Previous research indicates that the disproportionate distribution of income within society is associated with aggression and violence. Although research has been conducted identifying the ...relationship between income inequality and bullying victimization and perpetration, little is known about possible mediators. We investigated the association between income inequality and bullying perpetration and victimization among adolescents participating in the Cannabis, Obesity, Mental health, Physical activity, Alcohol use, Smoking, and Sedentary behavior (COMPASS) study. We identified whether school connectedness and psychosocial well-being mediated the relationship between income inequality and bullying behavior. This study used pooled cross-sectional data from 147,748 adolescents aged 13 to 18 from three waves (2015–2016, 2016–2017, 2017–2018) of the COMPASS study from 157 secondary schools in British Columbia, Alberta, Ontario, and Quebec (Canada). The Gini coefficient was calculated based on the school Census Divisions (CD) using the Canada 2016 Census and linked with student data. We used multilevel modeling to investigate the relationship between income inequality and self-reported bullying victimization and perpetration, while controlling for individual-, school-, and CD-level characteristics. A standard deviation increase in Gini coefficient was associated with increased odds for bullying victimization and perpetration. Findings were observed among girls; however, inequality was only associated with perpetration among boys. We identified social cohesion and psychosocial well-being as potential mediators. To counter the adverse effects of income inequality, school-based interventions designed to increase school connectedness and student psychosocial well-being should be implemented to protect against bullying.
Background There is a paucity of studies to substantiate whether the presence of a single mitosis justifies sentinel lymph node (SLN) biopsy (SLNB) in thin melanomas. Objective We sought to determine ...if mitotic rate is associated with SLNB outcome when taking into account other prognostic factors. Methods All cases of melanoma that underwent SLNB in the province of Alberta, Canada, between 2007 and 2013 were reviewed through a provincial tumor database. Results A total of 1072 patients fulfilled inclusion criteria. When analyzing all melanomas regardless of thickness, mitotic rate was a good predictor of SLN status. When stratified by Breslow thickness, only intermediate melanomas (1.01-2.0 mm) demonstrated a significant relationship between mitotic rate and positive SLN status ( P = .010). For melanomas 1 mm or smaller, mitotic rate was not associated with SLN status. A statistically significant interaction was identified between Breslow thickness and mitotic rate such that for decreasing Breslow depth, the effect of mitotic rate on SLNB status diminished ( P = .028). Limitations The study was retrospective in nature. There is underlying variability in mitotic rate reporting methods over time, and between different dermatopathologists. Conclusions Mitotic rate does not have unequivocal utility in predicting SLNB status in thin melanomas. There is a significant interaction between mitotic rate and Breslow depth, such that the predictive value of mitotic rate on SLN positivity may be dependent on Breslow thickness.
Abstract Background Venous thromboembolism is a major cause of morbidity and mortality, and comprehensive studies profiling the epidemiology and pattern of health services use are needed. In this ...study we provide contemporary estimates of venous thromboembolism incidence and case fatality over the past decade. Methods: We developed a population-based venous thromboembolism dataset by linking 6 administrative health databases in Alberta, Canada from April 1, 2002 to March 31, 2012. We defined acute symptomatic cases using a validated algorithm and used Poisson regression to model annual venous thromboembolism counts. Results We identified 31,656 cases of acute symptomatic venous thromboembolism between April 1, 2002, and March 31, 2012. The age and sex adjusted incidence rate of venous thromboembolism was 1.38 (95% CI: 1.37, 1.40) per 1000 person-years. For pulmonary embolism it was 0.38 (95% CI: 0.36, 0.40) per 1000 person-years and for deep vein thrombosis it was 1.0 (95% CI: 0.99, 1.1) per 1000 person-years. The adjusted model showed no significant change in the incidence of venous thromboembolism during the study period. The 30-day case fatality rate of venous thromboembolism was 2.0% (95% CI: 1.89, 2.21) and was almost doubled in patients with pulmonary embolism 3.9% (95% CI: 3.50, 4.33). The 1-year case fatality was 9.2% (95% CI: 8.88, 9.52) for venous thromboembolism and 12.9% (95% CI: 12.2, 13.6) for patients with pulmonary embolism. The case fatality increased with increasing subject age. The 1-year and 5-years survival after first acute venous thromboembolism were similar in patients with unprovoked and provoked events. However, in patients with cancer associated thrombosis, the 1-year and 5-years survival was 66% (95% CI: 64.71% to 67.29%) and 46% (95% CI: 43.28% to 48.72%) respectively. Conclusion The incidence of acute venous thromboembolism remained unchanged over a 10-years period. However, the case fatality of venous thromboembolism is substantial.
Workers in swine operations are exposed to indoor dusts and gases and are at increased risk of respiratory problems. Toll-like receptor (TLR) 2 recognizes ligands from gram-positive bacteria, whereas ...TLR4 responds to endotoxin from gram-negative bacteria.
To investigate the effects of TLR2 and TLR4 polymorphisms on lung function in workers from swine operations and nonfarming rural dwellers.
