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Biomedical subjects

J Manfreda

Publications and source records attributed to J Manfreda.

At least 73 records · Page 4Linked to original sources
PubMed1989

Morbidity and mortality from chronic obstructive pulmonary disease.

The National Mortality Database of Statistics Canada was used to study chronic obstructive pulmonary disease (COPD) mortality trends between 1950 and 1984 by age, sex, birth cohort, and province. Provincial hospital statistics were combined for the period 1971 to 1984 to determine age-specific hospital separation rates for COPD. Utilization of physician services for COPD was determined for one province using physicians' claims for payment. Results of these analyses indicate that mortality from COPD has leveled off for men and is increasing for women; the trend is different for combined chronic bronchitis-emphysema and for asthma. Mortality from COPD varies by age, sex, birth cohort, and province. Mortality from COPD stopped increasing with the 1910 to 1914 birth cohort in men and the 1920 to 1924 in women. Male and female birth cohorts born after 1920 to 1924 have decreased mortality. It is speculated that the age-standardized mortality will decrease in the near future. Surveys of smoking habits over time support the hypothesis that a proportion of sex, birth cohort, regional, and socio-economic variation of COPD mortality is due to smoking. Hospital morbidity is higher for men than for women particularly for those more than 65 yr of age. Between 1971 and 1983, mortality/morbidity ratios were relatively stable. Asthma mortality and morbidity are increasing; changing concepts about the disease may be one reason for this observation.

Adolescent↗
PubMed1988

Clinical trial of naloxone in birth asphyxia.

To determine whether endogenous opiates play a role in the pathogenesis of perinatal asphyxia, a blinded clinical trial of naloxone, a competitive opiate receptor blocker, was undertaken in infants with low 1-minute Apgar scores. Of 85 infants with 1-minute Apgar score 0 to 3, 44 received an injection of naloxone (approximately 0.4 mg/kg) and 41 received saline solution. In 108 infants with 1-minute Apgar score 4 to 6, 54 received naloxone and 54 saline solution. In neither group was there a significant effect of naloxone on respiratory frequency or heart rate up to 30 minutes after injection, nor at 24 hours of age. In both groups active muscle tone of upper and lower limbs was increased by naloxone, a response that may not be beneficial in the face of inadequate oxygen delivery to vital organs. We conclude that naloxone at this dose had no readily apparent benefit in the resuscitation of the asphyxiated newborn infant.

Adult↗
PubMed1987

Where Manitoba children obtain their cigarettes.

People who start to smoke as children put themselves at greater risk of dying prematurely or being disabled by tobacco-induced disease. One solution is to restrict children's access to cigarettes, thereby reducing consumption of the product and, ultimately, damage to health. This study found that in 1985 the majority of Manitoba public school children 8 to 15 years of age who smoked "regularly" (defined as usually every day) obtained their cigarettes from stores. This source could be reduced, if not eliminated, were a federal regulation passed in 1908 enforced. Under Canada's Tobacco Restraint Act it is illegal for merchants to sell tobacco to anyone under the age of 16 years. By implementing this existing law, authorities would not only be keeping the profit from almost a million dollars in cigarette sales in Manitoba alone out of tobacco company coffers but also be having an impact on the leading cause of preventable premature death and disability in Canada.

Adolescent↗
PubMed1987

Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease.

The effects of broad-spectrum antibiotic and placebo therapy in patients with chronic obstructive pulmonary disease in exacerbation were compared in a randomized, double-blinded, crossover trial. Exacerbations were defined in terms of increased dyspnea, sputum production, and sputum purulence. Exacerbations were followed at 3-day intervals by home visits, and those that resolved in 21 days were designated treatment successes. Treatment failures included exacerbations in which symptoms did not resolve but no intervention was necessary, and those in which the patient's condition deteriorated so that intervention was necessary. Over 3.5 years in 173 patients, 362 exacerbations were treated, 180 with placebo and 182 with antibiotic. The success rate with placebo was 55% and with antibiotic 68%. The rate of failure with deterioration was 19% with placebo and 10% with antibiotic. There was a significant benefit associated with antibiotic. Peak flow recovered more rapidly with antibiotic treatment than with placebo. Side effects were uncommon and did not differ between antibiotic and placebo.

Aged↗
PubMed1987

Tuberculosis status and social adaptation of Indochinese refugees.

The relationship between tuberculosis and social adaptation of Indochinese refugees in Manitoba, Canada, is examined in 43 randomly selected refugees treated for active and inactive tuberculosis (cases) and their matched controls. Tuberculosis status did not significantly affect adaptation as measured by selected scales and indicators. Significant predictors of better personal well-being included a low number of family members outside the household in Manitoba, non-use of traditional medicine, female gender, and high individual income. Tuberculosis status was not a significant predictor.

Acculturation↗
PubMed1986

The natural history of primary first-degree atrioventricular heart block.

