Biomedical subjects

M Karen Campbell

Publications and source records attributed to M Karen Campbell.

14 recordsLinked to original sources

PubMed2006

Factors influencing full breastfeeding in a southwestern ontario community: assessments at 1 week and at 6 months postpartum.

Factors associated with full breastfeeding (FBF) at 1 week and at 6 months postpartum were examined in a cohort of 856 mother-infant dyads. Questionnaires were mailed at 4 time points over the first 6 months postpartum. At 1 week, 68% of infants were FBF; at 6 months, 23% were FBF. Factors significantly associated with FBF at 1 week were hospital of delivery, residing with a smoker, maternal shiftwork during pregnancy, and having no prior breast-feeding experience. Cox proportional hazards regression analysis showed that residing with a smoker, having consumed caffeine during pregnancy, reporting elevated maternal trait anxiety at 1 week postpartum, having been employed full-time outside the home prior to delivery, and having received anesthesia/analgesia during labor/delivery were associated with earlier cessation of FBF, whereas not having previous breastfeeding experience predicted its continuation. Although most mothers are breastfeeding early on, a number of factors adversely affect its successful continuation.

Adult↗

PubMed2005

Socioeconomic status and non-fatal injuries among Canadian adolescents: variations across SES and injury measures.

BACKGROUND: While research to date has consistently demonstrated that socioeconomic status (SES) is inversely associated with injury mortality in both children and adults, findings have been less consistent for non-fatal injuries. The literature addressing SES and injury morbidity among adolescents has been particularly inconclusive. To explore potential explanations for these discrepant research findings, this study uniquely compared the relationship across different measures of SES and different causes of injury (recreation versus non-recreation injuries) within a sample of Canadian adolescents. METHODS: The sample included adolescent participants (aged 12 to 19 years) in the Canadian 1996-1997 cross-sectional National Population Health Survey (n = 6967). Five SES measures (household income, two neighbourhood-level proxy measures, two parental indicators) were examined in relation to three injury outcomes (total, recreation, and non-recreation injuries) using multivariable logistic regression. RESULTS: Among males, a clear relationship with injury was observed only for a parental SES index, which was positively associated with total and recreation injuries (odds ratios for the highest versus lowest SES category of 1.9 for total and 2.5 for recreation injuries). Among females, there was some evidence of a positive relationship between SES and injuries, particularly for a neighbourhood-level education measure with total and recreation injuries (odds ratios of 1.7 for total and 2.0 for recreation injuries). CONCLUSION: The results suggest that differences related to the measures of SES chosen and the causes of injury under study may both contribute to discrepancies in past research on SES and non-fatal injuries among adolescents. To clarify the potential SES-injury relationship among youth, the findings emphasize a need for a greater understanding of the meaning and relevance of different SES measures for adolescents, and for an exploration of the pathways through which SES may be related to injury risk.

Adolescent↗

PubMed2005

Omega-3 polyunsaturated fatty acids and depression: a review of the evidence and a methodological critique.

Several lines of evidence indicate an association between omega-3 polyunsaturated fatty acids (PUFAs) and depression. The purpose of this review was to evaluate the evidence to date within the context of the study design and methodology used. In case-control and cohort studies, concentrations of omega-3 PUFAs were lower in participants with unipolar and postpartum depression. Fish are the major dietary source of omega-3 PUFAs, and infrequent fish consumption is associated with depression in epidemiological studies. While these findings do not appear to be the result of confounding, in some studies failure to detect confounding may be due to a lack of power or incomplete control. In four of seven double-blind randomized controlled trials, depression was significantly improved upon treatment with at least 1 g/day of eicosapentaenoic acid, an omega-3 PUFA. While clinical significance was demonstrated, preservation of blinding may be a limitation in this area of research. It remains unclear whether omega-3 supplementation is effective independently of antidepressant treatment, for depressed patients in general or only those with abnormally low concentrations of these PUFAs. The relationship between omega-3 PUFAs and depression is biologically plausible and is consistent across study designs, study groups, and diverse populations, which increases the likelihood of a causal relationship.

Aged↗

PubMed2005

Is there value in using physician billing claims along with other administrative health care data to document the burden of adolescent injury? An exploratory investigation with comparison to self-reports in Ontario, Canada.

