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1.
Artigo em Inglês | MEDLINE | ID: mdl-33152181

RESUMO

OBJECTIVE: The Systemic Lupus International Collaborating Clinics (SLICC) frailty index (FI) predicts mortality and damage accrual in SLE, but its association with hospitalizations has not been described. We estimated the association of baseline SLICC-FI values with future hospitalizations in the SLICC inception cohort. METHODS: Baseline SLICC-FI scores were calculated. The number and duration of inpatient hospitalizations during follow-up were recorded. Negative binomial regression was used to estimate the association between baseline SLICC-FI values and the rate of hospitalizations per patient-year of follow-up. Linear regression was used to estimate the association of baseline SLICC-FI scores with the proportion of follow-up time spent in hospital. Multivariable models were adjusted for relevant baseline characteristics. RESULTS: The 1549 SLE patients eligible for this analysis were mostly female (88.7%) with mean (SD) age 35.7 (13.3) years and median (IQR) disease duration 1.2 (0.9-1.5) years at baseline. Mean (SD) baseline SLICC-FI was 0.17 (0.08). During mean (SD) follow-up of 7.2 (3.7) years, 614 patients (39.6%) experienced 1570 hospitalizations. Higher baseline SLICC-FI values (per 0.05 increment) were associated with more frequent hospitalizations during follow-up (Incidence Rate Ratio 1.21; 95%CI 1.13-1.30), adjusting for baseline age, sex, corticosteroid use, immunosuppressive use, ethnicity/location, SLE disease activity index 2000 (SLEDAI-2K), SLICC/ACR damage index (SDI), and disease duration. Among patients with ≥1 hospitalization, higher baseline SLICC-FI values predicted a greater proportion of follow-up time spent hospitalized (Relative Rate 1.09; 95%CI 1.02-1.16). CONCLUSION: The SLICC-FI predicts future hospitalizations among incident SLE patients, further supporting the SLICC-FI as a valid health measure in SLE.

2.
Arthritis Rheumatol ; 72(4): 658-666, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31631584

RESUMO

OBJECTIVE: The Systemic Lupus International Collaborating Clinics (SLICC) frailty index (FI) has been shown to predict mortality, but its association with other important outcomes is unknown. We examined the association of baseline SLICC FI values with damage accrual in the SLICC inception cohort. METHODS: The baseline visit was defined as the first visit at which both organ damage (SLICC/American College of Rheumatology Damage Index [SDI]) and health-related quality of life (Short Form 36) were assessed. Baseline SLICC FI scores were calculated. Damage accrual was measured by the increase in SDI between the baseline assessment and the last study visit. Multivariable negative binomial regression was used to estimate the association between baseline SLICC FI values and the rate of increase in the SDI during follow-up, adjusting for relevant demographic and clinical characteristics. RESULTS: The 1,549 systemic lupus erythematosus (SLE) patients eligible for this analysis were mostly female (88.7%) with a mean ± SD age of 35.7 ± 13.3 years and a median disease duration of 1.2 years (interquartile range 0.9-1.5 years) at baseline. The mean ± SD baseline SLICC FI was 0.17 ± 0.08. Over a mean ± SD follow-up of 7.2 ± 3.7 years, 653 patients (42.2%) had an increase in SDI. Higher baseline SLICC FI values (per 0.05 increase) were associated with higher rates of increase in the SDI during follow-up (incidence rate ratio [IRR] 1.19 [95% confidence interval 1.13-1.25]), after adjusting for age, sex, ethnicity/region, education, baseline SLE Disease Activity Index 2000, baseline SDI, and baseline use of glucocorticoids, antimalarials, and immunosuppressive agents. CONCLUSION: Our findings indicate that the SLICC FI predicts damage accrual in incident SLE, which further supports the SLICC FI as a valid health measure in SLE.


Assuntos
Fragilidade/diagnóstico , Lúpus Eritematoso Sistêmico/diagnóstico , Qualidade de Vida , Adulto , Progressão da Doença , Feminino , Humanos , Imunossupressores/uso terapêutico , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Adulto Jovem
3.
J Rheumatol ; 47(1): 72-81, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-30988130

RESUMO

OBJECTIVE: To construct a Frailty Index (FI) as a measure of vulnerability to adverse outcomes among patients with systemic lupus erythematosus (SLE), using data from the Systemic Lupus International Collaborating Clinics (SLICC) inception cohort. METHODS: The SLICC inception cohort consists of recently diagnosed patients with SLE followed annually with clinical and laboratory assessments. For this analysis, the baseline visit was defined as the first study visit at which sufficient information was available for construction of an FI. Following a standard procedure, variables from the SLICC database were evaluated as potential health deficits. Selected health deficits were then used to generate a SLICC-FI. The prevalence of frailty in the baseline dataset was evaluated using established cutpoints for FI values. RESULTS: The 1683 patients with SLE (92.1% of the overall cohort) eligible for inclusion in the baseline dataset were mostly female (89%) with mean (SD) age 35.7 (13.4) years and mean (SD) disease duration 18.8 (15.7) months at baseline. Of 222 variables, 48 met criteria for inclusion in the SLICC-FI. Mean (SD) SLICC-FI was 0.17 (0.08) with a range from 0 to 0.51. At baseline, 27.1% (95% CI 25.0-29.2) of patients were classified as frail, based on SLICC-FI values > 0.21. CONCLUSION: The SLICC inception cohort permits feasible construction of an FI for use in patients with SLE. Even in a relatively young cohort of patients with SLE, frailty was common. The SLICC-FI may be a useful tool for identifying patients with SLE who are most vulnerable to adverse outcomes, but validation of this index is required prior to its use.