The long-term prognosis of first-degree heart block in the absence of organic heart disease has not been clearly defined. We addressed this question in a 30-year longitudinal study of 3983 healthy men. We identified 52 cases that were present on entry into the study and 124 incident cases during follow-up. The incidence rose steadily after age 40 and was 1.13 per 1000 person-years over the entire period. Two thirds of the cases had only moderate prolongation of the PR interval (0.22 to 0.23 second). We compared four age-matched controls with each case for histories of scarlet fever, rheumatic fever, diphtheria, smoking, blood pressure, and body-mass index. No significant differences (P greater than 0.05) were found. Likewise, mortality from all causes did not differ between cases and controls. Although somewhat higher rates of morbidity and mortality from ischemic heart disease were observed in the cases than in the controls, the differences were not significant. Progression to higher grades of heart block occurred in only two cases. In view of the prognostic findings and the rare occurrence of advanced degrees of heart block, we conclude that primary first-degree heart block with moderate PR prolongation is a benign condition. This conclusion may not apply, however, to persons with more marked prolongation of the PR interval, a very rare condition.

Adult↗
PubMed1986

Acute symptoms following exposure to grain dust in farming.

History of acute symptoms (cough, wheezing, shortness of breath, fever, stuffy nose, and skin itching/rash) following exposure to grain dust was obtained from 661 male and 535 female current and former farmers. These symptoms were relatively common: 60% of male and 25% of female farmers reported at least one such symptom on exposure to grain dust. Association of cough, wheezing, shortness of breath, and stuffy nose with skin reactivity and capacity to form IgE is consistent with an allergic nature of these symptoms. Barley and oats dust were perceived as dust most often producing symptoms. On the other hand, grain fever showed a different pattern, i.e., it was not associated with either skin reactivity or total IgE. Smoking might modify the susceptibility to react to grain dust with symptoms. Only those who reported wheezing on exposure to grain dust may have an increased risk to develop chronic airflow obstruction.

Adult↗
PubMed1985

Risk factors for reactivation of tuberculosis in Manitoba.

Although rates of reported cases of active tuberculosis have been declining in Manitoba and throughout Canada over the past two decades, the percentage of active cases due to reactivated tuberculosis has remained relatively constant. From 1976 to 1981, 113 cases of reactivated tuberculosis were listed in the Manitoba tuberculosis registry. We found that 36 cases did not meet our criteria for reactivation, primarily because there was no 6-month period of inactivity; another 5 cases could not be verified. In more than half of the remaining 72 the initial episode had occurred before 1960. We also randomly selected from the registry as controls 118 age- and sex-matched cases of nonreactivated tuberculosis. We found that registered Indian status was significantly associated with risk of reactivation, especially when the initial disease had been extensive. Awareness of high-risk groups, earlier diagnosis and adequate treatment are needed to prevent reactivated tuberculosis.

Adolescent↗
PubMed1984

Serum total immunoglobulin E levels in Canadian adults.

A history of respiratory and allergic disorders was obtained in a white, rural population with ages 20 to 65 yr. Allergy skin testing was performed, and total IgE was measured by PRIST method. One thousand eight hundred and fourteen subjects were studied. Those subjects with positive allergic skin reactions and a history of allergic disorders and smoking were excluded to provide a reference group to derive "normal" values of total IgE. The mean level of the total IgE of this reference group was 12.1 U/ml. The upper limit of the normal range of total IgE levels was estimated at 87.3 U/ml. IgE levels did not differ between the sexes or with age in our adult population.

Adult↗
PubMed1982

The relationship between smoking and total immunoglobulin E levels.

Results of skin testing to common allergens, total serum IgE levels, and the responses to a respiratory questionnaire were obtained for 1768 individuals participating in a survey of a rural population. The geometric mean total IgE levels in a group of subjects without skin-test reactions and with no histories of asthma or hay fever was 14.8 U/ml for men and 11.9 U/ml for women. When individuals were classified according to skin reactivity and smoking history there was a significant difference in IgE levels among nonsmokers, exsmokers, and smokers, with smokers having the highest levels. The percentage of subjects with elevated total IgE levels was higher in smokers than in nonsmokers regardless of skin reactivity to common allergens. Among smokers there was no relationship between intensity and duration of smoking and IgE levels. Among exsmokers IgE levels tended to be lower in those who had stopped smoking earlier.

Adult↗
PubMed1982

Respiratory abnormalities in employees of the hard rock mining industry.

Respiratory symptoms, forced vital capacity, and the single breath N2 test were assessed in male employees (25 to 54 yr of age) who had been employed for more than 5 yr in the mining industry in Manitoba. The results were compared with those in a similar group of men selected from the general population. The prevalence of cough and/or phlegm in both nonsmoking and smoking mining employees was significantly greater than that in the sample of the general population (p less than 0.05). In both nonsmokers and ex-smokers amongst the mining employees, the parameters derived from the single breath N2 test tended to be lower and maximal expiratory flow rates tended to be higher than in comparable groups in the general population sample. In smokers, FVC, FEV1, FEV1/FVC, maximal expiratory flow rates, RV/TLC, and the slope of phase III were significantly worse in smelter workers than in underground workers. Alterations in lung function in those who worked underground, but not in those who worked in the smelter, was related to the duration of employment in the industry. The data suggest that exposure to mining irritants may result in disorders of lung function, and that this effect is greater in cigarette smokers.

