen (IgM anti-HBc), hepatitis B e antigen (HBeAg), and DNA polymerase, but positive for antibody to hepatitis B e antigen (anti-HBe). These data suggest that hepatitis B infection has become relatively uncommon in the inhabitants of this community born during the past 20-30 years. The apparent decline in prevalence did not appear to be related to recent demographic or socioeconomic changes in the area.

Adolescent↗
PubMed1982

Prevalence of antibody to hepatitis A virus in a Canadian Inuit community.

To determine the prevalence of hepatitis A in a Canadian Inuit population, serum from 85% of the 850 inhabitants of Baker Lake, Northwest Territories, was tested by radioimmunoassay for antibody to the hepatitis A virus (anti-HAV). The overall prevalence of anti-HAV in the community was 71%. Exposure to the virus occurred early in life, such that by the age of 6 years 53% of the children had anti-HAV in their serum. The rate approached 100% by the age of 50 years. These findings document the ubiquitous nature of the hepatitis A virus in this northern Inuit settlement and suggest that immunoprophylaxis be considered for individuals taking short-term employment in such places.

Adolescent↗
PubMed1982

Rheumatic fever in native children in Manitoba.

From data reported to a central computer file, cases of rheumatic fever in persons under 17 years of age in Manitoba were reviewed. Although the overall incidence of the disease declined throughout the study period, Jan. 1, 1970 to July 1, 1979, the rates per 100 000 population were higher overall (36) and for non-natives (29) and much higher for natives (126) than average rates in urban centres around the world. Rates of death and readmission showed that the disease was also more severe in the native Manitoba children.

Adolescent↗
PubMed1982

Hepatitis virus infection in an isolated Canadian Inuit (Eskimo) population.

The epidemiology of Hepatitis A virus (HAV) and hepatitis B virus (HBV) infection was studied in a northern Canadian Inuit (Eskimo) settlement. Sera from 720 of the 850 inhabitants of Baker Lake, Canada, were tested for markers of HAV and HBV infection. Anti-HAV was present in 71% of the residents and its prevalence increased with age. Serologic evidence of HBV infections was found in 27% of residents. The prevalence increased with age, being uncommon under the age of 20 (6%) and almost universal over the age of 60 (93%). Among the 29 hepatitis B surface antigen (HBsAg) carriers identified, all were adults, all had low levels of HBsAg, and all were negative for hepatitis B e antigen (HBeAg) and DNA polymerase but positive for antibody to HBeAg. These data demonstrate a high prevalence of HAV and HBV infection in this population. Further, they suggest that a dramatic decrease in the transmission of HBV infection has occurred over the past 20-30 years.

Adolescent↗