4.
Traffic Inj Prev ; 20(8): 771-776, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31647336

RESUMO

Objectives: To determine (1) whether the implementation of vehicle impoundment as part of provincial short-term administrative driver licensing suspension (ADLS) programs significantly reduced total and alcohol-related collision fatalities, and (2) if provinces with vehicle impoundment as part of their short-term ADLS programs see greater reductions in total and alcohol-related fatal collisions when compared to provinces without a vehicle impoundment law.Methods: Data on monthly total and alcohol-related fatal collisions from January 2005 to December 2016 are drawn from British Columbia (BC), Alberta (AB), Saskatchewan (SK), Manitoba (MB) and Ontario (ON). Changepoint time series analysis of fatal crashes is employed to detect within-province differences after implementing short-term impoundment programs, and between province differences comparing provinces with short-term impoundment programs (BC, introduced October 2010; AB, introduced July 2012; and SK, introduced July 2014) and those without (ON and MB). Outcome measures are the monthly per capita total and alcohol-related fatal collisions.Results: A significant reduction in per-capita alcohol-related fatal crashes was observed in British Columbia (-47.4%) in the period following the adoption of vehicle impoundment in their short-term ADLS. A significant decrease was also observed in Alberta (-37.5%), though this trend began prior to policy change; no significant effect was observed in per capita alcohol-related fatal crashes rates in Saskatchewan (-6.1%) in the two years following the introduction of vehicle impoundment. Ontario and Manitoba, two provinces without mandatory vehicle impoundment laws, also experienced significant reductions in per-capita alcohol-related fatal crashes between 2005 and 2016 (-36.4% and -35%, respectively).Conclusions: While mandatory vehicle impoundment programs for driving in the "warn" range (0.05%-0.08% BAC) have shown success in reducing fatal crashes in British Columbia, similar reductions in two other provinces with short-term vehicle impoundment were not observed. Moreover, large reductions in fatal crashes were observed in two provinces without vehicle impoundment as part of their short-term ADLS programs. Collectively, these findings suggest that vehicle impoundment, alone, has limited impact on fatal crash rates and that other factors help to explain the observed trends. Further analysis of new vehicle impoundment programs is warranted.


Assuntos
Acidentes de Trânsito/legislação & jurisprudência , Acidentes de Trânsito/prevenção & controle , Consumo de Bebidas Alcoólicas/legislação & jurisprudência , Dirigir sob a Influência/legislação & jurisprudência , Aplicação da Lei , Acidentes de Trânsito/mortalidade , Alberta , Colúmbia Britânica , Etanol , Humanos , Licenciamento , Manitoba , Ontário , Saskatchewan
5.
Pediatr Infect Dis J ; 38(11): 1121-1125, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31425330

RESUMO

BACKGROUND: Respiratory syncytial virus (RSV) is the leading cause of viral lower respiratory tract infections in infants. Preterm infants are at increased risk for hospitalization with RSV (RSV-H), but there are few data on the relationship between RSV-H and asthma in preterm infants, or any data stratified by gestational age, and most studies have short follow-up periods. We sought to evaluate the relationship between serious RSV illness and onset of asthma up to 5 years of age in a cohort of preterm children and to quantify this association. METHODS: A retrospective birth cohort of preterm infants (29 weeks 0 days to 35 weeks 6 days gestational age) was constructed from a provincial population-based database, and children were followed forward for 5 years. Incidence rates of RSV-H and asthma were determined. In a Cox proportional hazards model, controlled for putative confounding factors for asthma, the hazard ratio and 95% CI of asthma in children with and without RSV-H was evaluated. RESULTS: Among 3916 premature children, the incidence rate of RSV-H was 25/1000 infants. The cumulative incidence rate of asthma at 5 years of age in children with RSV-H was 57.9/1000 person-years compared with 36.7 in those without RSV-H; the adjusted hazards ratio for asthma in RSV-H infants was elevated at 1.58 (95% CI: 1.03-2.41). CONCLUSIONS: In prematurely born children, there is a moderate association between severe RSV infection, as measured by RSV-H in the first year of life, and asthma up to 5 years of age.


