Search

OBJECTIVE: Studies of loud noise exposure and vestibular schwannomas (VS) have shown conflicting results. The population-based INTERPHONE case‒control study was conducted in 13 countries during 2000–2004. In this paper, we report the results of analyses on the association between VS and self-reported loud noise exposure. METHODS: Self-reported noise exposure was analyzed in 1024 VS cases and 1984 matched controls. Life-long noise exposure was estimated through detailed questions. Odds ratios (OR) and 95% confidence intervals (CI) were estimated using adjusted conditional logistic regression for matched sets. RESULTS: The OR for total work and leisure noise exposure was 1.6 (95% CI 1.4–1.9). OR were 1.5 (95% CI 1.3–1.9) for only occupational noise, 1.9 (95% CI 1.4–2.6) for only leisure noise and 1.7 (95% CI 1.2–2.2) for exposure in both contexts. OR increased slightly with increasing lag-time. For occupational exposures, duration, time since exposure start and a metric combining lifetime duration and weekly exposure showed significant trends of increasing risk with increasing exposure. OR did not differ markedly by source or other characteristics of noise. CONCLUSION: The consistent associations seen are likely to reflect either recall bias or a causal association, or potentially indicate a mixture of both.

Timely public health surveillance is required to understand trends in opioid use and harms. Here, opioid dispensing data from the Nova Scotia Prescription Monitoring Program are presented alongside fatality data from the Nova Scotia Medical Examiner Service. Concurrent monitoring of trends in these data sources is essential to detect population-level effects (whether intended or unintended) of interventions related to opioid prescribing.

Une surveillance en santé publique en temps opportun est nécessaire pour comprendre les tendances associées à la consommation d’opioïdes et à ses méfaits connexes. Cet article met en correspondance les données sur la délivrance d’opioïdes recueillies par le Nova Scotia Prescription Monitoring Program et les données sur les décès compilées par le Service de médecin légiste de la Nouvelle-Écosse. La surveillance simultanée des tendances au moyen de ces sources de données est essentielle pour détecter les effets sur la population (qu’ils soient intentionnels ou non) des interventions liées à la prescription d’opioïdes.

Abstract Background Brain tumor etiology is poorly understood. Based on their ability to pass through the blood–brain barrier, it has been hypothesized that exposure to metals may increase the risk of brain cancer. Results from the few epidemiological studies on this issue are limited and inconsistent. Methods We investigated the relationship between glioma risk and occupational exposure to five metals - lead, cadmium, nickel, chromium and iron- as well as to welding fumes, using data from the seven-country INTEROCC study. A total of 1800 incident glioma cases and 5160 controls aged 30–69 years were included in the analysis. Lifetime occupational exposure to the agents was assessed using the INTEROCC JEM, a modified version of the Finnish job exposure matrix FINJEM. Results In general, cases had a slightly higher prevalence of exposure to the various metals and welding fumes than did controls, with the prevalence among ever exposed ranging between 1.7 and 2.2% for cadmium to 10.2 and 13.6% for iron among controls and cases, respectively. However, in multivariable logistic regression analyses, there was no association between ever exposure to any of the agents and risk of glioma with odds ratios (95% confidence intervals) ranging from 0.8 (0.7–1.0) for lead to 1.1 (0.7–1.6) for cadmium. Results were consistent across models considering cumulative exposure or duration, as well as in all sensitivity analyses conducted. Conclusions Findings from this large-scale international study provide no evidence for an association between occupational exposure to any of the metals under scrutiny or welding fumes, and risk of glioma.

Ixodes scapularis ticks, which transmit Borrelia burgdorferi, the causative agent of Lyme disease (LD), are endemic to at least 6 regions of Nova Scotia, Canada. To assess the epidemiology and prevalence of LD in Nova Scotia, we analyzed data from 329 persons with LD reported in Nova Scotia during 2002–2013. Most patients reported symptoms of early localized infection with rash (89.7%), influenza-like illness (69.6%), or both; clinician-diagnosed erythema migrans was documented for 53.2%. In a separate serosurvey, of 1,855 serum samples screened for antibodies to B. burgdorferi, 2 were borderline positive (both with an indeterminate IgG on Western blot), resulting in an estimated seroprevalence of 0.14% (95% CI 0.02%–0.51%). Although LD incidence in Nova Scotia has risen sharply since 2002 and is the highest in Canada (16/100,000 population in 2013), the estimated number of residents with evidence of infection is low, and risk is localized to currently identified LD-endemic regions.

