Maternal and child biomonitoring strategies and levels of exposure in western Canada during the past seventeen years: The Alberta Biomonitoring Program: 2005-2021.

The Alberta Biomonitoring Program (ABP) was created in 2005 with the initial goal of establishing baseline levels of exposure to environmental chemicals in specific populations in the province of Alberta, Canada, and was later expanded to include multiple phases. The first two phases focused on evaluating exposure in pregnant women (Phase One, 2005) and children (Phase Two, 2004-2006) by analyzing residual serum specimens. Phase Three (2013-2016) employed active recruitment techniques to evaluate environmental exposures using a revised list of chemicals in paired serum pools from pregnant women and umbilical cord blood. These three phases of the program monitored a total of 226 chemicals in 285 pooled serum samples representing 31,529 individuals. Phase Four (2017-2020) of the ABP has taken a more targeted approach, focusing on the impact of the federal legalization of cannabis on the exposure of pregnant women in Alberta to cannabis, as well as tobacco and alcohol using residual prenatal screening serum specimens. Chemicals monitored in the first three phases include herbicides, neutral pesticides, metals, metalloids, and micronutrients, methylmercury, organochlorine pesticides, organophosphate pesticides, parabens, phthalate metabolites, perfluoroalkyl substances (PFAS), phenols, phytoestrogens, polybrominated compounds, polychlorinated biphenyls (PCBs), dioxins and furans, polycyclic aromatic hydrocarbons (PAHs), and tobacco biomarkers. Phase Four monitored six biomarkers of tobacco, alcohol, and cannabis. All serum samples were pooled. Mean concentrations and 95% confidence intervals (CIs) were calculated for the chemicals detected in ≥25% of the sample pools. cross the first three phases, the data from the ABP has provided baseline exposure levels for the chemicals in pregnant women, children, and newborns across the province. Comparison within and among the phases has highlighted differences in exposure levels with age, geography, seasonality, sample type, and time. The strategies employed throughout the program phases have been demonstrated to provide effective models for population biomonitoring.

Deriving low-risk gambling limits from longitudinal data collected in two independent Canadian studies.

AIMS: To derive low-risk gambling limits using the method developed by Currie et al. (2006) applied to longitudinal data. DESIGN: Secondary analysis of data from the Quinte Longitudinal Study (n = 3054) and Leisure, Lifestyle and Lifecycle Project (n = 809), two independently conducted cohort studies of the natural progression of gambling in Canadian adults. SETTING: Community-dwelling adults in Southeastern Ontario and Alberta, Canada. PARTICIPANTS: A total of 3863 adults (50% male; median age = 44) who reported gambling in the past year. MEASUREMENTS: Gambling behaviours (typical monthly frequency, total expenditure and percentage of income spent on gambling) and harm (experiencing two or more consequences of gambling in the past 12 months) were assessed with the Canadian Problem Gambling Index. FINDINGS: The dose-response relationship was comparable in both studies for frequency of gambling (days per month), total expenditure and percentage of household income spent on gambling (area under the curve values ranged from 0.66 to 0.74). Based on the optimal sensitivity and specificity values, the low-risk gambling cut-offs were eight times per month, $75CAN total per month and 1.7% of income spent on gambling. Gamblers who exceeded any of these limits at time 1 were approximately four times more likely to report harm at time 2 [95% confidence interval (CI) = 2.9-6.6]. CONCLUSIONS: Longitudinal data in Canada suggest low-risk gambling thresholds of eight times per month, $75CAN total per month and 1.7% of income spent on gambling, all of which are higher than previously derived limits from cross-sectional data. Gamblers who exceed any of the three low-risk limits are four times more likely to experience future harm than those who do not.

Problem gambling symptomatology and alcohol misuse among adolescents: A parallel-process latent growth curve model.