Assuntos
Asma/virologia , Transtornos de Início Tardio/virologia , Infecções por Vírus Respiratório Sincicial/complicações , Asma/diagnóstico , Pré-Escolar , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Vírus Sincicial Respiratório Humano/patogenicidade , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida
6.
Arthritis Rheumatol ; 71(8): 1297-1307, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30771242

RESUMO

OBJECTIVE: To evaluate the properties of a frailty index (FI), constructed using data from the Systemic Lupus International Collaborating Clinics (SLICC) inception cohort, as a novel health measure in systemic lupus erythematosus (SLE). METHODS: For this secondary analysis, the baseline visit was defined as the first study visit at which both organ damage (SLICC/American College of Rheumatology Damage Index [SDI]) and health-related quality of life (Short-Form 36 [SF-36] scores) were assessed. The SLICC-FI was constructed using baseline data. The SLICC-FI comprises 48 health deficits, including items related to organ damage, disease activity, comorbidities, and functional status. Content, construct, and criterion validity of the SLICC-FI were assessed. Multivariable Cox regression was used to estimate the association between baseline SLICC-FI values and mortality risk, adjusting for demographic and clinical factors. RESULTS: In the baseline data set of 1,683 patients with SLE, 89% were female, the mean ± SD age was 35.7 ± 13.4 years, and the mean ± SD disease duration was 18.8 ± 15.7 months. At baseline, the mean ± SD SLICC-FI score was 0.17 ± 0.08 (range 0-0.51). Baseline SLICC-FI values exhibited the expected measurement properties and were weakly correlated with baseline SDI scores (r = 0.26, P < 0.0001). Higher baseline SLICC-FI values (per 0.05 increment) were associated with increased mortality risk (hazard ratio 1.59, 95% confidence interval 1.35-1.87), after adjusting for age, sex, steroid use, ethnicity/region, and baseline SDI scores. CONCLUSION: The SLICC-FI demonstrates internal validity as a health measure in SLE and might be used to predict future mortality risk. The SLICC-FI is potentially valuable for quantifying vulnerability among patients with SLE, and adds to existing prognostic scores.


Assuntos
Fragilidade/mortalidade , Lúpus Eritematoso Sistêmico/mortalidade , Medição de Risco/métodos , Índice de Gravidade de Doença , Adulto , Idoso , Feminino , Fragilidade/complicações , Humanos , Lúpus Eritematoso Sistêmico/complicações , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Qualidade de Vida , Reprodutibilidade dos Testes , Fatores de Risco
7.
J Interpers Violence ; 34(21-22): 4597-4619, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-27807204

RESUMO

Sexual victimization and depression are common on university campuses, especially among females. Both are associated with negative health outcomes and efforts are made to minimize these as much as possible on university campuses. The current study examines the prevalence of, and independent association between, non-consensual sex and current risk of depression after controlling for related factors. The primary study question is as follows: Are female undergraduate students who have been sexually victimized while attending university at an increased risk of depression compared with those who have not been victimized? Cross-sectional data collected online from female students below the age of 30 at eight universities in Maritime Canada were analyzed. Non-consensual sex while at university was measured using one dichotomous item and current risk of depression was measured using the validated Center for Epidemiologic Studies Depression (CES-D) Scale. All analyses were weighted and data were imputed using the sequential regression multiple imputation (SRMI) method. Analyses involved basic descriptive statistics, a series of unadjusted logistic regressions, and an adjusted multiple logistic regression. A total of 36.7% of female undergraduate students were found to be at risk of depression and 6.8% have been victim of non-consensual sex while attending university. After adjusting for covariates, females who were victimized were 2.11 times more likely to be at risk of depression than females who were not victimized (p < .0001). This study points to the possible unmet need for more mental health support for victims of sexual victimization and more efforts to prevent sexual violence on Canadian campuses. These findings can help to inform university mental health services such as mental health support for victims of sexual assault and can also be used to inform prevention and health promotion activities.


Assuntos
Vítimas de Crime/psicologia , Depressão/psicologia , Delitos Sexuais/psicologia , Comportamento Sexual/psicologia , Adolescente , Adulto , Canadá , Vítimas de Crime/estatística & dados numéricos , Estudos Transversais , Depressão/epidemiologia , Feminino , Humanos , Masculino , Saúde Mental/estatística & dados numéricos , Prevalência , Delitos Sexuais/estatística & dados numéricos , Comportamento Sexual/estatística & dados numéricos , Estudantes/psicologia , Universidades , Adulto Jovem
8.
JMIR Res Protoc ; 7(3): e76, 2018 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-29581089

