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1.
Am J Trop Med Hyg ; 102(3): 574-577, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31933459

RESUMEN

Human infection with the trematode Fasciola occurs with a worldwide prevalence of up to 17 million. Sheep and cattle are the normal host. Infection typically results in hepatobiliary disease, but extrahepatic manifestations are occasionally reported. Here, we present the case of a previously healthy 31-year-old Kurdish woman, admitted to hospital with a subarachnoid hemorrhage, eosinophilic meningitis, and lung and liver disease. A diagnosis of Fasciola infection was made based on strongly positive serology in blood and cerebrospinal fluid. The patient improved following treatment with triclabendazole and prednisolone.

2.
Can J Public Health ; 110(5): 649-656, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31102235

RESUMEN

OBJECTIVE: The Manitoba Infant Feeding Database (MIFD) is being piloted as a surveillance system leveraging infant vaccination visits as a point of contact to collect infant feeding data during the first year of life. The objective of this study was to assess data quality and acceptability of the MIFD as a sustainable population-based surveillance system. METHODS: Internal completeness and internal validity were measured to assess data quality. Internal completeness was defined as the number of completed data fields out of the total number of data fields. Internal validity was defined as the proportion of translation errors from one level of the system, the paper questionnaire, to the next, the electronic database. A survey assessed staff's acceptance of data collection and submission processes. RESULTS: A total of 947 records were reviewed. Data were 98.5% complete. Discrepancies were noted in 13.5% of data. The survey response rate was 78.4%. Nearly all respondents reported that the MIFD data collection tool was easy to use (96.6% agreed or strongly agreed). Whereas some challenges were identified, the majority were willing to continue with the MIFD data collection tool and process (93.1%). CONCLUSION: Results from this evaluation suggest that the MIFD data collection process worked well; however, data validation will require human resources. The MIFD approach provides a sustainable mechanism for collecting data on infant feeding for surveillance and research purposes.

3.
Health Promot Chronic Dis Prev Can ; 37(10): 350-356, 2017 Oct.
Artículo en Inglés, Francés | MEDLINE | ID: mdl-29043762

RESUMEN

INTRODUCTION: "Food deserts" have emerged over the past 20 years as spaces of concern for communities, public health authorities and researchers because of their potential negative impact on dietary quality and subsequent health outcomes. Food deserts are residential geographic spaces, typically in urban settings, where low-income residents have limited or no access to retail food establishments with sufficient variety at affordable cost. Research on food deserts presents methodological challenges including retail food store identification and classification, identification of low-income populations, and transportation and proximity metrics. Furthermore, the complex methods often used in food desert research can be difficult to reproduce and communicate to key stakeholders. To address these challenges, this study sought to demonstrate the feasibility of implementing a simple and reproducible method of identifying food deserts using data easily available in the Canadian context. METHODS: This study was conducted in Winnipeg, Canada in 2014. Food retail establishments were identified from Yellow Pages and verified by public health dietitians. We calculated two scenarios of food deserts based on location of the lowest-income quintile population: (a) living ≥ 500 m from a national chain grocery store, or (b) living ≥ 500 m from a national chain grocery store or a full-service grocery store. RESULTS: The number of low-income residents living in a food desert ranged from 64 574 to 104 335, depending on the scenario used. CONCLUSION: This study shows that food deserts affect a significant proportion of the Winnipeg population, and while concentrated in the urban core, exist in suburban neighbourhoods also. The methods utilized represent an accessible and transparent, reproducible process for identifying food deserts. These methods can be used for costeffective, periodic surveillance and meaningful engagement with communities, retailers and policy makers.