A total of 374 full-time workers from large swine operations and 411 nonfarming rural dwellers from Saskatchewan were included. Information on demography, lifestyle, and occupation, lung function measurements, and blood samples for genotyping were obtained from the participants. Multiple regression analysis and Bonferroni correction were used in the statistical analysis.
Workers with TLR2-16933T/A polymorphism (AA) had significantly greater mean values of lung function than workers with wild-type genotypes (AT+TT) after controlling for potential confounders (forced expiratory volume in 1 second, 3.7 vs 3.5 L; P=.009; forced expiratory flow between 25% and 75%, 3.7 vs 3.3 L; P=.003; predicted forced expiratory volume in 1 second; 100.3% vs 95.6%; P=.005; forced expiratory flow between 25% and 75%, 92.4% vs 83.4%; P=.009). These results were also observed for TLR2Arg677Trp polymorphism among the workers. No such significant differences were observed among nonfarming rural dwellers. For Asp299Gly and Thr399Ile polymorphisms in the TLR4 gene, no significant differences were observed in the mean lung function values between the polymorphic and wild-type groups in both workers and rural dwellers.
Our study is the first, to our knowledge, to report protective effects of TLR2 polymorphisms on lung function among workers in swine operations and raises the possibility that TLR2 polymorphisms are protective of airway disease in individuals exposed to gram-positive organisms in the inhaled airborne dust.
To the Editor: Previous studies have demonstrated that working in swine operations is associated with respiratory problems due to exposure to swine barn environment.1 Increased levels of nitric oxide ...(NO) in exhaled air have been reported among swine operation workers and healthy adults after 3-hour exposure in pig confinement buildings, suggesting that this may be an important mediator of the observed health effects.1 Of the 3 human NOS genes (NOS1, NOS2, and NOS3), the NOS3 gene is likely more important than others for respiratory problems in swine operation workers because human airway epithelial cells express only NOS3.2 The expression of the NOS1 gene in human airway epithelial cells is undetectable,3 and the NOS2 gene is expressed only after exposure to LPS or cytokines.4 The NOS3 gene also has a regulatory role in the activation and expression of NOS2.5 However, to date, there is limited research on the relationship between NOS3 polymorphisms and lung function in humans. ...this study is the first to show variation in the association between NOS3 polymorphisms and lung function in humans exposed to high and low levels of respiratory hazards, demonstrating a possible gene-environment interaction.\n25 (0.12)dagger 0.25 (0.15) 1.08 (1.60) 0.22 (0.26) -0.24 (0.12)dagger -0.22 (0.15) -1.66 (1.60) -0.40 (0.26)
BACKGROUND Acute asthma is a common ED presentation. In a prospective, multicenter cohort study, we determined the frequency and factors associated with asthma relapse following discharge from the ...ED. METHODS Adults aged 18 to 55 years who were treated for acute asthma and discharged from 20 Canadian EDs underwent a structured ED interview and a follow-up telephone interview 4 weeks later. Standardized antiinflammatory treatment was offered at discharge. Multivariable analyses were performed. RESULTS Of 807 enrolled patients, 58% were women, and the median age was 30 years. Relapse occurred in 144 patients (18%) within 4 weeks of ED discharge. Factors independently associated with relapse occurrence were female sex (women, 22% vs men, 12%; adjusted OR aOR, 1.9; 95% CI, 1.2-3.0); symptom duration of ≥ 24 h prior to ED visit (long duration, 19% vs short duration, 13%; aOR, 1.7; 95% CI, 1.3-2.3); ever using oral corticosteroids (ever use, 21% vs never use, 12%; aOR, 1.5; 95% CI, 1.1-2.0); current use of an inhaled corticosteroid (ICS/long-acting β-agonist combination product (combination product, 25% vs ICS monotherapy,15%; aOR, 1.9; 95% CI, 1.1-3.2); and owning a spacer device (owning one, 24% vs not owning one, 15%; aOR, 1.6; 95% CI, 1.3-1.9). CONCLUSIONS Despite receiving guideline-concordant antiinflammatory treatments at ED discharge, almost one in five patients relapsed within 4 weeks. Female sex, prolonged symptoms, treatment-related factors, and markers of prior asthma severity were significantly associated with relapse. These results may help physicians target more aggressive interventions for patients at high risk of relapse.
To determine if there is a relationship between low serum ferritin and sleep disturbance in children with autism spectrum disorder, an 8-week open-label treatment trial with oral iron supplementation ...was conducted as a pilot study. At baseline and posttreatment visits, parents completed a Sleep Disturbance Scale for Children and a Food Record. Blood samples were obtained. Thirty-three children completed the study. Seventy-seven percent had restless sleep at baseline, which improved significantly with iron therapy, suggesting a relationship between sleep disturbance and iron deficiency in children with autism spectrum disorder. Sixty-nine percent of preschoolers and 35% of school-aged children had insufficient dietary iron intake. Mean ferritin increased significantly (16 μg/L to 29 μg/L), as did mean corpuscular volume and hemoglobin, suggesting that low ferritin in this patient group resulted from insufficient iron intake. Similar prevalence of low ferritin at school age as preschool age indicates that children with autism spectrum disorder require ongoing screening for iron deficiency.
