Contesting criminal lunacy: narratives of law and madness in West Coast Canada, 1874-1950.
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Canada↗
Biomedical subjects
R Menzies
Publications and source records attributed to R Menzies.
Surveillance of pneumococcal disease in Australian states and territories.
Information on pneumococcal disease, including immunisation programs, and optimum future surveillance in each Australian State and Territory were discussed at the Pneumococcal Disease in Australia Workshop on 26-27 March 1999. Workshop participants further expanded on the surveillance aspects of the Workshop in this report. Most participants favoured notification by laboratories of pneumococcal isolates from sterile sites, to provide baseline surveillance data before immunisation programs are fully implemented. It was also thought that trends in antimicrobial resistance should be notified.
Australia↗
Treatment of irritable bowel syndrome with Chinese herbal medicine: a randomized controlled trial.
CONTEXT: Irritable bowel syndrome (IBS) is a common functional bowel disorder for which there is no reliable medical treatment. OBJECTIVE: To determine whether Chinese herbal medicine (CHM) is of any benefit in the treatment of IBS. DESIGN: Randomized, double-blind, placebo-controlled trial conducted during 1996 through 1997. SETTING: Patients were recruited through 2 teaching hospitals and 5 private practices of gastroenterologists, and received CHM in 3 Chinese herbal clinics. PATIENTS: A total of 116 patients who fulfilled the Rome criteria, an established standard for diagnosis of IBS. INTERVENTION: Patients were randomly allocated to 1 of 3 treatment groups: individualized Chinese herbal formulations (n = 38), a standard Chinese herbal formulation (n = 43), or placebo (n = 35). Patients received 5 capsules 3 times daily for 16 weeks and were evaluated regularly by a traditional Chinese herbalist and by a gastroenterologist. Patients, gastroenterologists, and herbalists were all blinded to treatment group. MAIN OUTCOME MEASURES: Change in total bowel symptom scale scores and global improvement assessed by patients and gastroenterologists and change in the degree of interference in life caused by IBS symptoms assessed by patients. RESULTS: Compared with patients in the placebo group, patients in the active treatment groups (standard and individualized CHM) had significant improvement in bowel symptom scores as rated by patients (P=.03) and by gastroenterologists (P=.001), and significant global improvement as rated by patients (P=.007) and by gastroenterologists (P=.002). Patients reported that treatment significantly reduced the degree of interference with life caused by IBS symptoms (P=.03). Chinese herbal formulations individually tailored to the patient proved no more effective than standard CHM treatment. On follow-up 14 weeks after completion of treatment, only the individualized CHM treatment group maintained improvement. CONCLUSION: Chinese herbal formulations appear to offer improvement in symptoms for some patients with IBS.
Adolescent↗
Height phobia and biases in the interpretation of bodily sensations: some links between acrophobia and agoraphobia.
The present study was designed to investigate some of the factors that might underlie the commonly found association between agoraphobia and fear of heights (acrophobia). The results showed that measures of acrophobia are highly associated with the tendency to interpret ambiguous bodily sensations as threatening, and with an increased tendency to report bodily sensations of anxiety. These features of acrophobia did not appear to be characteristics found in phobic states in general, nor did measures of acrophobia show any significant relationship to the tendency to interpret external and social stimuli as threatening. These findings suggest that the frequently found co-morbidity between agoraphobia and acrophobia may be linked to cognitive biases in the discrimination and interpretation of bodily sensations that agoraphobia and acrophobia share in common. In addition, the present findings also generate testable hypotheses about the aetiology of acrophobia.
Adolescent↗
Bacille Calmette-Guérin vaccination and incidence of IDDM in Montreal, Canada.