Asunto(s)
Abastecimiento de Alimentos , Canadá , Abastecimiento de Alimentos/métodos , Abastecimiento de Alimentos/estadística & datos numéricos , Humanos , Mercadeo , Salud Poblacional , Pobreza/estadística & datos numéricos , Salud Pública , Características de la Residencia , Factores Socioeconómicos
4.
BMJ Open ; 7(10): e017981, 2017 Oct 22.
Artículo en Inglés | MEDLINE | ID: mdl-29061626

RESUMEN

INTRODUCTION: Breast feeding is associated with many health benefits for mothers and infants. But despite extensive public health efforts to promote breast feeding, many mothers do not achieve their own breastfeeding goals; and, inequities in breastfeeding rates persist between high and low-income mother-infant dyads. Developing targeted programme to support breastfeeding dyads and reduce inequities between mothers of different socioeconomic status are a priority for public health practitioners and health policy decision-makers; however, many jurisdictions lack the timely and comprehensive population-level data on infant-feeding practices required to monitor trends in breastfeeding initiation and duration. This protocol describes the establishment of a population-based infant-feeding database in the Canadian province of Manitoba, providing opportunities to develop and evaluate breastfeeding support programme. METHODS AND ANALYSIS: Routinely collected administrative health data on mothers' infant-feeding practices will be captured during regular vaccination visits using the Teleform fax tool, which converts handwritten information to an electronic format. The infant-feeding data will be linked to the Manitoba Population Research Data Repository, a comprehensive collection of population-based information spanning health, education and social services domains. The linkage will allow us to answer research questions about infant-feeding practices and to evaluate how effective current initiatives promoting breast feeding are. ETHICS AND DISSEMINATION: Approvals have been granted by the Health Research Ethics Board at the University of Manitoba. Our integrative knowledge translation approach will involve disseminating findings through government and community briefings, presenting at academic conferences and publishing in scientific journals.


Asunto(s)
Lactancia Materna , Bases de Datos como Asunto , Promoción de la Salud/métodos , Madres/educación , Humanos , Modelos Logísticos , Manitoba , Análisis Multivariante , Estudios Prospectivos , Salud Pública/educación , Proyectos de Investigación
5.
Can J Microbiol ; 62(9): 781-93, 2016 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-27420183

RESUMEN

The etiology of inflammatory bowel disease (IBD) is unknown; current research is focused on determining environmental factors. One consideration is drinking water: water systems harbour considerable microbial diversity, with bacterial concentrations estimated at 10(6)-10(8) cells/L. Perhaps differences in microbial ecology of water sources may impact differential incidence rates of IBD. Regions of Manitoba were geographically mapped according to incidence rates of IBD and identified as high (HIA) or low (LIA) incidence areas. Bulk water, filter material, and pipe wall samples were collected from public buildings in different jurisdictions and their population structure analyzed using 16S rDNA sequencing. At the phylum level, Proteobacteria were observed significantly less frequently (P = 0.02) in HIA versus LIA. The abundance of Proteobacteria was also found to vary according to water treatment distribution networks. Gammaproteobacteria was the most abundant class of bacteria and was observed more frequently (P = 0.006) in LIA. At the genus level, microbes found to associate with HIA include Bradyrhizobium (P = 0.02) and Pseudomonas (P = 0.02). Particular microbes were found to associate with LIA or HIA, based on sample location and (or) type. This work lays out a basis for further studies exploring water as a potential environmental source for IBD triggers.


Asunto(s)
Agua Potable/microbiología , Enfermedades Inflamatorias del Intestino/etiología , Canadá/epidemiología , ADN Ribosómico/genética , Humanos , Incidencia , Enfermedades Inflamatorias del Intestino/epidemiología , Enfermedades Inflamatorias del Intestino/microbiología , Microbiota , Proteobacteria/genética , Pseudomonas/genética , ARN Ribosómico 16S/genética
6.
Med Teach ; 38(6): 613-20, 2016 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-26473273