The objective of the current study was to examine the possible temporal associations between alcohol misuse and problem gambling symptomatology from adolescence through to young adulthood. Parallel-process latent growth curve modeling was used to examine the trajectories of alcohol misuse and symptoms of problem gambling over time. Data were from a sample of adolescents recruited for the Leisure, Lifestyle, and Lifecycle Project in Alberta, Canada (n = 436), which included 4 assessments over 5 years. There was an average decline in problem gambling symptoms followed by an accelerating upward trend as the sample reached the legal age to gamble. There was significant variation in the rate of change in problem gambling symptoms over time; not all respondents followed the same trajectory. There was an average increase in alcohol misuse over time, with significant variability in baseline levels of use and the rate of change over time. The unconditional parallel process model indicated that higher baseline levels of alcohol misuse were associated with higher baseline levels of problem gambling symptoms. In addition, higher baseline levels of alcohol misuse were associated with steeper declines in problem gambling symptoms over time. However, these between-process correlations did not retain significance when covariates were added to the model, indicating that one behavior was not a risk factor for the other. The lack of mutual influence in the problem gambling symptomatology and alcohol misuse processes suggest that there are common risk factors underlying these two behaviors, supporting the notion of a syndrome model of addiction. (PsycINFO Database Record

A principal component analysis is conducted for a case series quality appraisal checklist.

OBJECTIVE: Because of a lack of a control group, a case-series study is considered one of the weaker study designs from which to obtain evidence on treatment effectiveness. Under certain circumstances, however, this is the only available evidence to inform health-care decisions. This study's intent was to develop and validate a quality appraisal checklist specifically for case-series studies. STUDY DESIGN AND SETTING: A modified Delphi process was used to develop the checklist, which was then used by multiple researchers to appraise a random sample of 105 case-series studies. A principal component analysis of these appraisals was conducted to further refine the checklist. RESULTS: The modified Delphi process resulted in a 20-criterion checklist. The principal component analysis of the appraisals for the 105 case-series studies revealed two components. The first component (10 criteria) indicated the extent to which a case series presented traditional features of a statistical hypothesis-testing paradigm. The second component (seven criteria) indicated whether detailed descriptions of the subjects' characteristics that might feature in the experimental design were present, particularly in judgments about the likelihood of confounding. CONCLUSION: This quality appraisal checklist may be useful in assessing case-series studies, but further validation of the checklist is required.

The influence of impulsiveness on binge eating and problem gambling: A prospective study of gender differences in Canadian adults.

This study investigated the degree to which facets of impulsiveness predicted future binge eating and problem gambling, 2 theorized forms of behavioral addiction. Participants were 596 women and 406 men from 4 age cohorts randomly recruited from a Canadian province. Participants completed self-report measures of 3 facets of impulsiveness (negative urgency, sensation seeking, lack of persistence), binge-eating frequency, and problem-gambling symptoms. Impulsiveness was assessed at baseline, and assessments of binge eating and problem gambling were followed up after 3 years. Weighted data were analyzed using zero-inflated negative binomial and Poisson regression models. We found evidence of transdiagnostic and disorder-specific predictors of binge eating and problem gambling. Negative urgency emerged as a common predictor of binge eating and problem gambling among women and men. There were disorder-specific personality traits identified among men only: High lack-of-persistence scores predicted binge eating and high sensation-seeking scores predicted problem gambling. Among women, younger age predicted binge eating and older age predicted problem gambling. Thus, there are gender differences in facets of impulsiveness that longitudinally predict binge eating and problem gambling, suggesting that treatments for these behaviors should consider gender-specific personality and demographic traits in addition to the common personality trait of negative urgency.

Comorbid Problem Gambling and Major Depression in a Community Sample.

Major depression is among the most common comorbid conditions in problem gambling. However, little is known about the effects of comorbid depression on problem gambling. The present study examined the prevalence of current major depression among problem gamblers (N = 105) identified from a community sample of men and women in Alberta, and examined group differences in gambling severity, escape motivation for gambling, family functioning, childhood trauma, and personality traits across problem gamblers with and without comorbid depression. The prevalence of major depression among the sample of problem gamblers was 32.4%. Compared to problem gamblers without depression (n = 71), problem gamblers with comorbid depression (n = 34) reported more severe gambling problems, greater history of childhood abuse and neglect, poorer family functioning, higher levels of neuroticism, and lower levels of extraversion, agreeableness, and conscientiousness. Furthermore, the problem gamblers with comorbid depression had greater levels of childhood abuse and neglect, worse family functioning, higher neuroticism, and lower agreeableness and conscientiousness than a comparison sample of recreational gamblers with depression (n = 160). These findings underscore the need to address comorbid depression in assessment and treatment of problem gambling and for continued research on how problem gambling is related to frequently co-occurring disorders such as depression.

