Edgar J. Love

Parkinson's disease and exposure to agricultural work and pesticide chemicals

This population-based case-control study of 130 Calgary residents with neurologist-confirmed idiopathic Parkinsons disease (PD) and 260 randomly selected age- and sex-matched community controls attempted to determine whether agricultural work or the occupational use of pesticide chemicals is associated with an increased risk for PD. We obtained by personal interviews lifetime occupational histories, including chemical exposure data, and analyzed the data using conditional logistic regression for matched sets. In the univariate analysis, a history of field crop farming, grain farming, herbicide use, or insecticide use resulted in a significantly increased crude estimate of the PD risk, and the data suggested a dose-response relation between the PD risk and the cumulative lifetime exposure to field crop farming and to grain farming. However, in the multivariate analysis, which controlled for potential confounding or interaction between the exposure variables, previous occupational herbicide use was consistently the only significant predictor of PD risk. These results support the hypothesis that the occupational use of herbicides is associated with an increased risk for PD.

Parkinson's disease A test of the multifactorial etiologic hypothesis

We studied the relative etiologic importance upon the development of Parkinsons disease (PD) of occupational exposure to herbicides and other compounds, ionizing radiation exposure, family history of PD and essential tremor, smoking, and history of various viral and other medical conditions. We identified patients (n = 130) with neurologist-confirmed idiopathic PD through contacts with Calgary general hospitals, long-term care facilities, neurologists, the Movement Disorder Clinic, and the Parkinsons Society of Southern Alberta, and selected two matched (by sex and age ± 2.5 years) community controls for each case by random digit dialing. We obtained lifetime work, chemical, radiation, medical, and smoking exposure histories and family histories of PD and essential tremor by personal interviews, and analyzed the data using conditional logistic regression for matched sets. After controlling for potential confounding and interaction between the exposure variables, using multivariate statistical methods, having a family history of PD was the strongest predictor of PD risk, followed by head trauma and then occupational herbicide use. Cases and controls did not differ in their previous exposures to smoking or ionizing radiation; family history of essential tremor; work-related contact with aluminum, carbon monoxide, cyanide, manganese, mercury, or mineral oils; or history of arteriosclerosis, chicken pox, encephalitis, hypertension, hypotension, measles, mumps, rubella, or Spanish flu. These results support the hypothesis of a multifactorial etiology for PD, probably involving genetic, environmental, trauma, and possibly other factors.

Serologic Response to Treatment of Infectious Syphilis

OBJECTIVE To evaluate the serologic response to treatment of patients with infectious syphilis. DESIGN Historical cohort study of all cases of infectious syphilis in Alberta from 1981 to 1987. PATIENTS A total of 1090 patients were entered; 857 with primary syphilis, 183 with secondary syphilis, and 50 with early latent disease. Two hundred and eight patients were excluded who either were pregnant, had negative serologic results before treatment, had clinical relapse, were treatment failures, or were lost to follow-up. INTERVENTIONS All 882 evaluable patients were treated with a recommended antibiotic regimen for infectious syphilis and returned for re-assessment including repeat serologic testing. MEASUREMENTS AND MAIN RESULTS Seventy-two percent (95% CI, 66% to 77%) and 56% (CI, 43% to 70%) of patients with initial episodes of primary or secondary syphilis had seroreverted according to rapid plasma reagin (RPR) test results by 36 months. A 2- and 3-tube decline was seen by 6 and 12 months in primary and secondary syphilis. Early latent syphilis resulted in only a 2-tube decrease at 12 months. Serologic response was not affected by sex, age, race, or sexual orientation. Patients with their first infection were more likely to experience RPR seroreversal than those with repeat infections. The RPR reversal rates also depended on the pretreatment titer and stage of disease. At 36 months, 24% (CI, 20% to 28%) of patients had nonreactive fluorescent treponemal antibody absorption tests (FTA-Abs), and 13% (CI, 11% to 15%) had nonreactive microhemoglutination tests for Treponema pallidum (MHA-TP). CONCLUSIONS Adequate therapeutic response for syphilis must be based on illness episode and the pretreatment RPR titer. Treponemal tests can demonstrate seroreversion after 36 months, and a negative treponemal test does not rule out a past history of syphilis.

Association between physical illness and suicide among the elderly

Background Only a few small studies have explored the association between various physical illnesses and suicide in the elderly and they have produced inconsistent results. Thus, we undertook this larger study to more definitively assess the association between elderly suicide and physical illness. Methods This case-control study compared the proportion with physical illnesses among 822 cases who committed suicide with that among 944 controls who died due to motor vehicle accident at age 55 years or over in Alberta, Canada. Results Compared to the motor vehicle accident deaths, the elderly who committed suicide were more likely to have cancer, ischemic heart disease, chronic pulmonary disease, peptic ulcer, prostatic disorder, depression and other psychiatric illnesses. There was no significant difference in the proportion of cerebrovascular disease and diabetes mellitus between the case and control groups before adjustment of demographic and clinical characteristics. After adjustment of these variables, the elderly with any of the following illnesses were more likely to die by suicide than those without the illness: cancer (adjusted odds ratio [95 % confidence interval]: 1.73 [1.16–2.58]), prostatic disorder (excluding prostatic cancer, 1.70 [1.16–2.49]), chronic pulmonary disease among the married (1.86 [1.22–2.83]), depression (6.70 [4.72–9.50]) or other psychiatric illness (2.16 [1.68–2.76]). There was no evidence that ischemic heart disease, cerebrovascular disease, peptic ulcer and diabetes mellitus might be associated with suicide in the elderly. Conclusions Cancer, prostatic disorder, chronic pulmonary disease among the married and psychiatric illness appear to be associated with suicide among the elderly.