BACKGROUND: Administrative health care databases may be particularly useful for injury surveillance, given that they are population-based, readily available, and relatively complete. Surveillance based on administrative data, though, is often restricted to injuries that result in hospitalization. Adding physician billing data to administrative data-based surveillance efforts may improve comprehensiveness, but the feasibility of such an approach has rarely been examined. It is also not clear how injury surveillance information obtained using administrative health care databases compares with that obtained using self-report surveys. This study explored the value of using physician billing data along with hospitalization data for the surveillance of adolescent injuries in Ontario, Canada. We aimed i) to document the burden of adolescent injury using administrative health care data, focusing on the relative contribution of physician billing information; and ii) to explore data quality issues by directly comparing adolescent injuries identified in administrative and self-report data. METHODS: The sample included adolescents aged 12 to 19 years who participated in the 1996-1997 cross-sectional Ontario Health Survey, and whose survey responses were linked to administrative health care datasets (N = 2067). Descriptive analysis was used to document the burden of injuries as a proportion of all physician care by gender and location of care, and to examine the distribution of both administratively-defined and self-reported activity-limiting injuries according to demographic characteristics. Administratively-defined and self-reported injuries were also directly compared at the individual level. RESULTS: Approximately 10% of physician care for the sample was identified as injury-related. While 18.8% of adolescents had self-reported injury in the previous year, 25.0% had documented administratively-defined injury. The distribution of injuries according to demographic characteristics was similar across data sources, but congruence was low at the individual level. Possible reasons for discrepancies between the data sources included recall errors in the survey data and errors in the physician billing data algorithm. CONCLUSION: If further validated, physician billing data could be used along with hospital inpatient data to make an important and unique contribution to adolescent injury surveillance. The limitations inherent in different datasets highlight the need to continue rely on multiple information sources for complete injury surveillance information.

Activities of Daily Living↗

PubMed2005

Adolescents' low-carbohydrate-density diets are related to poorer dietary intakes.

This study was undertaken to assess how low-carbohydrate-density diets below the acceptable macronutrient distribution range relate to food and micronutrient intake and sociodemographic and health-related characteristics. The multistage stratified cluster design in the 1990 Ontario Health Survey was used. There were 5,194 subjects, 12 to 18 years of age, in sampled households. Dietary data were collected via a food frequency questionnaire. Low-carbohydrate-density diets were consumed by 27.6% of males and 24.1% of females. Low-carbohydrate-density diets were related (P < .05) to reduced sufficiency of vegetables and fruit and higher consumption of meat and alternatives and added fats. The low-carbohydrate-density diet resulted in intakes lower in vitamin C and fiber and higher in cholesterol and total fat. The low-carbohydrate-density diet was directly associated with being Canadian-born (odds ratio [OR] = 1.78, 95% confidence interval [CI] = 1.27 to 2.50), overweight status (OR = 1.27, 95% CI = 1.02 to 1.57), smoking (OR = 1.53, 95% CI = 1.23 to 1.90), alcohol use (OR = 1.46, 95% CI = 1.21 to 1.75), and poorer self-rated health (OR = 1.47, 95% CI = 1.01 to 2.14). Use of the acceptable macronutrient distribution range identified adolescents with low-carbohydrate-density diets whose food choices and nutrient intake may impact negatively on short- and long-term health.

Adolescent↗

PubMed2005

A cohort study found that white blood cell count and endocrine markers predicted preterm birth in symptomatic women.

OBJECTIVE: This cohort study investigated potential clinical and biochemical predictors of subsequent preterm birth in women presenting with threatened preterm labor. STUDY DESIGN AND SETTING: Subjects were 218 pregnant women admitted to hospital with a diagnosis of threatened preterm labor at 22-36 weeks gestation. Exclusion criteria were multiple pregnancy, fetal anomalies, diabetes mellitus, abruptio placenta, preeclampsia, intrauterine growth restriction, cervical dilatation > 4 cm, and clinical signs of infection. Analyses used logistic regression. RESULTS: The presence of ruptured membranes was the best predictor of birth within 48 hours. Other important predictors were maternal white blood cell count at 22-27 weeks gestation and maternal adrenocorticotropin and corticotropin-releasing hormone concentrations at 28-36 weeks gestation. CONCLUSION: Subclinical infection may be an important etiologic factor in preterm births of gestational age < 28 weeks. For those at > or = 28 weeks gestation, the findings support the etiologic role of activation of the fetal and/or maternal hypothalamic pituitary adrenal axis leading to preterm birth.

