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Biomedical subjects

R Glazier

Publications and source records attributed to R Glazier.

At least 19 recordsLinked to original sources
PubMed2006

Beta2-agonists for acute bronchitis.

BACKGROUND: There are no clearly effective treatments for the cough of acute bronchitis, and beta2-agonists are often prescribed, perhaps because clinicians suspect many patients also have reversible airflow restriction contributing to the symptoms. OBJECTIVES: To determine whether beta2-agonists improve symptoms of acute bronchitis in patients who do not have underlying pulmonary disease. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 4, 2005), MEDLINE (January 1966 to November 2005) and EMBASE (1974 to November 2005). SELECTION CRITERIA: Trials in which patients (adults or children over two years of age) who were diagnosed with acute bronchitis or acute cough (without known pulmonary disease and without other cause) were randomized to beta2-agonist versus placebo, no treatment or alternative treatment. DATA COLLECTION AND ANALYSIS: Three authors independently selected outcomes and evaluated trial quality while blinded to study results, they then extracted data. Trials in children and in adults were analyzed separately. MAIN RESULTS: Two trials in children (n = 109) with acute cough and no evidence of airway obstruction did not find any benefits from beta2-agonists. Combined data did not show a significant difference in daily cough scores between patients given oral beta2-agonists and those in the control groups. Five trials in adults (n = 418) with acute cough or acute bronchitis had mixed results but overall summary statistics did not reveal any significant benefits from oral (three trials) nor inhaled (two trials) beta2-agonists. There were no significant differences in daily cough scores nor in the number of patients still coughing after seven days (control rate 73%; relative risks (RR) 0.77, 95% CI 0.54 to 1.09). Subgroups of patients with evidence of airflow limitation had lower symptom scores if given beta2-agonists, in one trial. Furthermore, the trials that did note quicker resolution of cough in patients given beta2-agonists were those that had a higher proportion of patients with wheezing at baseline. Patients given beta2-agonists were more likely to report tremor, shakiness or nervousness than patients in the control groups (for trials in children: control rate 0%; RR 6.76, 95% CI 0.86 to 53.12; number needed to harm (NNH) 9, 95% CI 5 to 100; for trials in adults: control rate 11%; RR 7.94, 95% CI 1.17 to 53.94; NNH 2.3, 95% CI 2 to 3). AUTHORS' CONCLUSIONS: There is no evidence to support the use of beta2-agonists in children with acute cough who do not have evidence of airflow obstruction. There is also little evidence that the routine use of beta2-agonists is helpful for adults with acute cough. These agents may reduce symptoms, including cough, in patients with evidence of airflow obstruction. However, this potential benefit is not well-supported by the available data and must be weighed against the adverse effects associated with beta2-agonists.

Acute Disease↗
PubMed2004

Antibiotics for acute bronchitis.

BACKGROUND: Antibiotic treatment of acute bronchitis, which is one of the most common illnesses seen in primary care, is controversial. Most clinicians prescribe antibiotics in spite of expert recommendations against this practice. OBJECTIVES: The objective of this review was to assess the effects of antibiotic treatment for patients with a clinical diagnosis of acute bronchitis. SEARCH STRATEGY: In this updated review, we searched the Cochrane Central Register of Controlled trials (CENTRAL) (The Cochrane Library Issue 2, 2004); MEDLINE (January 1966 to March 2004); EMBASE (January 2000 to December 2003); SciSearch from 1989 to 2004; reference lists of articles and the authors' personal collections up to 1996, and also wrote to study authors and drug manufacturers. EMBASE has previously been searched from 1974 to 2000). SELECTION CRITERIA: Randomised controlled trials comparing any antibiotic therapy with placebo in acute bronchitis or acute productive cough without other obvious cause in patients without underlying pulmonary disease. DATA COLLECTION AND ANALYSIS: At least two reviewers extracted data and assessed trial quality. Authors were contacted for missing data. MAIN RESULTS: Nine trials involving over 750 patients aged eight to over 65 and including smokers and non-smokers were included in the primary analysis. The quality of the trials was variable. A variety of outcome measures were assessed. Overall, patients receiving antibiotics had better outcomes than did those receiving placebo. At a follow-up visit, they were less likely to have a cough (relative risk (RR) 0.64, 95% confidence interval (CI) 0.49 to 0.85; number-needed-to-treat (NNT) 5; 95% CI 3 to 14), show no improvement on physician assessment (RR 0.52; 95% CI 0.31 to 0.87; NNT 14; 95% CI 8 to 50), or have abnormal lung findings (RR 0.48; 95% CI 0.26 to 0.89; NNT 11; 95% CI 6 to 50); and had shorter durations of cough (weighted mean difference 0.58 days; 95% CI 0.01 to 1.16 days), productive cough (weighted mean difference (WMD) 0.52 days; 95% CI 0.01 to 1.03 days), and feeling ill (WMD 0.58 days; 95% CI 0.00 to 1.16 days). There were no significant differences regarding the presence of night cough, productive cough, or activity limitations at follow up, or in the mean duration of activity limitations. The benefits of antibiotics were less apparent in a sensitivity analysis that included data from two other studies of patients with upper respiratory tract infections with productive cough. There was a non significant trend towards an increase in adverse effects in the antibiotic group, relative risk (RR) 1.22 (95% CI 0.94 to 1.58). REVIEWERS' CONCLUSIONS: Overall, antibiotics appear to have a modest beneficial effect in patients who are diagnosed with acute bronchitis. The magnitude of this benefit, however, is similar to that of the detriment from potential adverse effects.