RESUMO

BACKGROUND: Up to 25% of 1- to 10-year-old children experience insomnia (ie, resisting bedtime, trouble falling asleep, night awakenings, and waking too early in the morning). Insomnia can be associated with excessive daytime sleepiness and negative effects on daytime functioning across multiple domains (eg, behavior, mood, attention, and learning). Despite robust evidence supporting the effectiveness of behavioral treatments for insomnia in children, very few children with insomnia receive these treatments, primarily due to a shortage of available treatment resources. OBJECTIVE: The Better Nights, Better Days (BNBD) internet-based program provides a readily accessible electronic health (eHealth) intervention to support parents in providing evidence-based care for insomnia in typically developing children. The purpose of the randomized controlled trial (RCT) is to evaluate the effectiveness of BNBD in treating insomnia in children aged between 1 and 10 years. METHODS: BNBD is a fully automated program, developed based on evidence-based interventions previously tested by the investigators, as well as on the extant literature on this topic. We describe the 2-arm RCT in which participants (500 primary caregivers of children with insomnia residing in Canada) are assigned to intervention or usual care. RESULTS: The effects of this behavioral sleep eHealth intervention will be assessed at 4 and 8 months postrandomization. Assessment includes both sleep (actigraphy, sleep diary) and daytime functioning of the children and daytime functioning of their parents. Results will be reported using the standards set out in the Consolidated Standards of Reporting Trials statement. CONCLUSIONS: If the intervention is supported by the results of the RCT, we plan to commercialize this program so that it is sustainable and available at a low cost to all families with internet access. TRIAL REGISTRATION: ClinicalTrials.gov NCT02243501; https://clinicaltrials.gov/show/NCT02243501 (Archived by WebCite at http://www.webcitation.org/6x8Z5pBui).

9.
N Engl J Med ; 378(8): 699-707, 2018 02 22.
Artigo em Inglês | MEDLINE | ID: mdl-29466159

RESUMO

BACKGROUND: Clinical trials and meta-analyses have suggested that aspirin may be effective for the prevention of venous thromboembolism (proximal deep-vein thrombosis or pulmonary embolism) after total hip or total knee arthroplasty, but comparisons with direct oral anticoagulants are lacking for prophylaxis beyond hospital discharge. METHODS: We performed a multicenter, double-blind, randomized, controlled trial involving patients who were undergoing total hip or knee arthroplasty. All the patients received once-daily oral rivaroxaban (10 mg) until postoperative day 5 and then were randomly assigned to continue rivaroxaban or switch to aspirin (81 mg daily) for an additional 9 days after total knee arthroplasty or for 30 days after total hip arthroplasty. Patients were followed for 90 days for symptomatic venous thromboembolism (the primary effectiveness outcome) and bleeding complications, including major or clinically relevant nonmajor bleeding (the primary safety outcome). RESULTS: A total of 3424 patients (1804 undergoing total hip arthroplasty and 1620 undergoing total knee arthroplasty) were enrolled in the trial. Venous thromboembolism occurred in 11 of 1707 patients (0.64%) in the aspirin group and in 12 of 1717 patients (0.70%) in the rivaroxaban group (difference, 0.06 percentage points; 95% confidence interval [CI], -0.55 to 0.66; P<0.001 for noninferiority and P=0.84 for superiority). Major bleeding complications occurred in 8 patients (0.47%) in the aspirin group and in 5 (0.29%) in the rivaroxaban group (difference, 0.18 percentage points; 95% CI, -0.65 to 0.29; P=0.42). Clinically important bleeding occurred in 22 patients (1.29%) in the aspirin group and in 17 (0.99%) in the rivaroxaban group (difference, 0.30 percentage points; 95% CI, -1.07 to 0.47; P=0.43). CONCLUSIONS: Among patients who received 5 days of rivaroxaban prophylaxis after total hip or total knee arthroplasty, extended prophylaxis with aspirin was not significantly different from rivaroxaban in the prevention of symptomatic venous thromboembolism. (Funded by the Canadian Institutes of Health Research; ClinicalTrials.gov number, NCT01720108 .).


Assuntos
Artroplastia de Quadril , Artroplastia do Joelho , Aspirina/uso terapêutico , Inibidores do Fator Xa/uso terapêutico , Inibidores da Agregação de Plaquetas/uso terapêutico , Complicações Pós-Operatórias/prevenção & controle , Rivaroxabana/uso terapêutico , Tromboembolia Venosa/prevenção & controle , Idoso , Aspirina/efeitos adversos , Método Duplo-Cego , Inibidores do Fator Xa/efeitos adversos , Hemorragia/induzido quimicamente , Humanos , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação de Plaquetas/efeitos adversos , Fatores de Risco , Rivaroxabana/efeitos adversos
10.
Environ Sci Pollut Res Int ; 24(25): 20685-20698, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28712086