Adrenocorticotropic Hormone↗

PubMed2005

Dietary intake among young adolescents in Ontario: associations with vegetarian status and attitude toward health.

BACKGROUND: This study aimed to describe the dietary intakes of adolescent vegetarians and omnivores and determine if, and how, attitude toward personal health related to food consumption. METHODS: Among grade 9 students in Ontario, Canada (n = 630), vegetarian status and estimated consumption of foods and food groups were determined by food frequency questionnaire. Personal health was self-categorized as very important (the "health conscious") or somewhat/not important (the "non-health conscious"). RESULTS: The prevalence of vegetarianism was 6.5% (CI = 4.6-8.4%) among females and 1.0% (CI = 0.2-1.8%) among males. Health-conscious omnivores consumed more grain, vegetables and fruit, and milk product than non-health-conscious omnivores (P < 0.05). Health-conscious vegetarians ingested more grain products, vegetables and fruit, and meat and alternatives than non-health-conscious vegetarians (P < 0.05). Among non-health-conscious vegetarians, none consumed two daily servings of meat and alternatives compared to 60.5% of non-health-conscious omnivores (P < 0.001). Among health-conscious vegetarians, milk product consumption was lower than that of health-conscious omnivores (P = 0.015). CONCLUSIONS: Large proportions of both vegetarian and omnivore adolescents consumed suboptimal diets. Health consciousness had value as an indicator of dietary adequacy and may be useful as a rudimentary screen for problematic dietary consumption patterns.

Adolescent↗

PubMed2005

Re-utilization outcomes and costs of minor acute illness treated at family physician offices, walk-in clinics, and emergency departments.

OBJECTIVE: To examine factors associated with re-utilization of health services and to estimate and compare costs of treatment for minor acute illnesses in family physicians' offices (FPOs), walk-in clinics (WICs), and emergency departments (EDs). DESIGN: Prospective cohort study using questionnaires, telephone follow up, medical chart data, and costs according to Ontario Health Insurance Plan (OHIP) schedules. SETTING: 16 FPOs, 12 WICs, and 13 EDs in three Ontario cities. PARTICIPANTS: Consecutive patients with one of eight predefined minor acute illnesses found in all three settings (upper respiratory infection, pharyngitis, acute bronchitis, acute otitis media, serous otitis media, low back pain, gastroenteritis, and urinary tract infection). MAIN OUTCOME MEASURES: "Early" (< 3 days) versus "later" (3 days to 2 weeks) re-utilization of health services after initial encounter and direct cost to OHIP. RESULTS: The overall rate of re-utilization of health services for the same episode of illness was 11.3% for early and 20.6% for later re-utilization. Factors associated with early re-utilization were initial evaluation in ED setting (odds ratio [OR] = 6.5, confidence interval [CI] = 2.2-19.2) and, regardless of setting, less satisfaction with patient-centred care (OR = 1.7 for each one-point decrease on a four-point scale; CI = 1.1-2.7). Factors associated with later re-utilization were ED setting (OR = 4.9; CI = 2.4-9.9) and diagnosis of urinary tract infection (OR = 2.4; CI = 1.1-5.2). Factors tested and found not signifcantly associated with rate of re-utilization were patients' age, sex, responses to a variety of questions assessing psychosocial factors (stress, social support, independence), and opinions on health care. Cost of care was similar for FPOs and WICs and higher for EDs for all diagnoses. The initial visit was the largest component of cost in all settings, and this component (as well as total cost) was consistently higher in EDs. CONCLUSION: Both re-utilization rates and costs are higher for those seeking care in EDs for minor acute illness. Patient-centred care, an important feature of health care encounters regardless of setting, can reduce re-utilization rates.

Acute Disease↗

PubMed2003

Patient satisfaction and quality of care in walk-in clinics, family practices and emergency departments: the Ontario Walk-In Clinic Study.

