OBJECTIVETo confirm the existence of an increased risk of complications from influenza A (H1N1)p among patients with diabetes.RESEARCH DESIGN AND METHODSUsing data from an enhanced influenza surveillance project in Montreal, Canada, and age/sex-specific population estimates of diabetes prevalence, we estimated the risk of hospitalization among persons with diabetes. Comparing hospitalized patients admitted or not to an intensive care unit (ICU), we estimated the risk of ICU admission associated with diabetes, controlling for other patient characteristics.RESULTSAmong 239 hospitalized patients with PCR-confirmed influenza A (H1N1)p, 162 (68%) were interviewed, of whom 22 had diabetes, when 7.1 were expected (prevalence ratio 3.10 [95% CI 2.04–4.71]). The odds ratio for ICU admission was 4.29 (95% CI 1.29–14.3) among hospitalized patients with diabetes compared to those without.CONCLUSIONSDiabetes triples the risk of hospitalization after influenza A (H1N1)p and quadruples the risk of ICU admission once hospitalized.

Aims: To test the long term cost-benefit and cost-effectiveness of the Sherbrooke model of management of subacute occupational back pain, combining an occupational and a clinical rehabilitation intervention. Methods: A randomised trial design with four arms was used: standard care, occupational arm, clinical arm, and Sherbrooke model arm (combined occupational and clinical interventions). From the Quebec WCB perspective, a cost-benefit (amount of consequence of disease costs saved) and cost-effectiveness analysis (amount of dollars spent for each saved day on full benefits) were calculated for each experimental arm of the study, compared to standard care. Results: At the mean follow up of 6.4 years, all experimental study arms showed a trend towards cost benefit and cost effectiveness. These results were owing to a small number of very costly cases. The largest number of days saved from benefits was in the Sherbrooke model arm. Conclusions: A fully integrated disability prevention model for occupational back pain appeared to be cost beneficial for the workers' compensation board and to save more days on benefits than usual care or partial interventions. A limited number of cases were responsible for most of the long term disability costs, in accordance with occupational back pain epidemiology. However, further studies with larger samples will be necessary to confirm these results.

The authors report the results of a case-cohort study of 338 lung cancer deaths in 1950-1988 and a random sample (sub-cohort) of 1,138 from among 16,297 men who had worked at least one year between 1950 and 1979 in manual jobs at a large aluminum production plant. In the past, certain workers were exposed to substantial quantities of coal tar pitch volatiles, a mixture known to include polynuclear (polycyclic) aromatic hydrocarbons, and thus suspected to be capable of causing lung cancer. After they controlled for the effects of smoking, the authors found that rate ratios rose with cumulative exposure to coal tar pitch volatiles measured as benzene-soluble material to 2.25 (95% confidence interval (CI) 1.50-3.38) at 10-19 mg/m3-years benzene-soluble matter, but did not rise further at higher exposures. The data are compatible with a linear relation with benzene-soluble matter (rate ratio (RR) = 1 + 0.031 mg/m3-years benzene-soluble matter). This model predicts a rate ratio of 1.25, and lifelong excess risk of 2.2%, after 40 years exposure at the current hygiene standard (0.2 mg/m3). A curved relation (RR = 1 + 0.098 mg/m3-years benzene-soluble matter 0.7) fitted somewhat better. Under this model, the predicted risks after this exposure are higher: 1.42 and 3.8%. The data are compatible with both additive and multiplicative models for the combined effect of smoking and coal tar pitch volatiles.

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To confirm the relationship between exposure to coal tar pitch volatiles and bladder cancer among primary aluminum production workers, we carried out a case-control study among blue-collar workers who had worked more than 1 year between 1950-1979 in a major plant using mostly the Soderberg process in the Province of Québec. Cases of bladder cancer (ICD code 188) diagnosed between 1970-1979 (n = 69) were mostly included in a previously reported study. To these were added cases diagnosed between 1980-1988 (n = 69). Each case was matched to three controls on date of birth, date of hiring, and length of service at the company. Smoking habits were assessed from the medical records at the company. Benzene-soluble matter (BSM) and benzo(a)pyrene (BaP) were used as indicators of environmental exposure to coal tar pitch volatiles in the workplace. The estimated risk for current smokers was 2.63 (95% C.I. 1.29-5.37). Estimates of risk by occupational exposure were adjusted for smoking. Men who had worked in the Soderberg potrooms were at higher risk of developing the disease, the risk increasing with the time spent in these departments. Similarly, a strong association between risk and cumulative exposure to BSM or to BaP was observed. The risks associated with cumulative exposure to BSM (mg/m3-years) and to BaP (microgram/m3-years) were described with mathematical models. Using a linear model (1 + bx) and lagging 10 years before the diagnosis, BaP cumulative exposure was a better indicator of risk than BSM cumulative exposure. The risk for each year of exposure to BaP at a concentration of 1 microgram/m3 increased by 1.7% (0.8%-3.2%). Using the same model for BSM, a worker exposed to the current threshold limit value of 0.2 mg/m3 for 40 years will sustain a risk of 2.22 (1.56-3.48). Comparison of risks according to different periods of diagnosis (1970-1979 vs. 1980-1988) did not reveal any significant temporal changes on risk estimates.