Acute Disease↗
PubMed2004

Beta2-agonists for acute bronchitis.

BACKGROUND: The optimal treatment for acute bronchitis is not clear. Because many patients with acute bronchitis have airflow limitation as well as cough, beta2-agonists may be useful. OBJECTIVES: To determine whether beta2-agonists improve the symptoms of acute bronchitis in patients who do not have underlying pulmonary disease. SEARCH STRATEGY: The Cochrane Library (through August 2000), MEDLINE (1966 to 2000), EMBASE (1974 to 2000), and Conference Proceedings using "bronchodilator (exp)", "adrenergic beta-agonist (exp)", or "sympathomimetics (exp)" and "bronchitis" or "cough"; Science Citation Index for referenced publications; and letters to manufacturers of beta2-agonists. An updated search of the Cochrane Central Register of Controlled Trials (CENTRAL) (issue 3, 2003); MEDLINE (January 2000 to July 2003); EMBASE (January 2000 to July 2003) was run in July 2003. SELECTION CRITERIA: Trials in which patients (adults or children over two years of age) without known pulmonary disease who were diagnosed with acute bronchitis or acute cough without other cause were randomized to beta2-agonist versus placebo, no treatment, or alternative treatment. DATA COLLECTION AND ANALYSIS: Three reviewers independently first selected outcomes and evaluated trial quality while blinded to study results, and then extracted data. Trials in children and in adults were analyzed separately. MAIN RESULTS: Two trials in children (n = 109) with acute cough and no evidence of airway obstruction did not find any benefits from beta2-agonists. Combined data did not show a significant difference in daily cough scores between patients given oral beta2-agonists and those in the control groups. Five trials in adults (n = 418) with acute cough or acute bronchitis had mixed results, but overall summary statistics did not reveal any significant benefits from oral (three trials) nor inhaled (two trials) beta2-agonists. There were no significant differences in daily cough scores nor in the number of patients still coughing after seven days (control rate 73%; RR = 0.77, 95% CI 0.54-1.09). Subgroups of patients with evidence of airflow limitation had lower symptom scores if given beta2-agonists in one trial; and the trials that did note quicker resolution of cough in patients given beta2-agonists were those that had a higher proportion of patients with wheezing at baseline. Patients given beta2-agonists were more likely to report tremor, shakiness, or nervousness than patients in the control groups (for trials in children control rate 0%; RR 6.76, 95% CI 0.86 to 53.12, NNH 9, 95% CI 5 to 100; for trials in adults, control rate 11%; RR 7.94, 95% CI 1.17 to 53.94, NNH 2.3, 95% CI 2 to 3). REVIEWER'S CONCLUSIONS: There is no evidence to support using beta2-agonists in children with acute cough who do not have evidence of airflow obstruction. There is also little evidence that the routine use of beta2-agonists for adults with acute cough is helpful. These agents may reduce symptoms, including cough, in patients with evidence of airflow obstruction; but this potential benefit is not well-supported by the available data and must be weighed against the adverse effects associated with beta2-agonists.

Acute Disease↗
PubMed2003

Efficacy of a targeted, oral penicillin-based yaws control program among children living in rural South America.