RESUMEN

BACKGROUND: Rigorous reviews of available information, from a range of resources, are required to support medical and health educators in their decision making. AIM: The aim of this article is to highlight the importance of a review of theoretical frameworks specifically as a supplement to reviews that focus on a synthesis of the empirical evidence alone. Establishing a shared understanding of theory as a concept is highlighted as a challenge and some practical strategies to achieving this are presented. This article also introduces the concept of theoretical quality, arguing that a critique of how theory is applied should complement the methodological appraisal of the literature in a review. METHOD: We illustrate the challenge of establishing a shared meaning of theory through reference to experiences of an on-going review of this kind conducted in the field of interprofessional education (IPE) and use a high scoring paper selected in this review to illustrate how theoretical quality can be assessed. FINDINGS: In reaching a shared understanding of theory as a concept, practical strategies that promote experiential and practical ways of knowing are required in addition to more propositional ways of sharing knowledge. Concepts of parsimony, testability, operational adequacy and empirical adequacy are explored as concepts that establish theoretical quality. CONCLUSIONS: Reviews of theoretical frameworks used in medical education are required to inform educational practice. Review teams should make time and effort to reach a shared understanding of the term theory. Theory reviews, and reviews more widely, should add an assessment of theory application to the protocol of their review method.


Asunto(s)
Toma de Decisiones Clínicas , Educación Médica/organización & administración , Práctica Clínica Basada en la Evidencia/educación , Literatura de Revisión como Asunto , Humanos
7.
Int J Environ Res Public Health ; 12(12): 15143-53, 2015 Nov 30.
Artículo en Inglés | MEDLINE | ID: mdl-26633441

RESUMEN

BACKGROUND: The incidence of liver cancer has been increasing in Canada over the past decade, as has cyanobacterial contamination of Canadian freshwater lakes and drinking water sources. Cyanotoxins released by cyanobacteria have been implicated in the pathogenesis of liver cancer. OBJECTIVE: To determine whether a geographic association exists between liver cancer and surrogate markers of cyanobacterial contamination of freshwater lakes in Canada. METHODS: A negative binomial regression model was employed based on previously identified risk factors for liver cancer. RESULTS: No association existed between the geographic distribution of liver cancer and surrogate markers of cyanobacterial contamination. As predicted, significant associations existed in areas with a high prevalence of hepatitis B virus infection, large immigrant populations and urban residences. DISCUSSION AND CONCLUSIONS: The results of this study suggest that cyanobacterial contamination of freshwater lakes does not play an important role in the increasing incidence of liver cancer in Canada.


Asunto(s)
Toxinas Bacterianas/toxicidad , Cianobacterias/química , Lagos/microbiología , Neoplasias Hepáticas/epidemiología , Neoplasias Hepáticas/microbiología , Toxinas Marinas/toxicidad , Microcistinas/toxicidad , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Canadá/epidemiología , Emigrantes e Inmigrantes/estadística & datos numéricos , Exposición a Riesgos Ambientales , Eutrofización , Femenino , Hepatitis B/epidemiología , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Prevalencia , Análisis de Regresión , Población Rural/estadística & datos numéricos , Factores Sexuales , Población Urbana/estadística & datos numéricos
9.
Neuroepidemiology ; 43(1): 38-48, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-25323329

RESUMEN

BACKGROUND: Macroscopic geographic variation in the incidence and prevalence of MS is well-recognized. Microscopic geographic variation in the distribution of MS is also recognized, but less well-studied. Most studies have focused on prevalent cases of MS, although studies of variation in disease incidence are more relevant for developing etiologic hypotheses. We aimed to study geographic variation in the incidence of MS using three different methods. METHODS: We used population-based administrative (health claims) data to identify 2,290 incident cases of MS in the province of Manitoba, Canada from 1990 to 2006. We applied three focused cluster-detection procedures, including the circular spatial scan statistic (CSS), flexible spatial scan statistic (FSS), and Bayesian disease mapping (BYM), to the dataset. RESULTS: The CSS and FSS methods identified 30 and 26 regions as potential clusters, respectively, although the regions identified differed slightly due to the non-circular shape of some regions in Manitoba. The BYM approach identified 37 regions as potential clusters, again with some differences as compared to the other two methods. Twelve regions were identified as potential clusters by all three methods. All methods identified the western part of the city of Winnipeg as a significant cluster. Using the BYM approach, the incidence of MS was highest among areas of higher socioeconomic status. CONCLUSIONS: Two methods CSS and FSS only capture geographical variations and are not able to control for confounders at the same time which may lead to mis-identification of clusters. However, the BYM method can simultaneously identify geographical variations and control for possible confounders.