RESUMO

Air toxics are airborne pollutants known or suspected to cause cancer or other serious health effects, including certain volatile organic compounds (VOCs), prioritized by the US Environmental Protection Agency (EPA). While several EPA-designated air toxics are monitored at a subset of Canadian National Air Pollution Surveillance (NAPS) sites, Canada has no specific "air toxics" control priorities. Although pulp and paper (P&P) mills are major industrial emitters of air pollutants, few studies quantified the spectrum of air quality exposures. Moreover, most NAPS monitoring sites are in urban centers; in contrast, rural NAPS sites are sparse with few exposure risk records. The objective of this pilot study was to investigate prioritized air toxic ambient VOC concentrations using NAPS hourly emissions data from a rural Pictou, Nova Scotia Kraft P&P town to document concentration levels, and to determine whether these concentrations correlated with wind direction at the NAPS site (located southwest of the mill). Publicly accessible Environment and Climate Change Canada data (VOC concentrations [Granton NAPS ID: 31201] and local meteorological conditions [Caribou Point]) were examined using temporal (2006-2013) and spatial analytic methods. Results revealed several VOCs (1,3-butadiene, benzene, and carbon tetrachloride) routinely exceeded EPA air toxics-associated cancer risk thresholds. 1,3-Butadiene and tetrachloroethylene were significantly higher (p < 0.05) when prevailing wind direction blew from the northeast and the mill towards the NAPS site. Conversely, when prevailing winds originated from the southwest towards the mill, higher median VOC air toxics concentrations at the NAPS site, except carbon tetrachloride, were not observed. Despite study limitations, this is one of few investigations documenting elevated concentrations of certain VOCs air toxics to be associated with P&P emissions in a community. Findings support the need for more research on the extent to which air toxics emissions exist in P&P towns and contribute to poor health in nearby communities.


Assuntos
Poluentes Atmosféricos/análise , Poluição do Ar/análise , Monitoramento Ambiental , Compostos Orgânicos Voláteis/análise , Vento , Nova Escócia , Projetos Piloto
11.
Can J Public Health ; 107(2): e149-e154, 2016 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-27526211

RESUMO

OBJECTIVES: Individuals aged 15-29 years have the highest rates of diagnosed sexually transmitted infection (STI), and in Canada routine STI testing is recommended for sexually active individuals under 25 years of age. Despite its being readily available to most Canadian university students, testing is not accessed by all sexually active students. This study examines correlates of STI testing among sexually active heterosexual university students. Specifically, we sought to determine: i) the lifetime incidence of STI testing overall and stratified by biological sex; ii) whether those most at risk of STI are being tested; and iii) which other characteristics are associated with ever having been tested for STI. METHODS: A cross-sectional survey of undergraduate students at eight universities in Maritime Canada was carried out in 2012, gathering information on student demographic characteristics, sexual behaviours and use of sexual health services. We conducted a sex-stratified descriptive analysis of each covariate and of STI testing at three levels of STI risk. We then performed multiple logistic regressions to determine the factors associated with lifetime STI testing. RESULTS: Only 34% of the study population and 51% of those at higher risk of STI acquisition had ever been tested for STI. Individuals at moderate or higher risk of STI were more likely to be tested than those at lower risk. In both sexes, older students, those who reported experiencing non-consensual sex while enrolled at university and those with more sexual health knowledge were more likely to be tested. Higher perceived risk was associated with STI testing only among females. CONCLUSIONS: Individuals at higher risk of STI acquisition are more likely to be tested; however, STI testing rates are low in this sample. Health promotion with campaigns designed to increase general sexual health knowledge may be more effective in increasing testing when targeting younger students.


Assuntos
Heterossexualidade/psicologia , Programas de Rastreamento/estatística & dados numéricos , Assunção de Riscos , Comportamento Sexual/psicologia , Doenças Sexualmente Transmissíveis/diagnóstico , Estudantes/psicologia , Adolescente , Adulto , Canadá , Estudos Transversais , Feminino , Heterossexualidade/estatística & dados numéricos , Humanos , Masculino , Estudantes/estatística & dados numéricos , Universidades , Adulto Jovem
12.
J Sleep Res ; 25(5): 524-533, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-27140929

RESUMO

This study sought to: (1) compare actigraphy-derived estimated sleep variables to the same variables based on the gold-standard of sleep assessment, polysomnography; (2) examine whether the correlations between the measures differ between children with attention-deficit/hyperactivity disorder and typically developing children; and (3) determine whether these correlations are altered when children with attention-deficit/hyperactivity disorder are treated with medication. Participants (24 attention-deficit/hyperactivity disorder; 24 typically developing), aged 6-12 years, completed a 1-week baseline assessment of typical sleep and daytime functioning. Following the baseline week, participants in the attention-deficit/hyperactivity disorder group completed a 4-week blinded randomized control trial of methylphenidate hydrochloride, including a 2-week placebo and 2-week methylphenidate hydrochloride treatment period. At the end of each observation (typically developing: baseline; attention-deficit/hyperactivity disorder: baseline, placebo and methylphenidate hydrochloride treatment), all participants were invited to a sleep research laboratory, where overnight polysomnography and actigraphy were recorded concurrently. Findings from intra-class correlations and Bland-Altman plots were consistent. Actigraphy was found to provide good estimates (e.g. intra-class correlations >0.61) of polysomnography results for sleep duration for all groups and conditions, as well as for sleep-onset latency and sleep efficiency for the typically developing group and attention-deficit/hyperactivity disorder group while on medication, but not for the attention-deficit/hyperactivity disorder group during baseline or placebo. Based on the Bland-Altman plots, actigraphy tended to underestimate for sleep duration (8.6-18.5 min), sleep efficiency (5.6-9.3%) and sleep-onset latency, except for attention-deficit/hyperactivity disorder during placebo in which actigraphy overestimated (-2.1 to 6.3 min). The results of the current study highlight the importance of utilizing a multimodal approach to sleep assessment in children with attention-deficit/hyperactivity disorder.