Yaws is endemic in rural Guyana. An observational study was conducted to determine the efficacy of oral penicillin V therapy in treating skin lesions of yaws in children. In 1999, inhabitants of 7 rural villages near Bartica, Guyana, were screened for skin lesions of yaws. Cases were confirmed by serological testing. A control program was implemented in 2000: children < or =14 years old were screened, and those with active lesions were treated with oral penicillin V for 7-10 days. In 2001, children were rescreened and active cases were treated. Prevalence of yaws skin lesions fell from 5.1% (52 of 1020 children screened in 2000) to 1.6% (8 of 516 in 2001), a 71% drop. Sixteen (94%) of 17 children treated in 2000 and reassessed in 2001 had complete resolution of lesions. A targeted, oral penicillin-based treatment regimen can successfully treat dermatologic yaws in individual children and can decrease the prevalence of skin yaws in a community in which it is endemic. This information may aid in the implementation of additional control efforts.

Administration, Oral↗
PubMed2001

Beta2-agonists for acute bronchitis.

BACKGROUND: The optimal treatment for acute bronchitis is not clear. Because many patients with acute bronchitis have airflow limitation as well as cough, beta2-agonists may be useful. OBJECTIVES: To determine whether beta2-agonists improve the symptoms of acute bronchitis in patients who do not have underlying pulmonary disease. SEARCH STRATEGY: Cochrane Library, MEDLINE, EMBASE, and Conference Proceedings using "bronchodilator (exp)", "adrenergic beta-agonist (exp)", or "sympathomimetics (exp)" and "bronchitis" or "cough"; Science Citation Index for referenced publications; and letters to manufacturers of beta2-agonists. SELECTION CRITERIA: Trials in which patients (adults or children age > 2 years) without known pulmonary disease who were diagnosed with acute bronchitis or acute cough without other cause were randomized to beta2-agonist vs. placebo, no treatment, or alternative treatment. DATA COLLECTION AND ANALYSIS: Three reviewers independently first selected outcomes and evaluated trial quality while blinded to study results, and then extracted data. Trials in children and in adults were analyzed separately. MAIN RESULTS: Two trials in children with acute cough and no evidence of airway obstruction did not find any benefits from beta2-agonists. Five trials in adults with acute cough or acute bronchitis had mixed results, but overall summary statistics did not reveal any significant benefits from beta2-agonists. Subgroups of patients with evidence of airflow limitation had lower symptom scores if given beta2-agonists in one trial; and the trials that did note quicker resolution of cough in patients given beta2-agonists were those that had a higher proportion of patients with wheezing at baseline. Patients given beta2-agonists (whether oral or inhaled) were more likely to report tremor, shakiness, or nervousness than patients in the control groups (NNH for children 9, 95% CI 5 to 100; NNH for adults 2.3, 95% CI 2 to 3). REVIEWER'S CONCLUSIONS: There is no evidence to support using beta2-agonists in children with acute cough who do not have evidence of airflow obstruction. There is also little evidence that the routine use of beta2-agonists for adults with acute cough is helpful. These agents may reduce symptoms, including cough, in patients with evidence of airflow obstruction; but this potential benefit is not well-supported by the available data and must be weighed against the adverse effects associated with beta2-agonists.

Acute Disease↗
PubMed2001

Determining the need for hip and knee arthroplasty: the role of clinical severity and patients' preferences.

BACKGROUND: Area variation in the use of surgical interventions such as arthroplasty is viewed as concerning and inappropriate. OBJECTIVES: To determine whether area arthroplasty rates reflect patient-related demand factors, we estimated the need for and the willingness to undergo arthroplasty in a high- and a low-use area of Ontario, Canada. RESEARCH DESIGN: Population-based mail and telephone survey. SUBJECTS: All adults aged > or =55 years in a high (n = 21,925) and low (n = 26,293) arthroplasty use area. MEASURES: We determined arthritis severity and comorbidity with questionnaires, established the presence of arthritis with examination and radiographs, and evaluated willingness to have arthroplasty with interviews. Potential arthroplasty need was defined as severe arthritis, no absolute contraindication for surgery, and evidence of arthritis on examination and radiographs. Estimates of need were then adjusted for patients' willingness to undergo arthroplasty. RESULTS: Response rates were 72.0% for questionnaires and interviews. The potential need for arthroplasty was 36.3/1,000 respondents in the high-rate area compared with 28.5/1,000 in the low-rate area (P <0.0001). Among individuals with potential need, only 14.9% in the high-rate area and 8.5% in the low-rate area were definitely willing to undergo arthroplasty (P = 0.03), yielding adjusted estimates of need of 5.4/1,000 and 2.4/1,000 in the high- and low-rate areas, respectively. CONCLUSIONS: Demonstrable need and willingness were greater in the high-rate area, suggesting these factors explain in part the observed geographic rate variations for this procedure. Among those with severe arthritis, no more than 15% were definitely willing to undergo arthroplasty, emphasizing the importance of considering both patients' preferences and surgical indications when evaluating need and appropriateness of rates for surgery.