Asunto(s)
Esclerosis Múltiple/epidemiología , Adulto , Canadá/epidemiología , Análisis por Conglomerados , Femenino , Geografía Médica , Humanos , Incidencia , Masculino
10.
Artículo en Inglés | MEDLINE | ID: mdl-23984265

RESUMEN

BACKGROUND: Increased awareness of the wide spectrum of activity of vitamin D has focused interest on its role in the health of Canada's Aboriginal peoples, who bear a high burden of both infectious and chronic disease. Cutaneous vitamin D synthesis is limited at northern latitudes, and the transition from nutrient-dense traditional to nutrient-poor market foods has left many Canadian Aboriginal populations food insecure and nutritionally vulnerable. OBJECTIVE: The study was undertaken to determine the level of dietary vitamin D in a northern Canadian Aboriginal (Dené) community and to determine the primary food sources of vitamin D. DESIGN: Cross-sectional study. METHODS: Dietary vitamin D intakes of 46 adult Dené men and women were assessed using a food frequency questionnaire and compared across age, gender, season and body mass index. The adequacy of dietary vitamin D intake was assessed using the 2007 Adequate Intake (AI) and the 2011 Recommended Dietary Allowance (RDA) values for Dietary Reference Intake (DRI). RESULTS: Mean daily vitamin D intake was 271.4 IU in winter and 298.3 IU in summer. Forty percent and 47.8% of participants met the vitamin D 1997 AI values in winter and summer, respectively; this dropped to 11.1 and 13.0% in winter and summer using 2011 RDA values. Supplements, milk, and local fish were positively associated with adequate vitamin D intake. Milk and local fish were the major dietary sources of vitamin D. CONCLUSIONS: Dietary intake of vitamin D in the study population was low. Only 2 food sources, fluid milk and fish, provided the majority of dietary vitamin D. Addressing low vitamin D intake in this population requires action aimed at food insecurity present in northern Aboriginal populations.


Asunto(s)
Dieta/estadística & datos numéricos , Indios Norteamericanos/estadística & datos numéricos , Vitamina D/administración & dosificación , Adulto , Anciano , Anciano de 80 o más Años , Canadá/epidemiología , Encuestas sobre Dietas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estaciones del Año , Encuestas y Cuestionarios , Adulto Joven
11.
Am J Epidemiol ; 178(7): 1059-66, 2013 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-23897644

RESUMEN

In this study, we describe the geospatial variation in the incidence of multiple sclerosis (MS) in Manitoba, Canada, and the sociodemographic characteristics associated with MS incidence. By using administrative health data, we identified all incident cases of MS in Manitoba from 1990 to 2006 (n = 2,290) and geocoded them to 230 neighborhoods in the City of Winnipeg and 268 municipalities in rural Manitoba. Age-standardized incidence rates for 1990-2006 (combined) were calculated for each region. By using the spatial scan statistic, we identified high-rate clusters in southwestern (incidence rate ratio (IRR) = 1.48) and central Winnipeg (IRR = 1.54) and low-rate clusters in north-central Winnipeg (IRR = 0.52) and northern Manitoba (IRR = 0.48). Multivariable Poisson regression showed a positive association between MS incidence rates and socioeconomic status. Despite our finding that MS incidence varied geographically and by socioeconomic status, the low Gini coefficient of 0.152 for MS incidence identified in this study suggests that the causes of MS are pervasive across all population groups. Searching for local-level causes of the disease may therefore not be as productive as investigating etiological factors operating at the population level. This may require an examination of macro-level differences in environmental exposures between high- and low-incidence regions of the world.