Adult↗
PubMed1982

Steroid response in stable chronic obstructive pulmonary disease.

We compared a 2-week course of 32 mg/d methylprednisolone with placebo in a double-blind crossover trial in 46 well-characterized patients with stable chronic obstructive pulmonary disease. Placebo and steroid trials were separated by 2 weeks when no tablets were given. Response was assessed by measuring forced expiratory volume in 1 second (FEV1.0). Placebo responses were normally distributed (mean, 0.8% change in FEV1.0; range, -30% to 33%). Six patients showed a greater than 50% increase of FEV1.0 in response to steroid; a seventh showed a 36% increase and an eighth, a 29% increase. Because of these patients the group as a whole showed a significantly greater FEV1.0 after steroid than after placebo. The eight steroid responders did not differ from nonresponders in age, sex, smoking history, or duration and intensity of symptoms including wheeze. Baseline lung function and eosinophilia of blood or sputum did not differ between the two groups. Patients who responded to steroids also responded to inhaled beta agonists: Acute bronchodilator response averaged 25% in steroid responders and 13% in nonresponders, a difference that was statistically significant although there was overlap between the two groups.

Adrenal Cortex Hormones↗
PubMed1980

Respiratory symptoms in Manitoba farmers: association with grain and hay handling.

Of a random sample of farmers in two crop districts of Manitoba mailed a respiratory questionnaire in 1976, 833 (82% of those currently farming in the area) replied. More than half were grain farmers and nearly half had never smoked cigarettes. The prevalence of chronic cough and phlegm production, wheezing and exertional dyspnea was positively related to the amount of smoking but was also higher than expected in nonsmokers. Acute dyspnea, sometimes of delayed onset and accompanied by fever, was most commonly related to handling old grain and was reported by 44% of the farmers. Current smokers were more susceptible than nonsmokers to this type of dyspnea. Farmers with history of acute dyspnea while handling grain were more likely to wear masks, but the overall rate of mask wearing, even among those at highest risk, was low.

Adult↗
PubMed1979

Relationship between the single-breath N test and age, sex, and smoking habit in three North American cities.

This report describes a collaborative study conducted in Montreal, Canada, Portland, Ore., and Winnipeg, Canada, to establish the relationship between the single-breath N2 test and age, sex, and smoking and to determine the prevalence of functional abnormalities in these populations. In nonsmokers, age-related regressions for closing volume, closing capacity, and the slope of phase III obtained from the single-breath N2 test, plus the ratio of the I-s forced expiratory volume to the forced vital capacity had very similar slopes, suggesting that differences in geographic location, climate, air pollution, and occupation had no effect on lung function detectable by these tests. Among the 6 city/six groups there was no systematic difference in the prevalence of functional abnormalities between the cities, but closing capacity expressed as a percentage of total lung capacity was abnormal most often in men and the slope of the alveolar plateau was abnormal most often in women. The prevalence of respiratory symptoms within different smoking categories was similar in the 3 cities. Although the number of cigarettes smoked had a significant effect on every test except the ratio of the I-s forced expiratory volume to forced vital capacity in men, the effect of age was considerably greater than the effect of smoking, and the dose-response relationship was weak. We conclude that additional factors may interact with smoking to place a smoker at risk of developing chronic airflow limitation.

Adult↗
PubMed1978

Alpha1-antitrypsin phenotypes and lung function in a moderately polluted northern Ontario community.

To determine whether persons with intermediate value alpha1-antitrypsin phenotypes living in a polluted environment manifest significant abnormalities in lung function, a study was undertaken of an age-, sex- and smoking-stratified sample of 391 persons from the town of Fort Frances, Ont., which has elevated values of total dustfall, suspended particulates and hydrogen sulfide. Indices of pulmonary function were derived from the maximum expiratory flow and the single breath expiratory flow and the single breath expiratory nitrogen washout curves. The percentage frequency of the M, MS and MZ pheontypes was 91.7, 7.3 and 0.8, respectively. There was no significant difference between the M and MS groups as indicated by the nitrogen washout curve and maximum expiratory flow curve. There was no significant difference between the three MZ subjects and the M group. In both M and MS groups smokers displayed evidence of airflow obstruction when compared with nonsmokers. It would appear that, when compared with M subjects, persons with the MS phenotype living in a moderately polluted area show no changes in indicators of pulmonary function, including tests of early airway disease, that cannot be attributed to their smoking habit.

Adult↗