Activities of Daily Living↗
PubMed2001

Arthritis and rheumatism are neglected health priorities: a bibliometric study.

OBJECTIVE: To investigate the frequency of publications about arthritis and rheumatic diseases relative to other diseases and to examine which topics received most attention. METHODS: Available health statistics were used to quantify the burden of illness due to musculoskeletal (MSK) conditions. Next, a bibliographic analysis of MEDLINE was performed comparing disease categories using the MeSH tree structure for 1991 and 1996. Diseases were ranked according to the frequency of citations attributable to them and further analyses were performed for journal categories, MeSH subheadings, and the frequency of citations for specific types of arthritis and rheumatic diseases. RESULTS: Compared with 9 other causes, MSK diseases are leading contributors to health professional consultations, total health costs, chronic ill health, and disability. In contrast, MSK diseases ranked ninth among twelve major MEDLINE disease categories in 1996 and 1991. These rankings were similarly low across journal categories reflecting basic science research and clinical application. Radiography, rehabilitation, history and embryology were the most frequently used subheadings for MSK diseases. In 1996, there were 16,603 citations for MSK diseases, led by bone diseases (7,304 citations), joint diseases (4,987), muscular diseases (4,236), arthritis (3,555), and rheumatic diseases (3195). Among arthritic and rheumatic diseases, rheumatoid arthritis had the largest number of citations (2,004), followed by systemic lupus erythematosus (927) and osteoarthritis (793). CONCLUSION: Arthritis and rheumatic diseases receive far less attention in the scientific literature than is warranted by their enormous and growing disease burden. Both research and dissemination are lacking and more adequate resources for these activities are indicated.

Arthritis↗
PubMed2000

Differences between men and women in the rate of use of hip and knee arthroplasty.

BACKGROUND: Previous studies suggest that, for some conditions, women receive fewer health care interventions than men. We estimated the potential need for arthroplasty and the willingness to undergo the procedure in both men and women and examined whether there were differences between the sexes. METHODS: All 48,218 persons 55 years of age or older in two areas of Ontario, Canada, were surveyed by mail and telephone to identify those with hip or knee problems. In these subjects, we assessed the severity of arthritis and the presence of coexisting conditions by questionnaire, documented arthritis by examination and radiography, and conducted interviews to evaluate the subjects' willingness to undergo arthroplasty. The potential need for arthroplasty was defined by the presence of severe symptoms and disability, the absence of any absolute contraindications to surgery, and clinical and radiographic evidence of arthritis. The estimates of need were then adjusted for the subjects' willingness to undergo arthroplasty. RESULTS: The overall response rates were at least 72 percent for the questionnaires and interviews. As compared with men, women had a higher prevalence of arthritis of the hip or knee (age-adjusted odds ratio, 1.76; P<0.001) and had worse symptoms and greater disability, but women were less likely to have undergone arthroplasty (adjusted odds ratio, 0.78; P<0.001). Despite their equal willingness to have the surgery, fewer women than men had discussed the possibility of arthroplasty with a physician (adjusted odds ratio, 0.63). The numbers of people with a potential need for hip or knee arthroplasty were 44.9 per 1000 among women and 20.8 per 1000 among men. After adjustment for willingness to undergo the procedure, the numbers were 5.3 per 1000 for women and 1.6 per 1000 for men. CONCLUSIONS: There is underuse of arthroplasty for severe arthritis in both sexes, but the degree of underuse is more than three times as great in women as in men.

Aged↗
PubMed2000

Antibiotics for acute bronchitis.