Asunto(s)
Esclerosis Múltiple/epidemiología , Canadá/epidemiología , Femenino , Humanos , Incidencia , Masculino , Características de la Residencia , Análisis de Área Pequeña , Factores Socioeconómicos
12.
J R Army Med Corps ; 159(3): 240-2, 2013 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-23720504

RESUMEN

Hepatitis A virus (HAV) and hepatitis E virus (HEV) infections are endemic in most developing countries, including Nepal and Afghanistan, and may cause outbreaks in military personnel. Previously, more than 99% of new British Gurkha recruits were already immune to HAV because of prior infection, but this may be declining due to improved living conditions in their countries of origin. Acute HAV infections have occurred in Gurkha soldiers serving in Afghanistan, which made them unfit for duty for 2-3 months. In one case, early serological diagnosis was impeded by IgM results against both HAV and HEV that were caused by cross-reactivity or persistence from a previous infection. These cases have led to a policy change whereby all Gurkha recruits are now tested for previous HAV infection and if negative they are offered vaccination. Meanwhile, HEV infection remains a significant threat in Nepal and Afghanistan with low levels of background immunity and no commercially available vaccine.


Asunto(s)
Anticuerpos Antivirales/sangre , Virus de la Hepatitis A/inmunología , Hepatitis A/diagnóstico , Personal Militar , Adulto , Campaña Afgana 2001- , Hepatitis A/etnología , Hepatitis A/prevención & control , Humanos , Masculino , Nepal/etnología , Reino Unido , Adulto Joven
13.
Can Vet J ; 52(7): 753-8, 2011 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-22210939

RESUMEN

The operational logistics of mass killing of healthy, surplus piglets by manual blunt force trauma, controlled blunt force trauma, intraperitoneal injection of barbiturate, and free bullet were recorded. Objective performance variables evaluated were, speed of application, human resource and input cost, animal restraint required, and failure rate. Subjective evaluation of esthetics and difficulty of application indicated manual blunt force trauma is an unacceptable technique. Under field conditions, physical methods of killing were superior to intraperitoneal injection of concentrated pentobarbital. Considering animal welfare metrics in isolation, controlled blunt force trauma was superior to all other techniques attempted.


Asunto(s)
Adyuvantes Anestésicos/administración & dosificación , Eutanasia Animal/métodos , Pentobarbital/administración & dosificación , Porcinos , Heridas no Penetrantes/veterinaria , Crianza de Animales Domésticos/métodos , Bienestar del Animal , Animales , Animales Recién Nacidos , Inyecciones Intraperitoneales/veterinaria
14.
Can Vet J ; 51(4): 385-90, 2010 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-20592827

RESUMEN

Disease associated with Maedi-Visna infection results in substantial economic losses in affected sheep producing areas of the world. A survey was conducted to estimate herd and individual seroprevalence in the province of Manitoba and evaluate risk factors for seropositive herds. Of 2207 sheep sampled from 77 selected sheep flocks, the animal level seroprevalence was 2.47% and herd level seroprevalence was 25.10%. The herd-level factors of presence of clinical skin disease, herd size of > 70, history of musculoskeletal/lameness abnormalities, and the purchase of new stock (> 50) in the last 1 to 5 y, showed significant associations with seropositive herd status. The study documented a remarkable stability of low seroprevalence in the province over a 20-year period in the absence of a systematic disease control program.


Asunto(s)
Anticuerpos Antivirales/sangre , Neumonía Intersticial Progresiva de los Ovinos/epidemiología , Virus Visna-Maedi/inmunología , Animales , Femenino , Masculino , Manitoba/epidemiología , Densidad de Población , Factores de Riesgo , Estudios Seroepidemiológicos , Ovinos
16.
Can Vet J ; 50(8): 846-50, 2009 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-19881923

RESUMEN

The prevalence of Baylisascaris procyonis was estimated in the urban raccoon population of Winnipeg through the fecal flotation of raccoon feces collected at active latrines and through gross postmortem and fecal flotation of samples collected from nuisance raccoons. Fecal flotation of latrine-collected feces was positive in 33 of 89 samples and, of 52 latrines identified, 26 were positive on 1 or more occasions. Trapped individual raccoons subjected to postmortem examination were positive in 57 of 114 animals captured. Comparing a single fecal flotation to the gold standard of finding adult worms in the small intestine had a sensitivity of 78.9% and specificity of 92.9%. This study suggests that carriage of Baylisascaris procyonis is widespread in raccoons in the Winnipeg urban ecosystem. Raccoon latrines in Winnipeg should be treated as infectious sites and efforts should be made to limit access of pets and people at risk to those sites.