OBJECTIVE: To describe the association between Bacille Calmette-Guérin (BCG) vaccination and IDDM development in two different case-control series (A and B) in Montreal. RESEARCH DESIGN AND METHODS: Case-control series A comprised 93 IDDM cases and 2,903 control subjects who participated in a community-based tuberculin reactivity survey and who belonged to the same birth cohorts and areas of residence as the IDDM cases, Case-control series B comprised 249 IDDM cases and 431 age- and sex-matched friends and neighborhood control subjects. RESULTS: In series A, the BCG vaccination prevalence among cases and control subjects was 21.5% (95% CI 13.2-29.8%) and 22.3% (95% CI 20.8-23.8%), respectively. The odds ratio (OR) for IDDM associated with BCG vaccination was 1.09 (95% CI 0.62-1.91), after adjusting for the birth cohorts and areas of residence. The vaccination prevalence in series B was 17.7% (95% CI 13.0-22.4%) among cases and 15.1% (95% CI 11.7-18.5%) among control subjects. The OR for IDDM due to BCG vaccination was 1.26 (95% CI 0.79-2.02), taking into account the matched sets. Only one case (3.3%) from series B who had been vaccinated at birth was diagnosed by age 5, compared with 52 cases (24.5%) who had not been vaccinated (P < 0.01). CONCLUSIONS: The lower proportion of birth-vaccinated IDDM cases diagnosed at a very young age, compared with nonvaccinated cases, possibly reflects a temporary boost of the immune functions after vaccination. However, as a whole, results from these analyses fail to support a protective role of BCG vaccination against juvenile-onset IDDM.
Adolescent↗
Exercise-induced bronchospasm: a pilot survey in Nairobi school children.
Exercise-induced bronchospasm (EIB), a common feature of asthma in children, has been used as the outcome measure in community-based surveys of childhood asthma to circumvent difficulties arising from relative lack of objectivity in the use of questionnaires in communities with different cultural and language orientations. We report here the results of the first community-based study of childhood asthma in Kenya using EIB as the outcome measurement. The data was collected in a pilot study to develop methodology for a larger subsequent study. The survey targeted grade four children in five Nairobi City Council school each representing a neighbourhood social economic status (SES). Out of 597 eligible, 408 children took part in the study (68% participation rate). EIB defined as decline in FEV1 of 15% or more, post-exercise was found in 10.5% (95% CI; 10.3, 10.7) of the children studied, the highest rate reported so far in Africa. While boys were more likely to exhibit EIB compared to girls, the prevalence of EIB tended to decrease with age, especially among children residing in low SES neighbourhoods where the EIB prevalence rates tended to be lower compared to those among children from higher SES neighbourhoods. However, none of these differences was statistically significant. This study confirms the feasibility of undertaking exercise challenge tests in the African context and we recommend that additional studies of similar nature be carried out in other populations of Africa to explore the potential of using an exercise test as a marker of asthma in epidemiologic studies.
Age Distribution↗
The effect of interferon-alpha on the pituitary-adrenal axis.
This report concerns the use of a minimum stress animal model for evaluating the neuromodulatory effects of interferon-alpha (IFN-alpha). Male Sprague-Dawley rats, 350-450 g, received jugular catheters and were habituated to handling and sampling arenas. These procedures will minimize stress usually associated with i.v. injections and blood sampling. Natural rat IFN-alpha/beta (RaIFN-alpha/beta) endotoxin free (Lee Biomolecular Research Laboratories, San Diego, CA) or recombinant human IFN-alpha, (rHuIFN-alpha) (a gift from Hoffman La Roche, Nutley, NJ) was injected into rats via catheter at various IFN concentrations. Controls were injected with either (1) vehicle (saline), (2) human or bovine serum albumin in saline, or (3) heat-denatured RaIFN-alpha/beta. Experiments were begun (0 h) at about 0900 h, and blood samples were withdrawn at intervals up to 2 h after IFN or control injections and replaced by the same volume of saline. The concentrations of corticosterone and ACTH in peripheral plasma were measured by radioimmunoassay. Both IFN, when injected at concentrations of 300 or 600 U/g body weight (U/gbw), stimulated an increase above 0 h levels of both hormones in the same animals. Additionally, the stimulation was also evident when compared with plasma hormone levels in animals injected with control substance in a parallel time course. After administration of 150 U/gbw of either IFN, only the increase in the blood corticosterone was significant. These studies demonstrate that both homospecific (RaIFN-alpha/beta) and heterospecific (rHuIFN-alpha) IFN preparations are capable of stimulating the pituitary-adrenal axis.
Adrenal Cortex↗
Surveillance of medical students for TB urged.
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Canada↗
Construction and validation of risk assessments in a six-year follow-up of forensic patients: a tridimensional analysis.