BACKGROUND: Antibiotic treatment of acute bronchitis, which is one of the most common illnesses seen in primary care, is controversial. Most clinicians prescribe antibiotics in spite of expert recommendations against this practice. OBJECTIVES: People with acute bronchitis may show little evidence of bacterial infection. If effective, antibiotics could shorten the course of the disease. However if they are not effective, the risk of antibiotic resistance may be increased. The objective of this review was to assess the effects of antibiotic treatment for patients with a clinical diagnosis of acute bronchitis. SEARCH STRATEGY: We searched Medline, Embase, reference lists of articles and the authors' personal collections up to 1996, and Scisearch from 1989 to 1996. SELECTION CRITERIA: Randomised trials comparing any antibiotic therapy with placebo in acute bronchitis. DATA COLLECTION AND ANALYSIS: At least two reviewers extracted data and assessed trial quality. MAIN RESULTS: Eight trials involving 750 patients aged eight to over 65 and including smokers and non-smokers were included. The quality of the trials was variable. A variety of outcome measures were assessed. In many cases, only outcomes that showed a statistically significant difference between groups were reported. Overall, patients receiving antibiotics had slightly better outcomes than did those receiving placebo. They were less likely to report feeling unwell at a follow up visit (odds ratio 0.42, 95% confidence interval 0.22 to 0.82), to show no improvement on physician assessment (odds ratio 0.43; 0.23 to 0.79), or to have abnormal lung findings (odds ratio 0.33, 95% confidence interval 0.13 to 0.86), and had a more rapid return to work or usual activities (weighted mean difference 0.7 days earlier, 95% confidence interval 0.2 to 1. 3). Antibiotic-treated patients reported significantly more adverse effects (odds ratio 1.64; 1.05 to 2.57) such as nausea, vomiting, headache, skin rash or vaginitis. REVIEWER'S CONCLUSIONS: Antibiotics appear to have a modest beneficial effect in the treatment of acute bronchitis, with a corresponding small risk of adverse effects. The benefits of antibiotics may be overestimated in this analysis because of the tendency of published reports to include complete data on only the outcomes found to be statistically significant.

Acute Disease↗
PubMed2000

Interventions for shoulder pain.

OBJECTIVES: To review the efficacy of common interventions for shoulder pain. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Group trials register, Cochrane Controlled Trials Register, Medline, Embase, Cinahl, and Science Citation Index) up to May 1998, and hand searched major textbooks, bibliographies of relevant literature, the fugitive literature, and the subject indices of relevant journals including: American College of Rheumatology;British College of Rheumatologists; the Biennial Conference of the Manipulative Physiotherapy Association of Australia;International Federation of Manual Therapists conference proceedings; British Orthopaedic Association;and American Orthopaedic Association. SELECTION CRITERIA: Each identified study was assessed for possible inclusion by two independent reviewers based on the blinded methods sections. The determinants for inclusion were that the trial include an intervention of interest (non-steroidal anti-inflammatory drugs, intra-articular or subacromial glucocorticosteroid injection, oral glucocorticosteroid treatment, physiotherapy, manipulation under anaesthesia, hydrodilatation, or surgery); that treatment allocation was randomized; and that the outcome assessment was blinded. DATA COLLECTION AND ANALYSIS: Methodological quality was assessed by two independent, blinded reviewers. Data relating to selection criteria, outcome measurement and treatment effect was extracted from the blinded trials. Range of motion scores were entered as degrees of restriction to movement, and all pain and overall effect scores were transformed to 100 point scales. For continuous outcome measures, where standard deviation was not reported it was either calculated from the raw data or converted from standard error of the mean. If neither of these were reported, authors were contacted in an effort to obtain the missing values. Effect sizes were calculated and combined in a pooled analysis if study population, endpoint and intervention were comparable. MAIN RESULTS: Thirty one trials met inclusion criteria. Mean methodological quality score was 16.8 (9.5 - 22) out of possible score of 40. Selection criteria varied widely even for the same diagnostic label. There was no uniformity in outcome measures used and their measurement properties were rarely reported. Effect sizes for individual trials were small (-1.4 to 3. 0). The results of only three studies investigating rotator cuff tendonitis could be pooled. Benefit of subacromial steroid injection over placebo for improving range of abduction (weighted difference between means (WMD) 35 degrees, 95% CI 14 to 55) was the only positive finding. REVIEWER'S CONCLUSIONS: There is little evidence to support or refute the efficacy of common interventions for shoulder pain. As well as, the need for further well designed clinical trials, more research is needed to establish a uniform method of defining shoulder disorders and developing outcome measures which are valid, reliable and responsive in these study populations.