Rural children have lower reported rates of asthma compared with urban children. Although reasons for these differences remain unclear, 3 possible explanations exist: (1) environmental differences, ...(2) variations in health care access, and (3) variations in health risk behaviors.
We investigated asthma among children living on farms and in small towns and its potential determinants, including personal, behavioral, and environmental factors.
School children (n = 842, ages 6-13; participation rate = 72.0%) were involved in a 2003 cross-sectional study. Their parents completed a lung health survey that included questions about asthma, asthma-like symptoms, and potential determinants of asthma (demographic, environmental, health risk behaviors). Participating children were classified into farm dwellers (live on farm or acreage) and small town dwellers. Multiple logistic regression was used to investigate the association between asthma and wheeze with demographic, environmental, and behavioral exposures with simultaneous adjustment for confounders.
Asthma and wheeze prevalence was not significantly different between farm and small town areas (current asthma: 16% vs 13%, respectively; current wheeze: 27% vs 21%, respectively) and followed consistent patterns. Factors associated with diagnosed asthma were dampness (odds ratio OR = 1.85; 95% confidence interval CI = 1.08-3.17), with enrollment in daycare found to be protective (OR = 0.53; 95% CI = 0.33-0.85). Being obese or overweight was associated with wheeze (OR = 1.77; 95% CI = 1.06-2.97).
Given the differences between areas and the associations between environmental risk factors and obesity with asthma and wheeze, the study findings support environment and health risk behavior explanations for the observed geographic variations.
Background Toll-like receptor 4 (TLR4) variants have been shown to reduce the respiratory responses to inhaled LPS in controlled experiments among healthy volunteers. Objective We sought to ...investigate whether naive subjects with TLR 4 variants showed reduced respiratory response to a complex aerosol including endotoxin as a major constituent. Methods Twenty-nine nonsmoking, nonatopic healthy subjects with TLR4 299/399 polymorphisms and 29 age- and sex-matched, wild-type TLR4 control subjects were exposed for 5 hours each in a noncontaminated environment (baseline day) and in a swine confinement facility (exposure day). There were 16 men and 13 women in each of the 2 age- and sex-matched groups. Results TLR4 polymorphic subjects who were exposed to high endotoxin levels (≥1550 EU/m3 ) had less reduction in the percentage across-shift change in FEV1 from baseline than did wild-type subjects exposed to similar endotoxin levels. Among subjects exposed to higher endotoxin levels, the mean differences in the percentage across-shift changes between baseline and exposure days were significantly less in TLR4 polymorphic subjects compared with those seen in wild-type subjects in FEV1 (−8.48% ± 1.52% mean ± SE vs −11.46% ± 1.79%, P = .001), forced expiratory flow between 25% and 75% of forced vital capacity (−18.30% ± 1.99% vs −24.14% ± 3.28%, P = .009), and FEV1 /forced vital capacity ratio (−5.40% ± 0.56% vs −8.53% ± 1.51%, P = .04). These patterns were not observed in IL-6 levels from serum and nasal lavage fluid, IL-8 levels from nasal lavage fluid, white blood cell counts, or blood differential counts. Conclusion The association between TLR4 variants and reduced airway responsiveness to inhaled particulate was observed at high endotoxin concentrations, creating the possibility of certain threshold phenomena for the apparent protective effect of TLR4 variants.
The response to innate immune stimuli seems to be critical to conditioning adaptive immunity. Early exposure to endotoxin initiates immune responses that have been shown to alter the risk of asthma ...and allergic diseases. The toll-like receptor 4 (TLR4) gene encodes the principal innate immunity receptor in humans for bacterial endotoxin. Polymorphisms in the TLR4 gene may regulate the effects of endotoxin exposure and could play a role in the development of asthma and atopy-related phenotypes.
To investigate the association between TLR4 polymorphisms and allergic phenotypes in nonsmokers.
The data from 915 nonsmoking students were available for the study. The TLR4 299 and 399 polymorphisms were genotyped using mouthwash samples. The TLR4 299 and 399 polymorphisms were grouped together to define the TLR4 polymorphic group. Skin prick tests were conducted in a subgroup of healthy participants. A brief questionnaire was administered to determine demographic characteristics and chronic health conditions.
The prevalence of hay fever was 0% in the TLR4 polymorphic group and 7.5% in the wild-type group (P = .01). After controlling for age group and sex using logistic regression, the odds of having hay fever were reduced by 88% (P = .009) in the TLR4 polymorphic group compared with the wild-type group. In a subgroup analysis, the association between TLR4 polymorphisms and atopy was only observed among females.
To our knowledge, this study is the first to report an association between TLR4 polymorphisms and atopy-related phenotypes in a nonsmoking population. Further investigation of the role of TLR4 polymorphisms in asthma and atopy-related phenotypes is warranted.
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