BACKGROUND: Although walk-in clinics are an increasingly common feature of Ontario's health care system, the quality of care they provide is the subject of continuing debate. In this study we examined differences in patient satisfaction and quality of care for common acute conditions in walk-in clinics, family practices and emergency departments. METHODS: For this prospective cohort study, we recruited 12 walk-in clinics, 16 family practices and 13 emergency departments from 11 geographic areas in greater Toronto, Hamilton-Burlington and London, Ont. An expert review panel selected and established quality-of-care criteria for 8 common acute conditions. Patients who sought initial care for 1 of the 8 conditions were recruited by an on-site data collector. We used a questionnaire to assess the satisfaction of 433 patients with patient-centred communication, the physician's attitude and any delay in the waiting room during the study visit. Abstractors reviewed 600 charts for the study patients to assess whether the quality-of-care criteria had been met. A quality score for each case was computed as the percentage of applicable criteria that were met. Mean quality scores for the 3 settings were computed, with adjustment for potentially confounding variables (sex, age, city and diagnosis). RESULTS: After adjustment for 12 patient characteristics, walk-in clinic patients were significantly more satisfied than emergency department patients on all 3 satisfaction scales. Family practice patients were more satisfied than walk-in clinic patients on all 3 satisfaction scales, but the difference was statistically significant only for satisfaction with waiting time. Adjusted mean quality-of-care scores were 73.1% for emergency departments, 69.9% for walk-in clinics and 64.1% for family practices. The scores for walk-in clinics and emergency departments were significantly higher than that for family practices. INTERPRETATION: Satisfaction with waiting time was highest among family practice patients. Both family practices and walk-in clinics were perceived more positively than emergency departments on all 3 dimensions of satisfaction. Overall quality-of-care scores were higher in walk-in clinics and emergency departments than in family practices.

Adolescent↗

PubMed2003

Activity patterns during pregnancy.

UNLABELLED: The purpose of this study was to investigate determinants of the activity patterns of women prior to pregnancy and factors associated with quitting activities during pregnancy. METHODS: These data arose from a study designed to look at the impact of exercise in pregnancy on birth weight (Campbell and Mottola, 2001). This secondary analysis explored relationships between subject characteristics and exercise patterns via a self-completed questionnaire. Univariable and multivariable odds ratios were estimated using logistic regression. Multivariable models used backward stepwise variable selection. RESULTS: A total of 853 women agreed to participate and 529 women (62%) returned completed questionnaires. Of these, 369 (70%) and 258 (49%) engaged in a structured exercise program before pregnancy and in Trimester 3, respectively. Factors associated with engaging in regular structured exercise prior to pregnancy included: postsecondary education (OR = 1.50; 0.98, 2.30), no children (OR = 2.44; 1.56, 3.82), nonsmoker (OR = 1.84; 1.18, 2.88), and involvement in regular recreational activities (OR = 3.07; 1.81, 5.20). During pregnancy, all categories of activity decreased except walking, which increased by Trimester 3. Factors associated with quitting a regular structured exercise program by Trimester 3 were: having children (OR = 1.67; 1.05, 2.67), a prepregnancy BMI of 25 (OR = 1.79; 1.04, 3.13), and higher weight gain. IMPLICATIONS: Community programs that encourage active living should address these factors.

Body Mass Index↗

PubMed2002

Infant colic: empirical evidence of the absence of an association with source of early infant nutrition.

BACKGROUND: The etiology of infant colic remains unknown, despite an abundance of research on the topic. OBJECTIVE: To determine whether breastfeeding has a protective effect in colic's development. DESIGN: A prospective cohort study of 856 mother-infant dyads. Eligible participants included English-speaking adult residents of a region in Ontario, who gave birth, at term, to a live singleton whose birth weight was appropriate for gestational age. Self-administered questionnaires, mailed to mothers at 1 and 6 weeks post partum, requested information on several infant and maternal factors, including source of infant nutrition (exclusively breastfed, complementary fed, and exclusively formula fed). Cases of colic were identified by applying modified Wessel criteria to data recorded in the Barr Baby Day Diary or by interpreting responses to the Ames Cry Score. MAIN OUTCOME MEASURES: Prevalence of colic among breastfed, formula-fed, and complementary-fed infants; and adjusted odds ratios (AORs) reflecting the prevalence of colic among formula- and complementary-fed infants relative to those who were breastfed. RESULTS: Of 856 mothers, 733 (86%) completed the first questionnaire and 617 (72%) completed the second questionnaire. Overall, the prevalence of colic at 6 weeks was 24%. No association was seen between the source of infant nutrition and colic's development. In multivariate analyses, higher levels of maternal trait anxiety (AOR, 1.22; 95% confidence interval [CI], 0.96-1.54), maternal alcohol consumption at 6 weeks (AOR, 1.57; 95% CI, 1.03-2.40), and shift work during pregnancy (AOR, 1.27; 95% CI, 0.73-2.21) were associated with an increased likelihood of colic, after controlling for feeding method, maternal age, and parity. In these same analyses, being married or having a common-law partner (AOR, 0.30; 95% CI, 0.10-0.87) and being employed full-time during pregnancy (AOR, 0.60; 95% CI, 0.32-1.14) were associated with a reduced likelihood of colic. CONCLUSIONS: Breastfeeding did not have a protective effect on the development of colic. Although colic was statistically associated with several variables, including preexisting maternal anxiety, much of colic's etiology remains unexplained.