Humans↗
PubMed1998

Psychological outcomes following maternal serum screening: a cohort study.

BACKGROUND: Maternal serum screening is used to assist in the prenatal detection of congenital anomalies. Its use is controversial, and one concern that has been expressed is its psychological effects on women. The authors examined whether this test leads to an increase in anxiety and depression among women who have a false-positive result as compared with those who have a true-negative result or do not undergo testing. METHODS: A prospective cohort study with baseline assessment at 15 to 18 weeks' gestation and follow-up at 24 weeks' gestation was conducted. Pregnant women at 8 geographically diverse sites across Ontario were recruited. The main outcome measures were the state portion of the State--Trait Anxiety Inventory and the Center for Epidemiologic Studies Depression Scale. RESULTS: Of the 2418 potential subjects 2020 (83.5%) were enrolled and eligible; 1741 (86.2%) completed the follow-up. A total of 1177 women (67.6%) underwent maternal serum screening. No overall adverse psychological effects as a result of testing were found at 24 weeks' gestation. Women with a false-positive result had a mean increase in anxiety score of 1.6 (95% confidence interval [CI] -1.7 to 4.9), whereas women with a true-negative result had a mean decrease of 1.1 (95% CI -1.8 to -0.3) and those not tested had a mean decrease of 0.4 (95% CI -1.3 to 0.5). The mean depression score increased by 0.5 (95% CI -0.9 to 2.0) in the false-positive group, was unchanged (95% CI -0.3 to 0.4) in the true-negative group and increased by 0.2 (95% CI -1.7 to 1.2) in the not tested group. Of the women who underwent testing, 87 (7.6%) were unsure of their result at the time of follow-up. INTERPRETATION: The results suggest that maternal screening in Ontario is not causing serious psychological harm to women. Communication regarding test results could be improved, since a substantial proportion of women were unsure of their test result.

Adult↗
PubMed1998

Systematic review of randomised controlled trials of interventions for painful shoulder: selection criteria, outcome assessment, and efficacy.

OBJECTIVE: To review the efficacy of common interventions for shoulder pain. DESIGN: All randomised controlled trials of non-steroidal anti-inflammatory drugs, intra-articular and subacromial glucocorticosteroid injection, oral glucocorticosteroid treatment, physiotherapy, manipulation under anaesthesia, hydrodilatation, and surgery for shoulder pain that were identified by computerised and hand searches of the literature and had a blinded assessment of outcome were included. MAIN OUTCOME MEASURES: Methodological quality (score out of 40), selection criteria, and outcome measures. Effect sizes were calculated and combined in a pooled analysis if study population, end point, and intervention were comparable. RESULTS: Thirty one trials met inclusion criteria. Mean methodological quality score was 16.8 (9.5-22). Selection criteria varied widely, even for the same diagnostic label. There was no uniformity in the outcome measures used, and their measurement properties were rarely reported. Effect sizes for individual trials were small (range -1.4 to 3.0). The results of only three studies investigating "rotator cuff tendinitis" could be pooled. The only positive finding was that subacromial steroid injection is better than placebo in improving the range of abduction (weighted difference between means 35 degrees (95% confidence interval 14 to 55)). CONCLUSIONS: There is little evidence to support or refute the efficacy of common interventions for shoulder pain. As well as the need for further well designed clinical trials, more research is needed to establish a uniform method of defining shoulder disorders and developing outcome measures which are valid, reliable, and responsive in affected people.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1998

Disease patterns among Canadian aboriginal children. Study in a remote rural setting.

OBJECTIVE: To describe disease patterns among children in an isolated aboriginal community, and to compare them with patterns found among other aboriginal and non-aboriginal Canadian children. DESIGN: Retrospective review of logbooks and patient charts extracted from nursing station records for all visits to the community's nursing station between April 1, 1990, and March 31, 1991. SETTING: An isolated aboriginal community located in northwestern Ontario. PARTICIPANTS: All aboriginal children younger than 5 years. MAIN OUTCOME MEASURES: Disease-specific incidence per 100 person-years by age, sex, and season. RESULTS: Upper and lower respiratory tract infections, skin conditions, otitis media, and chickenpox were the leading causes of illness. Except for chickenpox, these illnesses occurred at a significantly higher rate among infants than among children 1 to 4 years old. No important differences were found by sex for any condition, except asthma where boys predominated. Autumn and winter seasonal patterns were most evident for respiratory tract infections. The rate of illness for most conditions was higher than that reported among other aboriginal and non-aboriginal Canadian children. CONCLUSIONS: The illnesses most frequently seen in these children are respiratory tract infections and skin conditions. Etiologic factors are likely to be related to multiple interacting forces (both environmental and genetic) and require further investigation.