ABSTRACT Aim To identify characteristics of children who died in the community rather than hospital. Methods All children admitted to a PICU in England or Wales (1st Jan 2004 and 31st Dec 2014) were identified in the PICANet dataset. Linkage to death certificate data was available up to the end of 2014. Place of death was categorised as hospital (hospital or PICU) or community (hospice, home or other) for multivariable logistic modelling. Results The cohort consisted of 110,328 individuals. 4760 deaths occurred on first admission in PICU (excluded from analyses) and 7709 deaths occurred after first discharge from PICU. Overall 41.2% of these deaths occurred in hospital, 32.5% in PICU, 16.6% at home, 8.7% in hospice and 0.7% elsewhere. Deaths in hospital (incl PICU) decreased from more 83.8% in 2004 to 68.1% in 2014. 852 (0.8%) of children were discharged to palliative care. Children discharged to palliative care were 8.4 times more likely to die in the community (OR 8.36 95%CI (6.76-10.34)). Children in all older age groups were significantly more likely to die outside hospital than the under 1s. Children from a South Asian background (OR 0.48 95%CI (0.36-0.58)) and those living in the most deprived categories were significantly less likely to die outside the hospital. Conclusions A large proportion of children dying after discharge from PICU continue to die in hospital. More involvement of palliative care at the point of discharge has the potential to offer choice around place of care and death for these children and families.

ABSTRACT Objective To identify children with a Life-Limiting Condition (LLC) who have had an admission to a Paediatric Intensive Care Unit (PICU) in England and their outcomes. Approach Data for all children who had had a PICU admission in the UK between 1st Jan 2004 and 31st March 2015 were identified from the PICANet dataset. Linkage to inpatient Hospital Episode Statistics (HES) data was undertaken by the NHS Health and Social Care Information Centre for all children who had been resident in England. Their standard algorithm using NHS number, date of birth, sex and postcode was used. All inpatient HES episodes from the financial years 1997/98-2014/15 were received. Although the data quality is high in the PICANet dataset, comorbidities are variably coded therefore identifying whether a child has a LLC or not is not possible. A previously developed ICD10 coding framework was used to identify individuals with one or more of these LLC codes in the inpatient HES dataset. Results A total of 199,548 PICU admissions in the UK for 135,759 individuals occurred during the time period of the study. Data for 43,565 admissions (32,025 individuals) were excluded due to not having been resident in England or poor quality demographic data. Data on 103,734 individuals (155,983 admissions) were sent for linkage. Successful linkage occurred in 102,722 individuals (99.4%). Individuals who could not be linked were excluded from the analysis. 51.0% of these children had a LLC and these children accounted for 62.7% of the PICU admissions. The crude PICU death rate in the children with a LLC was 5.0% (n=4826) compared to 3.1% (n=1786) in those without a LLC. The OR of death in a model adjusted for diagnostic group, sex, age, and expected risk of mortality for children with a LLC was 2.11 (95%CI 1.97-2.27). Conclusions Children with a LLC account for a large proportion of all PICU admissions in England. Although only one in twenty of these children die in PICU, as death may be expected in this population of children more integration of specialist palliative care with PICU services may allow more choice for children and families.

Abstract This study aimed to determine the appropriate IELTS band scores in Writing and Speaking for admission to and success in Computer Systems Technology (CST) and Computer Information Technology (CIT) programs at a large Canadian polytechnic post-secondary institute. A second aim was to explore whether the quality of admissions decisions could be enhanced by aligning their processes more closely with the English language demands of actual tasks required within their target programs. This was done by examining course materials, activities, and assignments in which students are required to read, write, speak, and listen in English and then comparing the required proficiency in English for those tasks to band score descriptors provided by the IELTS measure. Data consisted of student interviews, faculty interviews, observations of lectures and labs, and course documents. Because of the small number of interviewees and the limited depth and scope of content analysis, results should be viewed as indicative rather than conclusive.

ABSTRACT The Mississippi Alluvial Valley provides important habitats for migrating and wintering waterfowl and is a priority area for restoration of wetlands through the U.S. Department of Agriculture's Wetlands Reserve Program (WRP). Management of WRP wetlands varies from no management to active annual management of vegetation and water levels, which may influence wintering waterfowl use. We modeled variation in species richness and density of dabbling and diving ducks (Anatini, Aythyini) relative to a published Vegetative Forage Quality Assessment Index (VFQI; Fleming et al. 2012) of duck foods, other floristic metrics, and management type of WRP wetlands in Mississippi, USA, during autumns–winters 2007–2009. Duck species richness was correlated positively with wetland area when precipitation was below normal (winter 2007–2008), but not in 2008–2009 when landscape‐level flooding occurred. Duck densities varied positively with VFQI on wetlands with active management and late‐summer drawdown, but not on passive or active managed areas with early drawdown. Duck densities decreased with increasing woody vegetation. Models including VFQI explain ≤27% of the variation in duck densities, suggesting that ducks may also be selecting wetlands based on metrics that are not related to VFQI or wetland management. Active managed wetlands may produce the greatest VFQI, but our results suggest this technique need not always result in increased use by ducks. Nevertheless, we recommend active management of WRP wetlands to sustain food at the landscape level for migrating and wintering ducks. We also recommend continued study of metrics other than VFQI that may potentially influence use of wetlands by waterfowl. © 2015 The Wildlife Society.