Social judgments of behavioral versus substance-related addictions: a population-based study.

BACKGROUND: Recently, the concept of addiction has expanded to include many types of problematic repetitive behaviors beyond those related to substance misuse. This trend may have implications for the way that lay people think about addictions and about people struggling with addictive disorders. The aim of this study was to provide a better understanding of how the public understands a variety of substance-related and behavioral addictions. METHODS: A representative sample of 4000 individuals from Alberta, Canada completed an online survey. Participants were randomly assigned to answer questions about perceived addiction liability, etiology, and prevalence of problems with four substances (alcohol, tobacco, marijuana, and cocaine) and six behaviors (problematic gambling, eating, shopping, sexual behavior, video gaming, and work). RESULTS: Bivariate analyses revealed that respondents considered substances to have greater addiction liability than behaviors and that most risk factors (moral, biological, or psychosocial) were considered as more important in the etiology of behavioral versus substance addictions. A discriminant function analysis demonstrated that perceived addiction liability and character flaws were the two most important features differentiating judgments of substance-related versus behavioral addictions. Perceived addiction liability was judged to be greater for substances. Conversely, character flaws were viewed as more associated with behavioral addictions. CONCLUSIONS: The general public appreciates the complex bio-psycho-social etiology underlying addictions, but perceives substance-related and behavioral addictions differently. These attitudes, in turn, may shape a variety of important outcomes, including the extent to which people believed to manifest behavioral addictions feel stigmatized, seek treatment, or initiate behavior changes on their own.

Mobility of Vulnerable Elders study: effect of the sit-to-stand activity on mobility, function, and quality of life.

OBJECTIVES: The aim of this study is to assess the effect of the sit-to-stand activity on the mobility, function, and health-related quality of life of nursing home residents with dementia. DESIGN: A longitudinal quasi-experimental intervention study with intervention and control groups. SETTING: The study was conducted in 7 nursing homes (4 intervention; 3 control) in Edmonton, Canada. PARTICIPANTS: Eligible residents had a diagnosis of dementia and were able to transfer independently, or with the assistance of 1 person. INTERVENTION: Health care aides prompted residents to repeat the sit-to-stand activity daily during care routines on day and evening shifts. MEASUREMENTS: Mobility was measured using the 30-second sit-to-stand test and the time to complete one sit-to-stand. Function (Functional Independence Measure), health status (Health Utilities Index Mark 2 & 3) and disease-specific quality of life (Quality of Life-Alzheimer's Disease instrument) were also measured. Outcome measures were collected at baseline, and at 3 and 6 months. The covariates cognition, depression, and medical instability were derived from the Resident Assessment Instrument Minimum Data Set (Version 2.0), and the facility context covariate was measured using the Alberta Context Tool. RESULTS: A total of 111 residents completed the 6-month trial (56 intervention; 55 control). Residents in the intervention facilities maintained mobility, as measured by the time to complete one sit-to-stand (P = .01), and experienced a slower functional decline, as measured by the Functional Independence Measure (P = .01), from baseline to 6 months compared with residents in the control facilities, after adjusting for age, sex, cognition, depression, medical instability, and context. CONCLUSIONS: Maintaining the ability to transfer using the sit-to-stand activity is a promising means of optimizing the mobility and function for residents with dementia in nursing homes.

Home-based secondary prevention programs for patients with coronary artery disease: a meta-analysis of effects on anxiety.