Asunto(s)
Infecciones por Ascaridida/veterinaria , Ascaridoidea , Reservorios de Enfermedades/veterinaria , Mapaches/parasitología , Animales , Infecciones por Ascaridida/epidemiología , Infecciones por Ascaridida/transmisión , Ascaridoidea/aislamiento & purificación , Reservorios de Enfermedades/parasitología , Heces/parasitología , Femenino , Masculino , Manitoba/epidemiología , Recuento de Huevos de Parásitos/veterinaria , Prevalencia , Población Urbana
17.
J Public Health (Oxf) ; 31(4): 541-5, 2009 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-19321518

RESUMEN

BACKGROUND: The National Institute for Health and Clinical Excellence (NICE) did not recommend laparoscopic surgery for colorectal cancer in 2000, but updated its guidance in 2006. We investigated the uptake of laparoscopic surgery for colorectal cancer before and after NICE guidance in 2000 and 2006. METHODS: Using hospital episode statistics (HES) data for men and women in England, the annual percentages of open and laparoscopic resections for colorectal cancer were calculated between 1997 and 2007. RESULTS: A total of 182,191 patient spells containing a diagnosis of colorectal cancer plus either a procedure code for surgical resection of the large bowel and/or a laparoscopic procedure were identified: 177,537 (97.4%) were for open resection; 4193 (2.3%) for laparoscopic surgery; and for 461 (0.3%) the procedure was unclear. The annual number of open procedures performed remained stable, whereas the numbers of laparoscopic resections increased steadily. CONCLUSIONS: Despite NICE guidance in 2000 recommending open surgery for colorectal cancer, there was a continuous increase in the laparoscopic approach in England, starting 3 years before the modified guidance supporting this technique. Whether NICE guidance was an effective deterrent and the guidelines protected patients cannot be determined from this retrospective study, but a similar staged approach for the adoption of other complex laparoscopic procedures is recommended.


Asunto(s)
Neoplasias Colorrectales/cirugía , Adhesión a Directriz , Laparoscopía/estadística & datos numéricos , Comités Consultivos , Bases de Datos como Asunto , Inglaterra , Femenino , Humanos , Laparoscopía/métodos , Masculino , Guías de Práctica Clínica como Asunto
18.
Clin Med (Lond) ; 9(6): 534-8, 2009 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-20095293

RESUMEN

By the beginning of July 2009 the West Midlands had seen more cases of novel H1N1 influenza (swine flu) than any other region in the U.K. Over a three-week period almost 850 people presented to Heartlands Hospital with flu-like symptoms. Of those admitted 52 adults were subsequently confirmed as having H1N1 infection. Most were younger than 30 and not from traditional influenza risk groups. The main risk factor for severe disease was asthma, and to a lesser extent pregnancy and obesity. Seven patients were admitted to intensive care and five developed an acute lung injury requiring prolonged admission. Two patients required extra corporeal membrane oxygenation and one died. Despite increased workload normal clinical services were unaffected. The hospital was not closed to admissions nor was it paralysed by staff absence. With a predicted second wave expected at the end of 2009, efforts to maintain effective community assessment remain crucial.


Asunto(s)
ADN Viral/análisis , Servicio de Urgencia en Hospital/estadística & datos numéricos , Control de Infecciones/métodos , Subtipo H1N1 del Virus de la Influenza A/genética , Gripe Humana/epidemiología , Admisión del Paciente/estadística & datos numéricos , Adulto , Asma/complicaciones , Asma/epidemiología , Inglaterra/epidemiología , Femenino , Humanos , Incidencia , Gripe Humana/complicaciones , Gripe Humana/virología , Masculino , Persona de Mediana Edad , Obesidad/complicaciones , Obesidad/epidemiología , Reacción en Cadena de la Polimerasa , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/virología , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Tasa de Supervivencia
19.
BMC Pregnancy Childbirth ; 8: 15, 2008 May 01.
Artículo en Inglés | MEDLINE | ID: mdl-18452623