Evaluations of risk were conducted for 162 Canadian mentally disordered criminal defendants through the assembly of actuarial data, scores from special-to-purpose psychometric instruments, and scaled global predictions of dangerousness to others by clinicians and nonclinical raters. Violent conduct by participants was tracked across legal and medical institutions and the community for a subsequent 6 years, with aggregate violence base rates reaching 62%. Decisions about risk were strongly associated with participant attributes and presentations during forensic interviews, but neither linear regression equations involving background and scale items nor direct discretionary judgments could account for more than 25% of variance in the frequency of outcome violence. Predictive accuracy maximized after 3 years, and was strongest for hospital-based violence. Professional clinicians were no more accurate than nonclinical raters. Implications of these findings for the sociolegal control of violence, and for the resurgent "second generation" of risk research, are explored.
Adult↗
Home environment and asthma in Kenyan schoolchildren: a case-control study.
BACKGROUND: There is increasing evidence that environmental factors contribute to the development of asthma, so the relationship was studied between home environment factors and asthma among school children of varying socioeconomic backgrounds living in a developing country. METHODS: A case-control study was performed in participants of a prevalence survey which included 77 schoolchildren with asthma (defined by a history of wheeze, doctor diagnosis, or a decline in FEV1 of > or = 10% at five or 10 minutes after exercise) and 77 age and gender matched controls. Subjects were selected from 402 school children aged 9-11 years attending five primary schools in the city of Nairobi who participated in a prevalence survey of asthma. Visits were made to the homes of cases and controls and visual inspection of the home environment was made using a checklist. A questionnaire regarding supplemental salt intake, parental occupation, cooking fuels, and health of all children in the family was administered by an interviewer. RESULTS: In multivariate analysis the following factors were associated with asthma: damage caused by dampness in the child's sleeping area (adjusted odds ratio (OR) 4.9; 95% confidence interval (CI) 2.0 to 11.7), air pollution in the home (OR 2.5; 95% CI 2.0 to 6.4), presence of rugs or carpets in child's bedroom (OR 3.6; 95% CI 1.5 to 8.5). Children with asthma reported a supplemental mean daily salt intake of 817 mg compared with 483 mg in controls. CONCLUSIONS: Home environmental factors appear to be strongly associated with asthma in schoolchildren in a developing nation. These findings suggest a number of hypotheses for further studies.
Air Pollution, Indoor↗
Measuring ventilation of patient care areas in hospitals. Description of a new protocol.
It has been recommended that ventilation of health care facilities should be monitored regularly to reduce the risk of nosocomial transmission of tuberculosis. We developed a simple method to measure air-change rates and direction of airflow in patient care areas. Pure carbon dioxide (CO2) was released at 13.5 L/min for 5 min, then measured for 30 min within the room and outside in the hallway. Smoke tubes were also used to measure direction of airflow. Doors and windows (if openable) were manipulated. This protocol, when conducted in five offices in 30 patients care areas in two hospitals, provided good mixing and reproducible decay curves, with less than 15% coefficient of variation for repeated measures over a wide range of air-change rates. Manipulation of door and/or window produced significant changes in air-change rates and airflow direction, although calculated air-change rates were more variable. Smoke tube measurements were inconsistent, agreed poorly with evidence of CO2 movement from room to hall, and were strongly affected by room to hallway temperature differentials. CO2 release and measurement proved to be a simple, yet reliable, method to measure air-change rates and the effect of door or window manipulation. Smoke tube measurements were not reliable to characterize direction of airflow.
Air Movements↗
Community-based tuberculin screening in Montreal: a cost-outcome description.
OBJECTIVES: This study describes the costs and outcomes of community-based tuberculin screening programs conducted between 1987 and 1991 in Montreal, Quebec, Canada. METHODS: Follow-up information was abstracted from hospital records of all reactors detected in tuberculin screening of students in grades 6 and 10, of first-year health professional students, and of workers aged 18 to 25 in a number of workforces. Screening costs were estimated directly from survey records, and follow-up costs were estimated from the annual financial report of the Montreal Chest Hospital for 1989/90. RESULTS: Of 7669 persons tested, 782 (10.2%) had positive results and 757 (9.9%) were referred to a clinic. Of those, 525 (6.8% of the original 7669) reported, 293 (3.8%) were prescribed therapy, and 154 (2.0%) were compliant. In Canadian dollars, screening cost $5.70 per person tested and $56 per tuberculin reactor detected, but follow-up of reactors accounted for 73% of the total program cost of $13,455 to $18,753 per case of tuberculosis prevented. CONCLUSIONS: Because of high rates of patient and provider noncompliance, a tuberculin screening program was much less cost-effective than anticipated. Screening costs must be targeted to the highest risk populations, and compliance with recommendations for preventive therapy must be maximized.