Assuntos
Actigrafia , Transtorno do Deficit de Atenção com Hiperatividade/fisiopatologia , Polissonografia , Atenção/efeitos dos fármacos , Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Estimulantes do Sistema Nervoso Central/farmacologia , Estimulantes do Sistema Nervoso Central/uso terapêutico , Criança , Feminino , Humanos , Masculino , Metilfenidato/farmacologia , Metilfenidato/uso terapêutico , Reprodutibilidade dos Testes , Sono/efeitos dos fármacos , Fatores de Tempo
13.
Pediatr Infect Dis J ; 35(8): 851-5, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-27124687

RESUMO

BACKGROUND: Prophylaxis against respiratory syncytial virus-associated hospitalization (RSV-H) with anti-RSV monoclonal antibody is not considered cost-effective for routine use in most jurisdictions. The aim of this study was to develop a scoring tool to estimate local risk of RSV-H in the first year of life among moderately premature infants to assist in prophylaxis decision making. METHODS: A retrospective cohort was constructed from population-based databases in Nova Scotia, Canada, to follow 32- to 35-week gestation infants from the prenatal period to <12 months of age, from 1998 to 2008. Potential risk factors were entered into the logistic regression model, where the dependent variable was RSV-H. Receiver operator characteristic analysis demonstrated cutoff scores producing the highest predictive accuracy, and the likelihood ratio test was used to select the final set of variables for the predictive tool. RESULTS: In 2811 eligible infants, the overall RSV-H rate was 3.1% (88/2811). Of 17 variables considered, 3 were used to create the scoring tool: birth during December to February, household smoke exposure and household crowding. The positive likelihood ratios of predictive tool scores for high, moderate and low of RSV-H were 3.57, 3.38 and 1.95, whereas posttest probabilities (risk of RSV-H) were 11.4%, 10.8% and 1.6%, respectively. CONCLUSIONS: While able to predict infants at low risk of RSV-H, the tool did not discriminate high from moderate risk infants. The tool could be used in anticipatory care to help educate families about reducing risk of serious RSV illness in their newborn.


Assuntos
Hospitalização/estatística & dados numéricos , Recém-Nascido Prematuro , Infecções por Vírus Respiratório Sincicial/epidemiologia , Vírus Sincicial Respiratório Humano , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Valor Preditivo dos Testes , Curva ROC , Estudos Retrospectivos , Fatores de Risco
14.
Arch Gerontol Geriatr ; 60(3): 464-70, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25697060

RESUMO

The two most commonly employed frailty measures are the frailty phenotype and the frailty index. We compared them to examine whether they demonstrated common characteristics of frailty scales, and to examine their association with adverse health measures including disability, self-reported health, and healthcare utilization. The study examined adults aged 50+ (n=4096) from a sequential, cross-sectional sample (2003-2004; 2005-2006), National Health and Nutrition Examination Survey. The frailty phenotype was modified from a previously adapted version and a 46-item frailty index was created following a standard protocol. Both measures demonstrated a right-skewed distribution, higher levels of frailty in women, exponential increase with age and associations with high healthcare utilization and poor self-reported health. More people classified as frail by the modified phenotype had ADL disability (97.8%) compared with the frailty index (56.6%) and similarly for IADL disability (95% vs. 85.6%). The prevalence of frailty was 3.6% using the modified frailty phenotype and 34% using the frailty index. Frailty index scores in those who were classified as robust by the modified phenotype were still significantly associated with poor self-reported health and high healthcare utilization. The frailty index and the modified frailty phenotype each confirmed previously established characteristics of frailty scales. The agreement between frailty and disability was high with each measure, suggesting that frailty is not simply a pre-disability stage. Overall, the frailty index classified more people as frail, and suggested that it may have the ability to discriminate better at the lower to middle end of the frailty continuum.


Assuntos
Avaliação da Deficiência , Pessoas com Deficiência/estatística & dados numéricos , Idoso Fragilizado/estatística & dados numéricos , Inquéritos Nutricionais , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fenótipo , Estudos Retrospectivos , Estados Unidos
15.
Maturitas ; 80(2): 187-91, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25542406

RESUMO

OBJECTIVES: (1) To examine how sedentary behaviour and moderate-vigorous (MVPA) are each experienced during the day across different levels of frailty; (2) estimate and compare the extent to which high levels of sedentary behaviour and low levels of MVPA are associated with increased frailty and self-reported health, disability and healthcare utilization. METHODS: Community dwelling adults aged 50+ from the National Health and Nutrition Examination Survey (2003-2004; 2005-2006). Frailty was measured with the frailty index and physical activity was measured using ActiGraph accelerometers. RESULTS: On average, people engaged in about 8.5h of sedentary behaviour each day. The most frail individuals were more sedentary and less likely to meet weekly MVPA guidelines (9.57 h/day; 8.3%) than non-frail individuals (8.18 h/day; 1.1%; p<0.001). Frail individuals failed to demonstrate the patterns of the healthier individuals-higher levels of sedentary behaviour on Sundays and in the evenings and decreasing MVPA throughout the week. High sedentary behaviour and low MVPA were independently associated with higher levels of frailty, poor self-reported health, high ADL disability and higher healthcare usage. CONCLUSIONS: Many people over the age of 50, and most of those who are frail, were highly sedentary with very few meeting the recommended weekly levels of MVPA. Sedentary behaviour and MVPA were independently associated with frailty and adverse health outcomes in middle to older aged adults. Future research should focus on a longitudinal study to determine the temporal relationship between sedentary behaviour and frailty.