PURPOSE: Anxiety is common among patients with coronary artery disease (CAD). Despite the benefits of home-based CAD prevention interventions on quality of life and atherosclerotic risk factors, the efficacy of home-based programs in reducing patient anxiety is unknown. METHODS: We performed a systematic review and meta-analysis of all randomized trials that examined the effects of home-based interventions on anxiety reduction in patients with CAD published in 18 databases until December 2009. Analyses were based on changes in the standardized mean difference between treatment groups. RESULTS: Eight trials containing intervention means and standard deviations on anxiety were reviewed. Overall quality of the trials was low to moderate. Compared with usual care or center-based cardiac rehabilitation, home-based interventions had a small but significant effect in reducing anxiety (total effect size: -0.13; 95% CI: -0.20 to -0.06; P < .001; I = 66%). CONCLUSIONS: This meta-analysis provides evidence that home-based secondary prevention programs are effective in reducing anxiety level in CAD patients. However, because of the limited number of trials available and high degrees of heterogeneity in the data, further research needs to be done to provide a definitive answer on the benefits of home-based programs on anxiety management in CAD patients.

Examining the predictive validity of low-risk gambling limits with longitudinal data.

AIMS: To assess the impact of gambling above the low-risk gambling limits developed by Currie et al. (2006) on future harm. To identify demographic, behavioural, clinical and environmental factors that predict the shift from low- to high-risk gambling habits over time. DESIGN: Longitudinal cohort study of gambling habits in community-dwelling adults. SETTING: Alberta, Canada. PARTICIPANTS: A total of 809 adult gamblers who completed the time 1 and time 2 assessments separated by a 14-month interval. MEASUREMENTS: Low-risk gambling limits were defined as gambling no more than three times per month, spending no more than CAN$1000 per year on gambling and spending less than 1% of gross income on gambling. Gambling habits, harm from gambling and gambler characteristics were assessed by the Canadian Problem Gambling Index. Ancillary measures of substance abuse, gambling environment, major depression, impulsivity and personality traits assessed the influence of other risk factors on the escalation of gambling intensity. FINDINGS: Gamblers classified as low risk at time 1 and shifted into high-risk gambling by time 2 were two to three times more likely to experience harm compared to gamblers who remained low risk at both assessments. Factors associated with the shift from low- to high-risk gambling behaviour from time 1 to time 2 included male gender, tobacco use, older age, having less education, having friends who gamble and playing electronic gaming machines. CONCLUSIONS: An increase in the intensity of gambling behaviour is associated with greater likelihood of future gambling related harm in adults.

A meta-analysis of the effects of exercise training on left ventricular remodeling following myocardial infarction: start early and go longer for greatest exercise benefits on remodeling.

BACKGROUND: The effects of variations in exercise training on left ventricular (LV) remodeling in patients shortly after myocardial infarction (MI) are important but poorly understood. METHODS: Systematic review incorporating meta-analysis using meta-regression. Studies were identified via systematic searches of: OVID MEDLINE (1950 to 2009), Cochrane Central Register of Controlled Trials (1991 to 2009), AMED (1985 to 2009), EMBASE (1988 to 2009), PUBMED (1966 to 2009), SPORT DISCUS (1975 to 2009), SCOPUS (1950 to 2009) and WEB OF SCIENCE (1950 to 2009) using the medical subject headings: myocardial infarction, post myocardial infarction, post infarction, heart attack, ventricular remodeling, ventricular volumes, ejection fraction, left ventricular function, exercise, exercise therapy, kinesiotherapy, exercise training. Reference lists of all identified studies were also manually searched for further relevant studies. Studies selected were randomized controlled trials of exercise training interventions reporting ejection fraction (EF) and/or ventricular volumes in patients following recent MI (≤ 3 months) post-MI patients involving control groups. Studies were excluded if they were not randomized, did not have a 'usual-care' control (involving no exercise), evaluated a non-exercise intervention, or did not involve human subjects. Non-English studies were also excluded. RESULTS: After screening of 1029 trials, trials were identified that reported EF (12 trials, n = 647), End Systolic Volumes (ESV) (9 trials, n = 475) and End Diastolic Volumes (EDV) (10 trials, n = 512). Meta-regression identified that changes in EF effect size difference decreased as the time between MI and initiation of the exercise program lengthened, and increased as the duration of the program increased (Q = 25.48, df = 2, p < 0.01, R2 = 0.76). Greater reductions in ESV and EDV (as indicated by effect size decreases) occurred with earlier initiation of exercise training and with longer training durations (ESV: Q = 23.89, df = 2, p < 0.05, R2 = 0.79; EDV: Q = 27.42, df = 2, p < 0.01, R2 = 0.83). Differences remained following sensitivity analysis. Each week that exercise was delayed required an additional month of training to achieve the same level of benefit on LV remodeling. CONCLUSIONS: Exercise training has beneficial effects on LV remodeling in clinically stable post-MI patients with greatest benefits occurring when training starts earlier following MI (from one week) and lasts longer than 3 months.