RESUMEN

BACKGROUND: The objectives of this study were to determine rates of prenatal care utilization in Winnipeg, Manitoba, Canada from 1991 to 2000; to compare two indices of prenatal care utilization in identifying the proportion of the population receiving inadequate prenatal care; to determine the association between inadequate prenatal care and adverse pregnancy outcomes (preterm birth, low birth weight [LBW], and small-for-gestational age [SGA]), using each of the indices; and, to assess whether or not, and to what extent, gestational age modifies this association. METHODS: We conducted a population-based study of women having a hospital-based singleton live birth from 1991 to 2000 (N = 80,989). Data sources consisted of a linked mother-baby database and a physician claims file maintained by Manitoba Health. Rates of inadequate prenatal care were calculated using two indices, the R-GINDEX and the APNCU. Logistic regression analysis was used to determine the association between inadequate prenatal care and adverse pregnancy outcomes. Stratified analysis was then used to determine whether the association between inadequate prenatal care and LBW or SGA differed by gestational age. RESULTS: Rates of inadequate/no prenatal care ranged from 8.3% using APNCU to 8.9% using R-GINDEX. The association between inadequate prenatal care and preterm birth and LBW varied depending on the index used, with adjusted odds ratios (AOR) ranging from 1.0 to 1.3. In contrast, both indices revealed the same strength of association of inadequate prenatal care with SGA (AOR 1.4). Both indices demonstrated heterogeneity (non-uniformity) across gestational age strata, indicating the presence of effect modification by gestational age. CONCLUSION: Selection of a prenatal care utilization index requires careful consideration of its methodological underpinnings and limitations. The two indices compared in this study revealed different patterns of utilization of prenatal care, and should not be used interchangeably. Use of these indices to study the association between utilization of prenatal care and pregnancy outcomes affected by the duration of pregnancy should be approached cautiously.


Asunto(s)
Resultado del Embarazo/epidemiología , Atención Prenatal/estadística & datos numéricos , Adulto , Femenino , Edad Gestacional , Humanos , Recién Nacido de Bajo Peso , Recién Nacido , Modelos Logísticos , Manitoba/epidemiología , Embarazo , Nacimiento Prematuro , Atención Prenatal/normas
20.
Mol Cancer Res ; 5(11): 1191-200, 2007 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-18025262

RESUMEN

The estrogen receptor (ER), like other members of the nuclear receptor superfamily, possesses two separate transcriptional activation functions, AF-1 and AF-2. Although a variety of coactivators and corepressors of AF-2 have been identified, less is known of the mechanism of action of AF-1. We have used the yeast two-hybrid system to isolate a cDNA coding for a protein that binds specifically to the AF-1 region of human ERalpha. This cDNA codes for the transcription factor basal transcription factor 3 (BTF3). The specificity of the interaction between BTF3 and ERalpha has been confirmed in vivo and in vitro. Transient transfection experiments reveal that overexpression of BTF3 modulates the transcriptional response of reporter genes to ERalpha. BTF3 interacts with ERalpha that has been activated either by 17beta-estradiol (ligand-dependent activation) or by epidermal growth factor (ligand-independent activation). The effects of BTF3 on the reporter genes requires the presence of ERalpha containing an active AF-1 function. BTF3 may be a component of the mechanism by which the AF-1 function of ERalpha stimulates gene transcription.


Asunto(s)
Receptor alfa de Estrógeno/metabolismo , Proteínas Nucleares/metabolismo , Factores de Transcripción/metabolismo , Línea Celular Tumoral , ADN Complementario/genética , Factor de Crecimiento Epidérmico/farmacología , Estradiol/farmacología , Receptor alfa de Estrógeno/agonistas , Genes Reporteros , Humanos , Proteínas Nucleares/genética , Mapeo de Interacción de Proteínas , Estructura Terciaria de Proteína , Factores de Transcripción/genética , Transcripción Genética , Técnicas del Sistema de Dos Híbridos
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