Adult↗

PubMed2002

Sequelae of infant colic: evidence of transient infant distress and absence of lasting effects on maternal mental health.

BACKGROUND: Colic is widely believed to remit by 3 months of age, with little lasting effect on the infant or the family. OBJECTIVES: To determine the prevalence of colic at 3 months and the proportion of cases of colic (identified at 6 weeks) that remitted by 3 months; to identify the factors predictive of colic's remission; and to explore the potential lasting effects of colic on maternal mental health. DESIGN: Prospective cohort study of 856 mother-infant dyads. Self-administered questionnaires were mailed to mothers at 1 and 6 weeks and 3 and 6 months post partum. Standardized instruments were incorporated into the first and last questionnaires to assess maternal anxiety, postnatal depression, and social support. At 6 weeks and at 3 months, mothers completed the Barr diary and/or the Ames Cry Score. RESULTS: Data from 547 dyads were available for analysis. The prevalence of colic at 3 months was 6.4%. More than 85% of cases of colic had remitted by 3 months of age. These infants were more likely to be female, whereas the mothers of these infants were more likely to have received pain relief during labor/delivery and to have been employed during pregnancy. Reductions in scores for trait anxiety and postnatal depression, although smaller for mothers whose infants were colicky at 6 weeks of age, were not significantly different from those of mothers whose infants were never colicky. CONCLUSION: This study provides support for the belief that, in most cases, colic is self-limiting and does not result in lasting effects to maternal mental health.

Colic↗

PubMed2002

Perinatal mortality in term and preterm twin and singleton births.

Although, in general, twins have higher perinatal mortality rates than singletons, preterm twins have lower perinatal mortality rates than singletons of the same birth weight or gestational age. This study investigated the hypotheses that this paradoxical twin advantage: 1) is due to gestational age distribution differences between the singleton and twin populations, and 2) is due to increased likelihood of birth having occurred in a tertiary perinatal center. A pre-existing, time-limited data set of all births in the province of Ontario in odd years between 1979 and 1985 was chosen for this study because of the large sample size (n = 618,579). Multivariable logistic regression of the relationship between perinatal mortality and twin status was controlled for mother's age, hospital level and gestational age. Findings confirm the lower mortality of preterm twins. After controlling for level of hospital of birth this difference remained, suggesting that level of hospital of birth was not a major factor responsible for the twin advantage. Analyses in which gestational age was standardized indicate that, for those whose gestational age was less than 2 SD below the mean for their particular group (twin or singleton), twins were actually at higher risk than singletons. These results support hypothesis 1 and do not strongly support hypothesis 2. The results also support earlier authors' suggestions that the definition of term birth should be different for twins and singletons

Gestational Age↗

PubMedDate not supplied

A comparison of measures of socioeconomic status for adolescents in a Canadian national health survey.

The purpose of this study was to explore and compare measures of socioeconomic status (SES) in a national sample of Canadian adolescents. Issues of missing data and interrelationships among the measures were addressed. Measures of SES included household income, parental education, two parental occupation-based measures, and four neighbourhood proxy indicators. The proportion of adolescents with missing data was largest for household income (21.1 percent). Data were not missing at random, as adolescents missing household income information were less likely to reside in a high income neighbourhood. Pair-wise Spearman correlations ranged from: 0.40-0.79 between neighbourhood SES measures; 0.12-0.37 between household/parental and neighbourhood indicators; and 0.36-0.87 between household/parental measures. Correlations were lower among rural adolescents, particularly for the neighbourhood SES measures. The results highlight both measurement and conceptual challenges for researchers who wish to gain insight into SES-health relationships for adolescents. In particular, the findings emphasize the importance of incorporating multiple measures of SES and suggest a need to further explore the meaning of socioeconomic position for this population.

Adolescent↗