The association between childhood maltreatment and gambling problems in a community sample of adult men and women.

The association between childhood maltreatment and gambling problems was examined in a community sample of men and women (N = 1,372). As hypothesized, individuals with gambling problems reported greater childhood maltreatment than individuals without gambling problems. Childhood maltreatment predicted severity of gambling problems and frequency of gambling even when other individual and social factors were controlled including symptoms of alcohol and other drug use disorders, family environment, psychological distress, and symptoms of antisocial disorder. In contrast to findings in treatment-seeking samples, women with gambling problems did not report greater maltreatment than men with gambling problems. These results underscore the need for both increased prevention of childhood maltreatment and increased sensitivity towards trauma issues in gambling treatment programs for men and women.

Comparison of costs and associated outcomes between women choosing newly integrated autonomous midwifery care and matched controls: a pilot study.

OBJECTIVE: In response to consumer demand and a critical shortage of Canadian maternity care providers, provinces have integrated or are in the process of integrating midwives into their health care systems. We compared the costs and outcomes of newly integrated, autonomous midwifery care with existing health care services in the province of Alberta. METHODS: Alberta Health and Wellness cost data from (1) physician fee-for-service, (2) outpatient, and (3) inpatient records, as well as outcome data from vital statistics records, were compared between participants in a midwifery integration project and individually matched women who received standard perinatal care during the same time period. Records of births occurring within the same time frame were matched according to risk score, maternal age, parity, and postal code. RESULTS: For women who chose midwifery care, an average saving of $1172 per course of care was realized without adversely affecting maternal or neonatal outcomes. Cost reductions are partially realized through provision of out-of-hospital health services. Women who chose midwifery care had more prenatal visits (P < 0.01) and fewer inductions of labour (P < 0.01); their babies had greater gestational ages (P < 0.05) and higher birth weights (P < 0.05) than controls. The sample size was insufficient to compare events associated with extremely high costs, or rare or catastrophic outcomes. CONCLUSION: Regulated and publicly funded midwifery care appears to be an effective intervention for low-risk women who make this choice. When compared with existing care, autonomous care by newly integrated midwives does not increase health care costs.

Association of functional variants in the dopamine D2-like receptors with risk for gambling behaviour in healthy Caucasian subjects.

Pathological gambling (PG) is an impulse control disorder with suggestive genetic vulnerability component. We evaluated the association of genetic variants in the dopaminergic receptor genes (DRD1-3s) with risk for gambling in healthy subjects using the Canadian Problem Gambling Index (CPGI). Healthy Caucasian subjects who had gambled at least once in their lifetime (n=242) were included in the analysis. Gender was not associated with the CPGI, while younger age was associated with higher CPGI scores. We have found that none of the single polymorphisms investigated on DRD1 and DRD3 were associated with CPGI scores in healthy subjects. However, we observed trends for association on the TaqIA/rs1800497 polymorphism (P=0.10) and the haplotype flanking DRD2 (G/C/A rs11604671/rs4938015/rs2303380; P=0.06). Both trends were associated with lower CPGI score. Our results provide further evidence for the role of dopamine D2-like receptor in addiction susceptibility.

Longitudinal epidemiology of major depression as assessed by the Brief Patient Health Questionnaire (PHQ-9).