Parkinson's disease and exposure to rural environmental factors : a population based case-control study

To determine whether a history of exposure to rural environmental factors leads to an increased likelihood of developing idiopathic Parkinsons disease, we conducted a case-control study of 130 cases and 260 randomly selected community controls (matched with the cases by sex and age +/- 2.5 years at a ratio of 2 controls: 1 case) in the city of Calgary. The data were collected by personal interviews and were analyzed using conditional logistic regression for matched sets. The ages of the cases ranged from 36.5 to 90.7 years (mean = 68.5 +/- 11.3 years). The mean age at diagnosis was 61.1 +/- 12.4 years. The mean duration of disease was 7.8 +/- 0.6 years. Eleven (9.1%) cases were diagnosed before age 40. In this sample from the Province of Alberta, Canada, no significant increase in risk for Parkinsons disease was associated with a history of rural living, farm living, or well water drinking in early childhood or at any time during the first 45 years of life.

Athletic Injury Reporting Development of Universal Systems

SummaryThere are numerous athletic injury reporting systems currently in place. In order for our understanding of athletic injury epidemiology to advance, we must be able to compare data from divergent sources. This paper provides a review of existing athletic injury reporting systems in North America. The epidemiological designs employed in these systems are outlined, along with a description of the strengths and weaknesses of each approach to reporting. The differences between the case-series and cohort methods are delineated and the importance of injury definition, sources of error, denominator data and exposure estimation are discussed within this context.Four recommendations are then offered to assist in moving toward more universal systems for athletic injury reporting. First, comparability of data between systems should be maximised through clear indication of the reporting system design and the methods of data collection. Secondly, an exact definition should be given as to what constitutes a reportable event (‘injury’). Thirdly, whenever possible, outcome information should be collected on each reported event so that an injury definition may be applied at the time of data analysis. Lastly, any limitations or sources of error should be acknowledged.

Association of semen quality and occupational factors: comparison of case-control analysis and analysis of continuous variables

OBJECTIVE To compare two statistical approaches, case-control and analysis of continuous parameters of semen, in examining the relationship between occupational exposures and male reproductive function. DESIGN Case-control study. SETTING Males providing semen samples at a university infertility clinic. PATIENT(S) Nonvasectomized males who provided at least one semen sample at an infertility clinic. MAIN OUTCOME MEASURE(S) Standard clinical semen analysis. RESULT(S) Analyses using a dichotomous dependent variable did not uncover significant associations between any occupational factor and infertility case status. However, linear models incorporating continuous variables identified a number of occupational factors that were associated with specific parameters of semen. A reduction in percentage of progressive sperm and an increase in percentage of coiled tail sperm defects in welders, compared with unexposed subjects, were found. Significant dose-response relationships between level of perceived job stress and percentage of progressive sperm, total motile count, morphology, abnormal heads, and coiled tail defects were found. CONCLUSION(S) The findings suggest that subtle changes in semen variables, possibly associated with workplace exposure, may be detected only with parametric analyses of continuous variables of semen.

Clinical efficacy and safety of cyproterone acetate in severe hirsutism: results of a multicentered Canadian study*†

We compared the efficacy and safety of cyproterone acetate (Shering AC, Berlin, FRG) at a low (Diane, 2 mg) or a high dose (Androcur, 100 mg) in the treatment of 158 patients with severe hirsutism. At baseline, no difference was observed in mean hirsutism total index (19.5 Diane versus 20.1 Androcur) or distribution (facial, bust, or abdomen). By the end of the study, patient loss in Diane and Androcur groups was 29.1% and 27.8%, respectively, and the mean percent difference in the scoring index was as follows: total, 24.6 Diane versus 30.8 Androcur, P less than 0.05; facial, 30.1 Diane versus 33.0 Androcur, P less than 0.10; bust, 12.1 Diane versus 31.2 Androcur, P less than 0.02; and abdomen, 20.1 Diane versus 31.2 Androcur, P less than 0.02. Except for breast tenderness (Diane greater than Androcur), amenorrhea, and weight gain, (Androcur greater than Diane), the incidence of side effects was comparable in both groups.

Women and exercise participation: The mixed blessings of motherhood

Exercise participation, perceived barriers to exercise, and perceived benefits of exercise were analyzed in a large random sample of urban women ages 20-49 (N = 1,113). Although mothers and women without children perceived similar benefits of exercising, mothers were much less active than women without children. The differences were greatest for women under the age of 40. After age 40, the differences were smaller as a result of the decrease in exercise in women without children. The study also indicated that motherhood itself, rather than the number and ages of children, was a barrier to exercise participation. In general, mothers perceived more barriers to exercising than did women without children. These findings illustrate the differences in opportunities for mothers and women without children due to sociocultural circumstances and have implications for the planning of exercise promotion for mothers.

Women's Knowledge of Prenatal Ultrasound and Informed Choice

This study evaluated womens understanding of prenatal ultrasound in terms of meeting the requirements for informed choice. A cross-sectional survey was conducted to evaluate (1) how information is provided, (2) womens perceived value of the information received and, (3) their understanding of ultrasound in relation to the principles of informed choice. Women (n = 113) completed a questionnaire prior to their 18-week ultrasound. Fifty-five percent stated they received no information from their care provider. Only 31.9% considered health care providers as a “very helpful” source of information. Yet, 69.0% stated their care provider gave them information that facilitated their understanding. Gaps were identified in womens understanding of ultrasound. Specifically, 46.0% did not view ultrasound as a screen for anomalies; some were uncertain about the safety (18.6%), diagnostic capabilities (26.5%), and limitations of testing (37.2%). These results suggest that womens understanding of ultrasound does not meet the requirements of informed choice.