Assuntos
Atividades Cotidianas , Exercício Físico , Idoso Fragilizado , Serviços de Saúde/estatística & dados numéricos , Atividade Motora , Comportamento Sedentário , Acelerometria , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Estudos Transversais , Feminino , Humanos , Vida Independente , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Autorrelato
16.
PLoS One ; 9(10): e105123, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25329469

RESUMO

INTRODUCTION: Multiple sclerosis (MS) is a chronic disease of the central nervous system. Estimates of MS natural history (NH) disability progression speed from clinical observations vary worldwide. This may reflect, in part, variance in censoring-bias) (missing observations) and assumptions about when irreversible disability progression events occurred. We test whether estimates of progression speed which assume midpoint survival time at irreversible disability endpoints are significantly faster than estimates which assume maximum survival time, and are more stable across study groups and time periods. METHODS: Our Nova Scotia NH study population includes 2,240 definite relapsing-onset multiple sclerosis (R-MS) natural history patients with 18,078 Expanded Disability Status Scale (EDSS) clinical observations in study period 1979-2010. Progression speed is measured by rate-of-change in range EDSS 0-6 and by survival time at irreversible endpoints EDSS 1-9. Midpoint censoring-bias-reduction methods are applied to clinical observations. FINDINGS: Typical EDSS increase per year in range EDSS 0-6, assuming midpoint survival time, is estimated to be 0.168 for all R-MS, 0.204 for eventually-DMD-treated patients and 0.155 for never-DMD-treated patients. Estimates assuming midpoint rather than maximum survival time are significantly faster: 16% faster for all R-MS natural history patients, 6% faster for eventually-DMD-treated patients, and 21% faster for never-DMD-treated patients. The variability of estimates across study groups and time periods decreased when midpoint survival time was assumed. CONCLUSIONS: Estimates of typical disease progression speed from 1979-2010 Nova Scotia clinical observations are sensitive to censoring-bias and to analysts' survival time assumptions. Censoring-bias-adjusted estimates of typical natural history disability progression speed in relapsing-onset multiple sclerosis patients are significantly faster, and less variable within and across study groups and time periods, than unadjusted estimates, and are, arguably, more relevant for various stakeholders. The application of censoring-bias-reduction methods to other multiple sclerosis clinical databases may reduce variability in estimates of disability progression speed worldwide.


Assuntos
Avaliação da Deficiência , Esclerose Múltipla/diagnóstico , Progressão da Doença , Humanos , Esclerose Múltipla/epidemiologia , Esclerose Múltipla/patologia , Nova Escócia
17.
Can J Anaesth ; 61(6): 551-7, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24668315

RESUMO

PURPOSE: Acute pain after open abdominal hysterectomy limits the function of patients in the postoperative period, but data regarding the analgesic efficacy of a low dose of pregabalin (75 or 150 mg) have been conflicting. This study was performed to determine if a low dose of pregabalin could decrease postoperative opioid use following abdominal hysterectomy when compared with placebo. METHODS: American Society of Anesthesiologists I-II patients older than 18 yr and scheduled for open elective abdominal hysterectomy were recruited for participation and randomized to one of three groups: pregabalin 75 mg (P75), pregabalin 150 mg (P150), or placebo. The study drug was administered two hours prior to surgery and 12 hr following the initial dose. Anesthetic technique and postoperative analgesia were standardized. Postoperative pain was managed using patient-controlled analgesia with morphine. Pain at rest and movement as well as nausea were assessed with an 11-point numeric rating scale. RESULTS: One hundred and one patients were recruited, and 89 patients completed the study. Mean (SD) cumulative morphine consumption at 24 hr postoperatively was 54.0 (26.2) mg for the placebo group, 53.1 (22.7) mg for the P75 group, and 44.3 (20.9) mg for the P150 group. Independent Student's t tests indicated no difference between the placebo group and either the P75 group (95% confidence interval [CI]: -11.75 to 13.44; P = 0.8937) or the P150 group (95% CI: -2.74 to 22.15; P = 0.1238). CONCLUSIONS: At the doses used in this study, pregabalin treatment may not be effective in reducing opioid use up to 24 hr postoperatively following abdominal hysterectomy. This trial was registered at www.ClinicalTrials.gov : NCT00781131.