BACKGROUND: Most diagnostic interviews depend on recall of past symptoms and may be vulnerable to recall bias. The objective of this study was to describe the epidemiology of major depression using an approach that is less reliant on recall using an assessment scale, the 9-item Brief Patient Health Questionnaire (PHQ-9). The pattern observed is relevant both to understanding major depression epidemiology and to assessing a possible role for the PHQ-9 as a screening instrument. METHOD: Random digit dialing was used to select a sample of 3304 community residents. Each respondent was assessed with a baseline interview followed by a series of 6 subsequent follow-up interviews 2 weeks apart. RESULTS: Prevalence was between 2.5% and 3.3% during each interview, consistent with prior reports. The incidence of new episodes was surprisingly high, and many of the episodes were brief. Similarly, high rates of recovery (according to PHQ-9 scoring) were seen early in follow-up but declined subsequently. Episodes of major depression detected by the PHQ-9 tended to be preceded and followed by elevated levels of depressive symptoms. CONCLUSIONS: The long-standing episodes of major depression typical of clinical practice appear to represent a minority of episodes occurring in the community. These results suggest that, in general population screening applications, the PHQ-9 will identify many respondents having brief and perhaps self-limited episodes. Although some episodes are characterized by large increases in symptoms, many respondents appear to move above and below the diagnostic threshold as a result of small changes in their symptom levels. Efforts to develop more effective approaches to screening may benefit from severity-based decision rules and serial measurement strategies.

Trends in antidepressant prescriptions among the elderly in Alberta during 1997 to 2004.

OBJECTIVE: To analyze trends in antidepressant (AD) prescription rates among the elderly (aged 65 years and older) in Alberta during 1997 to 2004. METHOD: Numerical data on AD prescriptions were obtained from Alberta Blue Cross. Age-standardized prescription rates were calculated according to type of AD. RESULTS: The prescription rate for all ADs combined increased by 59% for men and 55% for women. This change was due entirely to serotonin reuptake inhibitors (SSRIs) and other recently-introduced ADs, that by 2004 accounted for 72% of AD prescriptions for men and 69% for women. For each year and type of AD, the prescription rate for women was almost double that for men. CONCLUSIONS: In the elderly in Alberta, prescription rates for ADs increased markedly during 1997 to 2004, especially for SSRIs and other recently introduced ADs.

Designing a longitudinal cohort study of gambling in Alberta: rationale, methods, and challenges.

Longitudinal research on the determinants of gambling behavior is sparse. This article briefly reviews the previous seventeen longitudinally designed studies, focusing on the methodology for each study. This is followed by a description of our ongoing longitudinal study entitled the Leisure, Lifestyle, and Lifecycle Project (LLLP). Participants for the LLLP were recruited from four locations in Alberta, Canada, including both rural and urban populations. In the LLLP most participants were recruited using random digit dialing (RDD), with 1808 participants from 5 age cohorts at baseline: 13-15, 18-20, 23-25, 43-45, and 63-65. Individuals completed telephone, computer, and face-to-face surveys at baseline, with the data collection occurring between February and October, 2006. At baseline, a wide variety of constructs were measured, including gambling behavior, substance use, psychopathology, intelligence, family environment, and internalizing and externalizing problems. Finally, the conclusions that can be drawn thus far are discussed as well as the plans for three future data collections.

Utilization rates for surgical procedures in rural and urban Canada.