We developed a liposome-intercalated preparation of amphotericin B by using small, unilamellar vesicles 0.06 to 0.1 gim in diameter. In contrast to previously described liposomal preparations of amphotericin B, these vesicles have the advantage that they are small enough to be filter sterilized. We compared the efficacy of liposomal amphotericin B with that of the commercial drug given as an intravenous bolus every other day for 13 days (seven doses) in mice with disseminated candidiasis. Survival rates were similar for the two preparations at each dosage of amphotericin B; however, the highest survival rates occurred at dosages of liposomal amphotericin B which would be lethal to these animals if administered as the commercial drug. Viable colony counts of fungi in various organs, particularly the kidneys, tended to be lower with increasing dosage of the drug. However, some organisms persisted even after 13 days. These studies indicate that liposomal formulations of amphotericin B merit further investigation because of their improved therapeutic margins.Although amphotericin B is the most effective agent available for the treatment of many systemic fungal infections, its use is frequently complicated by serious adverse reactions (3,5,9). Attempts to circumvent the toxicity of amphotericin B by using the methyl ester at first appeared promising but were followed by reports that this formulation might cause leukoencephalopathy (4). Suggestions that the coadministration of mannitol might reduce the nephrotoxic potential of amphotericin B could not be substantiated (2).Incorporation of amphotericin B into liposomes offers a potential means to reduce the toxicity of this antifungal drug.Two groups have reported marked reductions in the acute lethality of liposome-intercalated amphotericin B and improved survival in murine models of histoplasmosis (12), cryptococcosis (6), and disseminated candidiasis (7), presumably because higher doses can be tolerated. However, both groups used relatively large multilamellar liposomes, leading to the possibility of embolization to organs, particularly lungs (12).We have developed a liposomal preparation of amphotericin B consisting of small, unilamellar vesicles with a size range of 0.06 to 0.1 ,um. The acute 50% lethal dose (LD50) of this liposomal amphotericin B preparation given as an intravenous bolus to mice is 11.8 mg/kg, compared with 2.3 mg/kg for commercial amphotericin B. One-half to three-quarters of the LD50 can be administered every third day to mice for at least 2 weeks without adverse effects (unpublished data). The present paper reports the activity of this liposomal preparation of amphotericin B in mice with disseminated candidiasis.MATERIALS AND METHODS Drug preparations. Amphotericin B was obtained from The Squibb Institute, Princeton, N.J., as the commercial preparation containing sodium desoxycholate.Small unilamellar vesicles were prepared by sonication in a bath-type sonicator (11) Ala.), cholesterol, and tocopherol succinate (Sigma Chemical Co., St. Louis,...

The Quebec Task Force Classification demonstrated good predictive ability by discriminating between subjects with and those without distal radiating pain.

Study design: To compare results obtained with a variety of locomotor rating scales in Th9/10 spinal cord transected (Tx) mice. Objectives: To assess spontaneous recovery with a variety of rating scales to find the most sensitive methods for assessing recovery levels in Tx mice and differences associated with gender and condition. Setting: Laval University Medical Center, Neuroscience Unit & Laval University, Department of Anatomy and Physiology, Quebec City, Quebec, Canada. Methods: Scales including the Basso, Beattie and Bresnahan (BBB), the Basso Mouse Score (BMS), the Antri, Orsal and Barthe (AOB), the Motor Function Score (MFS) and the Averaged Combined Score (ACOS) were used to assess, in open-field and treadmill conditions, spontaneous locomotor recovery in male and female Tx mice. Results: The ACOS scale revealed a progressive increase of spontaneous recovery during 5-weeks post-Tx. The other methods detected a progressive increase for the first 2-3 weeks postTx without any significant progress in weeks 4 and 5. Generally, scores obtained with each method were nonsignificantly different between males and females or between open-field and treadmill conditions. Conclusion: These results further confirm the existence of a limited but significant increase of locomotor function recovery, occurring without intervention, in Tx animals. Although each method could detect small levels of recovery, the ACOS method was discriminative enough to detect progressive changes up to 5 weeks post-Tx. In conclusion, the ACOS rating scale was the most discriminative method for assessing the spontaneous return of hindlimb movements found in Tx mice, both in open-field and treadmill conditions.