Assuntos
Analgésicos/uso terapêutico , Histerectomia/métodos , Dor Pós-Operatória/tratamento farmacológico , Ácido gama-Aminobutírico/análogos & derivados , Dor Aguda/tratamento farmacológico , Dor Aguda/etiologia , Adulto , Analgesia Controlada pelo Paciente/métodos , Analgésicos/administração & dosagem , Analgésicos Opioides/administração & dosagem , Relação Dose-Resposta a Droga , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Morfina/administração & dosagem , Pregabalina , Ácido gama-Aminobutírico/administração & dosagem , Ácido gama-Aminobutírico/uso terapêutico
18.
BMC Public Health ; 14: 162, 2014 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-24524307

RESUMO

BACKGROUND: Although efforts have been made to articulate rural-urban health inequalities in recent years, results have been inconsistent due to different geographical scales used in these studies. Small-area level investigations of health inequalities will likely show more detailed pictures of health inequalities among diverse rural communities, but they are difficult to conduct, particularly in a small population region. The objectives of this study were: 1) to compare life expectancy at birth for females and males across small-areas classified by locally defined settlement types for a small province in Canada; 2) to assess whether any of the settlement types explains variations in life expectancy over and above the extent of socioeconomic disadvantage and social isolation; and 3) to examine variations in life expectancies within a (larger) area unit used as the basis of health inequality investigations in previous studies. METHODS: Seven settlement types were determined for the 'community' units based on population per-kilometre-road density and settlement forms. Mean life expectancies at birth for both genders were compared by settlement type, both for the entire province and within the Halifax Regional Municipality--the province's only census designated metropolitan area, but also contains rural settlements. Linear regression analyses were conducted to assess the statistical associations between life expectancy and the settlement types, adjusting for indicators of community-level deprivation. RESULTS: While types of communities considered as 'rural' generally had lower life expectancy for both genders, the effects of living in any settlement type were attenuated once adjusted for socioeconomic deprivation and social isolation. An exception was the village and settlement cluster type, which had additionally negative effects on health for females. There were some variations observed within the Halifax Regional Municipality, suggesting the importance of further investigating a variety of health and disease outcomes at smaller area-levels than those employed in previous studies. CONCLUSIONS: This paper highlighted the importance of further articulating the differences in the characteristics of rural at finer area-levels and the differential influence they may have on health. Further efforts are desirable to overcome various data challenges in order to extend the investigation of health inequalities to hard-to-study provinces.


Assuntos
Disparidades nos Níveis de Saúde , Expectativa de Vida , População Rural , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Modelos Lineares , Masculino , Nova Escócia/epidemiologia , Serviços de Saúde Rural
19.
PLoS One ; 8(9): e73990, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24040139

RESUMO

The use of standardised tools is an essential component of evidence-based practice. Reliance on standardised tools places demands on clinicians to understand their properties, strengths, and weaknesses, in order to interpret results and make clinical decisions. This paper makes a case for clinicians to consider measurement error (ME) indices Coefficient of Repeatability (CR) or the Smallest Real Difference (SRD) over relative reliability coefficients like the Pearson's (r) and the Intraclass Correlation Coefficient (ICC), while selecting tools to measure change and inferring change as true. The authors present statistical methods that are part of the current approach to evaluate test-retest reliability of assessment tools and outcome measurements. Selected examples from a previous test-retest study are used to elucidate the added advantages of knowledge of the ME of an assessment tool in clinical decision making. The CR is computed in the same units as the assessment tool and sets the boundary of the minimal detectable true change that can be measured by the tool.


Assuntos
Medicina Baseada em Evidências/normas , Reprodutibilidade dos Testes , Assertividade , Criança , Empatia , Feminino , Humanos , Masculino , Modelos Teóricos
20.
PLoS One ; 8(9): e73924, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24040116

RESUMO

The social skills rating system (SSRS) is used to assess social skills and competence in children and adolescents. While its characteristics based on United States samples (US) are published, corresponding Australian figures are unavailable. Using a 4-week retest design, we examined the internal consistency, retest reliability and measurement error (ME) of the SSRS secondary student form (SSF) in a sample of Year 7 students (N = 187), from five randomly selected public schools in Perth, western Australia. Internal consistency (IC) of the total scale and most subscale scores (except empathy) on the frequency rating scale was adequate to permit independent use. On the importance rating scale, most IC estimates for girls fell below the benchmark. Test-retest estimates of the total scale and subscales were insufficient to permit reliable use. ME of the total scale score (frequency rating) for boys was equivalent to the US estimate, while that for girls was lower than the US error. ME of the total scale score (importance rating) was larger than the error using the frequency rating scale. The study finding supports the idea of using multiple informants (e.g. teacher and parent reports), not just student as recommended in the manual. Future research needs to substantiate the clinical meaningfulness of the MEs calculated in this study by corroborating them against the respective Minimum Clinically Important Difference (MCID).


Assuntos
Testes Psicológicos/normas , Autorrelato , Comportamento Social , Adolescente , Austrália , Criança , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes , Inquéritos e Questionários
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