OBJECTIVE: To investigate whether utilization rates of common surgical procedures are different between urban and rural Canadians in 2 provinces and to examine whether these rates are influenced by the presence and scope of local surgical programs and by the availability of different physician providers. METHODS: Utilization rates for 8 common surgical procedures (appendectomy, carpal tunnel release, closed hip fracture repair, rectal cancer surgery, joint replacement, thyroidectomy, unilateral or bilateral inguinal herniorrhaphy, and cholecystectomy) were identified in rural Alberta and rural Northern Ontario from hospital discharge records. Rural populations were characterized by 3 types of communities, based on availability of local physician and diagnostic resources. Travel time for consultations and surgery were estimated. Age-sex-adjusted rates, their standard errors, and 95% confidence intervals (CIs) were calculated for the purpose of comparisons among residents' locations using the method of direct standardization. To test a possible association between travel times and utilization rates, hierarchical linear and nonlinear modelling was used to analyze a 2-level model, with patients nested within rural hospital catchment areas in the province of Alberta. RESULTS: Utilization rates for appendectomy, cholecystectomy and carpal tunnel release are significantly greater for rural populations compared with urban in both Alberta and Northern Ontario. Rural Northern Ontario had higher rates of utilization than rural Alberta for carpal tunnel release and cholecystectomy (p < 0.01) and closed hip fracture repair (p < 0.05). No statistical differences between the provinces were noted for the remaining procedures. No difference in utilization rates was found between the 3 types of rural centres. The modelling found a significant association between travel time and use for only one procedure--carpal tunnel release. Patients who had to travel < or =1 hour had a 13% higher surgery rate. CONCLUSION: Rates of utilization were higher in rural areas for procedures where greater surgical variability is known to exist. These higher rural rates were not influenced by either the presence or scope of local surgical programs nor by the differences in providers. There was no difference in rates for procedures where previous research has shown little variability.

The relationship between birth weight and childhood asthma: a population-based cohort study.

BACKGROUND: Because obesity promotes inflammation and imposes mechanical constraints to the airways, a high birth weight may be a risk factor for asthma in childhood. However, to our knowledge, few studies have examined this potential relationship. OBJECTIVE: To determine the relationship between high birth weight and risk of emergency visits for asthma during childhood. DESIGN: Population-based cohort study. SETTING: Alberta, Canada. PARTICIPANTS: All neonates born at term (> or =37 weeks) between April 1, 1985, and March 31, 1988, in Alberta (N = 83,595). We divided the cohort into birth-weight categories: low (<2.5 kg), normal (2.5-4.5 kg), or high (>4.5 kg). The cohort was observed prospectively for 10 years.Main Outcome Measure Comparison of risk of emergency visits for asthma over 10 years across the birth-weight categories. RESULTS: Neonates born with a high birth weight had a significantly increased risk of emergency visits for asthma during childhood compared with neonates born with a normal birth weight (relative risk [RR], 1.16; 95% confidence interval [CI], 1.04-1.29). The relationship between birth weight and emergency visits for asthma beyond a birth weight of 4.5 kg was linear, such that every increment of 0.10 kg in birth weight was associated with an additional 10% (95% CI, 2%-19%) increase in the risk of emergency visits for asthma. Other factors associated with an elevated risk for emergency asthma visits during childhood included male sex (RR, 1.26; 95% CI, 1.22-1.30), aboriginal status (RR, 1.20; 95% CI, 1.11-1.29), and low-income status (RR, 1.11; 95% CI, 1.06-1.16). CONCLUSIONS: A high, but not low, birth weight is a risk factor for increased emergency visits during childhood. The risk increases linearly beyond a birth weight of 4.5 kg.

Population-based study of medically treated self-inflicted injuries.

OBJECTIVE: Self-inflicted injury is commonly seen in emergency departments (EDs). It may be a pre-cursor to death by suicide. The objective of this study was to examine the epidemiology of self-inflicted injury presentations to EDs in the province of Alberta. METHODS: Self-inflicted injury records for the 3 fiscal years 1998/99 to 2000/01 were accessed from the Ambulatory Care Classification System, a database that captures all ED encounters in the province of Alberta. Available data for each case included demographic details, location and time of visit, diagnoses and procedures. RESULTS: There were 22 396 self-inflicted injury presentations to Alberta EDs during the study period. Self-inflicted injury rates were higher in females, younger patients, those on social services and those with Aboriginal treaty status. There were higher rates of return visits in the year following the self-inflicted injury than in other patient groups. Data showed regional variation. Trends could be seen in the timing of self-inflicted injury presentations by hour of day, day of week, and month of year. CONCLUSIONS: Self-inflicted injury is common, with particularly high rates demonstrated among marginalized populations. This study provides comprehensive data on those who present with self-inflicted injuries, and can be used to guide further treatment, research and evaluation for this population.