Adolescent↗
Immunisation against Haemophilus influenzae type b.
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Adolescent↗
The booster effect in two-step tuberculin testing among young adults in Montreal.
OBJECTIVES: No consensus exists regarding the definition and interpretation of a significant boosting reaction after sequential tuberculin testing. The booster phenomenon is thought to represent remote tuberculous infection where tuberculin reactivity has waned, but it has also been described among persons with previous exposure to other mycobacteria or Bacille Calmette-Guérin (BCG) vaccine. We studied the factors affecting the booster phenomenon among Canadian-born young adults to determine the definition that would maximize sensitivity and specificity of a positive booster reaction in these persons. DESIGN: Point-prevalence survey of initial tuberculin reactions and response to repeated tuberculin testing after 1 to 4 weeks. SETTING: Community-based study of all students entering health professional training programs at six post-secondary institutions. MEASUREMENTS: In 1989, 1990, and 1991, students completed self-administered questionnaires, underwent two-step tuberculin testing with purified protein derivative-tuberculin (PPD-T), and had their childhood BCG vaccination status verified. In 1991, students were also tested with purified protein derivative-Battey (PPD-B) (for Mycobacterium intracellulare). RESULTS: Overall, 74 students (5.2%) had positive booster reactions, which were significantly associated with older age (P < 0.001), larger initial tuberculin reactions (P < 0.001), previous BCG vaccination (P < 0.001), older age when vaccinated (P < 0.02), longer interval from vaccination to testing (P < 0.01), and sensitivity to PPD-B (P < 0.001). Boosting was not associated with the number of BCG vaccinations, sex, or risk factors for tuberculous infection. The pattern, mean, and mode of the frequency distributions of booster reactions among those with BCG vaccination and sensitivity to PPD-B were similar to those with assumed tuberculous infection. CONCLUSIONS: In young adults, booster reactions due to previous tuberculous infection are uncommon and cannot be distinguished from false-positive reactions due to past exposure to other mycobacteria.
Adolescent↗
The effect of war on tuberculosis. Results of a tuberculin survey among displaced persons in El Salvador and a review of the literature.
SETTING: During wartime, civilian populations usually experience a drop in caloric intake, disruption of housing, and a diminution in availability of medical services. These disturbances might be expected to result in increased reactivation of tuberculosis, which may result in increased transmission. Such privations occurred in El Salvador during its 1980-92 civil war, particularly among the 20% of the population, or over 1 million people, who were displaced. OBJECTIVE: (1) To estimate the rate of transmission of tuberculosis among displaced Salvadorians prior to and during the war, and (2) to compare this result with experience in the literature. DESIGN: (1) A tuberculin survey was conducted in El Salvador in July 1992 among all residents aged 1-30 years in 12 communities of formerly displaced persons. (2) The English language literature on tuberculosis during wartime was reviewed. RESULTS: (1) Overall, 21.2% of the non-BCG vaccinated had significant tuberculin reactions, equivalent to an annual risk of infection of 2.3%. The trend in the annual risk of infection was upward over the latter 6 years of the war, stable over the first 6 years, and was downward prior to the war years. The estimated incidence of smear positive pulmonary tuberculosis was 125 per 100,000 or 3 times the reported rate for El Salvador. (2) A review of the literature showed consistent evidence for increased morbidity and mortality from tuberculosis during wartime. Increased transmission was suggested by those studies showing a rise in both incidence of tuberculous meningitis during war years and excess morbidity and mortality many years after a war. Two major population-based studies found no evidence of increased transmission based on the calculated annual risk of infection; however other studies examining younger or more severely affected populations, or following more prolonged wars, detected an apparent increase in the transmission of tuberculosis. CONCLUSIONS: Conditions of war are associated with a rapid increase in morbidity and mortality from tuberculosis, which appears to result in increased transmission among populations most severely affected by war. This increased transmission will result in increased morbidity and mortality for many years, underscoring the need for improved tuberculosis control in the post-war period in countries such as El Salvador that have been devastated by war.