Age Distribution↗
PubMed1997

Written patient information about triple-marker screening: a randomized, controlled trial.

OBJECTIVE: To investigate to what extent a newly revised educational pamphlet on triple-marker screening improves patient knowledge and to identify subgroups of women who may not benefit from these materials. METHODS: Women in six geographically and demographically diverse Ontario sites were allocated randomly to receive the pamphlet on triple-marker screening or a similar-appearing educational pamphlet on daily activities during pregnancy. The primary outcome measure was the Maternal Serum Screening Knowledge Questionnaire, a previously validated 14-item scale. RESULTS: Baseline demographic, obstetric, and medical factors were comparable in the intervention and control groups, as were measures of previous exposure to triple-marker screening. Knowledge scores were significantly higher among the 133 women receiving the intervention pamphlet than among 64 women who received the control pamphlet (0.89 versus 0.52 on a scale from -2 to +2, P < .001). Subgroups not benefiting from the pamphlet on triple-marker screening were women age 25 and younger and those not speaking English at home. Those who had completed university or postgraduate education had high levels of knowledge with and without the pamphlet. CONCLUSION: Written patient information can contribute in an important way to patient knowledge about triple-marker screening. Providers of antenatal care should be made aware of the value of written patient information as well as the limitations for some subgroups of women. These subgroups are likely to require additional educational materials and resources. It would be appropriate to make these materials available to the general public and pregnant women in their physicians' offices.

Adult↗
PubMed1997

Adverse effects of screening for gestational diabetes: a prospective cohort study in Toronto, Canada.

OBJECTIVE: To investigate the adverse effects associated with a false positive 50 g glucose challenge test for gestational diabetes mellitus (GDM). SETTING: Consecutive women attending a prenatal registration clinic at a large community hospital in suburban Toronto, Canada. METHODS: Prospective cohort study of women between 12 and 24 weeks' gestation with no previous history of diabetes mellitus or GDM. Main outcome measures included anxiety (Spielberger's State-Trait Anxiety Inventory), depression (Centers for Epidemiologic Studies Depression Scale), perceived maternal health, and concern about health of the newborn. RESULTS: Among 2564 eligible subjects, there were 897 subjects with complete data at enrollment and at 32 weeks' gestation, including 88 who had false positive glucose challenge test results. At 32 weeks, only 20% (95% confidence limits 11%, 28%) of women with false positive glucose challenge test results rated their health as excellent, compared with 38% (35%, 42%) of those having negative results and those not tested (P = 0.001). These results were sustained at 36 weeks. There was no association between glucose challenge test result and the change in anxiety (P = 0.57), depression (P = 0.09) or concern about health of the newborn (P = 0.91) between baseline and 32 weeks' gestation, nor were these associations found at 36 weeks. CONCLUSIONS: False positive glucose challenge test results are about six times more likely than true positive results in the general population. Pregnant women with false positive GDM screening results experience a significant decline in their perception of their own health. These adverse effects should be taken into account when deciding about a policy of screening all pregnant women for gestational diabetes.

Canada↗
PubMed1996

Evaluating patient's knowledge of maternal serum screening.

The objective was to describe the development, characteristics, and initial use of an instrument for assessing knowledge about maternal serum screening (MSS). Items for a knowledge scale were selected based on a review of educational materials, the literature, and expert opinion. Items were pre-tested for comprehensibility and ambiguity in a convenience sample. After extensive pre-testing and pilot testing a 14-item scale, the Maternal Serum Screening Knowledge Questionnaire (MSSKQ) was developed. It was administered to 1084 women attending a maternal registration clinic. The overall knowledge score was compared across socio-demographic groups, and by sources of information about MSS. Mean MSSKQ scores increased with age, education, and family income, and among those reporting having an opportunity to discuss MSS and receiving written material. The MSSKQ is a reliable instrument with good content and construct validity. This tool should be valuable in assessing knowledge and level of informed consent in women receiving MSS and in evaluating the implementation of MSS programmes.

Adult↗