Adolescent↗
Factors affecting compliance with preventive treatment for tuberculosis at Mistassini Lake, Quebec, Canada.
Non-compliance is the most important cause of failure of anti-tuberculous therapy throughout the world. In 1990 and 1991, an outbreak of tuberculosis occurred on the Mistassini Cree territory in Northern Quebec, Canada, and a number of cases of active tuberculosis occurred among known tuberculin-positive contacts who were non-compliant with preventive therapy. To better understand the factors affecting compliance with preventive treatment, a review of patients prescribed preventive treatment over the past 10 y was conducted. A freely-translated, interviewer-administered questionnaire was used to measure personal/lifestyle factors and knowledge/attitudes about tuberculosis. Clinic dossiers were reviewed to assess compliance. One hundred and two (102) subjects prescribed preventive treatment between 1981 and 1991 were interviewed, of whom 33.7% were judged to have been compliant. The most significant factor associated with compliance with preventive therapy was year of therapy. Between 1981 and 1985, 78% completed treatment, compared to less than 20% since 1986 (p < .0001). The major factor identified as associated with this sudden change was a shift in responsibility for tuberculosis treatment follow-up from native community health workers to non-native nurses in 1985/86. We conclude that tuberculosis control programs must be tailored to take into account the importance of cultural factors in promoting compliance with therapy.
Adult↗
The effect of varying levels of outdoor-air supply on the symptoms of sick building syndrome.
BACKGROUND: The sick building syndrome is the term given to a constellation of symptoms reported by workers in modern office buildings, hypothesized to occur when the supply of outdoor air is reduced, because of the accumulation of contaminants arising from within the building. We undertook this study to determine the effect of changing the supply of outdoor air in four office buildings on the symptoms reported by workers and their perception of the indoor environment. METHODS: Within each of three consecutive two-week blocks, the ventilation systems in each building were manipulated, in random order, to deliver to the indoor environment an intended 20 or 50 ft3 (0.57 or 1.4 m3) of outdoor air per minute per person for one week at a time. Each week, the participants, unaware of the experimental intervention, reported symptoms and the indoor environment was thoroughly evaluated. RESULTS: Of 1838 eligible workers in the four buildings, 1546 (84 percent) participated in the study. The supply of outdoor air averaged 7 percent and 32 percent in the ventilation systems and 30 and 64 ft3 (0.85 and 1.8 m3) per minute per person in the work sites at the lower and higher ventilation levels, respectively. These changes in the supply of outdoor air were not associated with changes in the participants' ratings of the office environment or in symptom frequency (crude odds ratio, 1.0; 95 percent confidence interval, 0.9 to 1.1). After work-site measures of ventilation, temperature, humidity, and air velocity were included in the regression analysis, the adjusted odds ratio was also 1.0 (95 percent confidence interval, 0.8 to 1.2). CONCLUSIONS: Increases in the supply of outdoor air did not appear to affect workers' perceptions of their office environment or their reporting of symptoms considered typical of the sick building syndrome.
Adult↗
A longitudinal study of the relationships between psychometric test scores, offence history and the plasma concentrations of phenylacetic and 5-hydroxyindoleacetic acids in seven inmates of a prison for the psychiatrically disturbed.
1. The plasma concentrations of phenylacetic (PAA) and 5-hydroxyindoleacetic (5HIAA) acids in seven inmates incarcerated in the Regional Psychiatric Centre (Prairies), Correctional Service of Canada, were assessed each weekday for four weeks (i.e., 20 samples each). Psychometric assessments for hostility, anger, depression and anxiety were also performed daily. Mean differences between subjects in psychometric and biochemical measures were subjected to tests of statistical significance. 2. The subject who was clearly most aggressive by offence history/institutional behavior scored significantly highest on scales of anger and hostility and significantly lowest with respect to PAA concentration. It was concluded that PAA may be a trait marker for aggression. 3. Plasma 5HIAA concentrations were invariant between subjects. 4. The psychometric measures were intercorrelated, thus confounding the variables of interest. They also varied little, proving insensitive to subtle mood changes.
Adult↗