Infants Born Large for Gestational Age and Developmental Attainment in Early Childhood.

Objectives: To investigate if an association exists between being born large for gestational age (LGA) and verbal ability or externalizing behaviour problems at ages 4-5 years.

Method: A secondary analysis was conducted using the National Longitudinal Survey of Children and Youth, including singleton births in 2004-2005 followed till 4-5 years ( = 1685). LGA was defined as a birth weight > 90th percentile.

Mild prematurity, proximal social processes, and development.

Objective: To elucidate the role of gestational age in determining the risk of poor developmental outcomes among children born late preterm (34-36 weeks) and early term (37-38 weeks) versus full term (39-41 weeks) by examining the contribution of gestational age to these outcomes in the context of proximal social processes.

Methods: This was an analysis of the Canadian National Longitudinal Survey of Children and Youth. Developmental outcomes were examined at 2 to 3 (N= 15099) and 4 to 5 years (N= 12302).

The validity and reliability of the neurogenic bladder symptom score.

Purpose: The neurogenic bladder symptom score is a tool to measure urinary symptoms and consequences in patients with acquired or congenital neurogenic bladder. We describe score validity and reliability.

Materials And Methods: Exploratory factor analysis was used to assess item variability and subscale structure.

Neonatal morbidity associated with late preterm and early term birth: the roles of gestational age and biological determinants of preterm birth.

Background: The aim of this study was to elucidate the role of gestational age in determining the risk of neonatal morbidity among infants born late preterm (34-36 weeks) and early term (37-38 weeks) compared with those born full term (39-41 weeks) by examining the contribution of gestational age within the context of biological determinants of preterm birth.

Methods: This was a retrospective cohort study. The sample included singleton live births with no major congenital anomalies, delivered at 34-41 weeks of gestation to London-Middlesex (Canada) mothers in 2002-11.

Hypertension in pregnancy after Escherichia coli O157:H7 gastroenteritis: a cohort study.

Background: Escherichia coli O157:H7 is a common cause of bacterial gastroenteritis and may increase the risk of hypertension. We studied the risk of hypertension in pregnancy following a large E. coli O157:H7 outbreak that occurred in Walkerton, Canada, in the year 2000.

Urine volume and change in estimated GFR in a community-based cohort study.

Background And Objectives: The effect of increased fluid intake on kidney function is unclear. This study evaluates the relationship between urine volume and renal decline over 6 years in a large community-based cohort.

Design, Setting, Participants, & Measurements: This prospective cohort study was undertaken in Canada from 2002 to 2008.

Dipstick proteinuria as a screening strategy to identify rapid renal decline.

Rapid kidney function decline (RKFD) predicts cardiovascular morbidity and mortality, but serial assessment of estimated GFR (eGFR) is not cost-effective for the general population. Here, we evaluated the predictive value of albuminuria and three thresholds of dipstick proteinuria to identify RKFD in 2,574 participants in a community-based prospective cohort study with a median of 7 years follow-up. Median change in eGFR was -0.

Controlling quality in CME/CPD by measuring and illuminating bias.

Introduction: There has been a surge of interest in the area of bias in industry-supported continuing medical education/continuing professional development (CME/CPD) activities. In 2007, we published our first study on measuring bias in CME, demonstrating that our assessment tool was valid and reliable. In light of the increasing interest in this area, and building on our experience, we wanted to further understand the application of this tool in different environments.

Performance of the creatinine-based and the cystatin C-based glomerular filtration rate (GFR) estimating equations in a heterogenous sample of patients referred for nuclear GFR testing.

Cystatin C may be a more accurate marker of the glomerular filtration rate (GFR) than creatinine. We evaluated the performance of the creatinine-based abbreviated modification of diet in renal disease (MDRD), the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations, and 6 cystatin C-based equations in estimating GFR (eGFR) in a heterogeneous sample of patients. Measured GFR (mGFR) was obtained from the plasma clearance of 99mtechnetium Diethylenetriaminepentaacetic acid in 42 adult patients referred for nuclear GFR testing (January to March 2008).

Patient attitudes towards the arteriovenous fistula: a qualitative study on vascular access decision making.

Background: The use of arteriovenous fistulas (AVFs) among hemodialysis (HD) patients has been consistently associated with lower rates of morbidity and mortality; however, up to 30% of eligible patients refuse the creation or cannulation of an AVF. We aimed to understand the attitudes, beliefs, preferences and values of patients who refused creation or use of an AVF.

Methods: With qualitative methodology, we conducted semi-structured interviews with 13 HD patients (Canada, 2009), who previously refused creation or use of an AVF.

Association between estimated glomerular filtration rate at initiation of dialysis and mortality.

Background: Recent studies have reported a trend toward earlier initiation of dialysis (i.e., at higher levels of glomerular filtration rate) and an association between early initiation and increased risk of death.

Long term risk for hypertension, renal impairment, and cardiovascular disease after gastroenteritis from drinking water contaminated with Escherichia coli O157:H7: a prospective cohort study.

Objectives: To evaluate the risk for hypertension, renal impairment, and cardiovascular disease within eight years of gastroenteritis from drinking water contaminated with Escherichia coli O157:H7 and Campylobacter.

Design: A prospective cohort study. Setting Walkerton, Ontario, Canada.

Risk of pregnancy-related hypertension within 5 years of exposure to drinking water contaminated with Escherichia coli O157:H7.

The authors evaluated the risk for pregnancy-related hypertension among previously healthy women who conceived within 5 years of exposure to drinking water contaminated with Escherichia coli O157.H7 in Walkerton, Canada (2000). Chronic hypertension was defined as systolic/diastolic blood pressure >/=140/90 mm Hg before 20 weeks gestation; gestational hypertension was defined as new onset systolic/diastolic blood pressure >/=140/90 mm Hg >/=20 weeks gestation.

Who should be referred for a fistula? A survey of nephrologists.

Background: There is marked variation in the use of the arteriovenous fistula (AVF) across programmes, regions and countries not explained by differences in patient demographics or comorbidities. The lack of clear criteria of who should or should not get a fistula may contribute to this, as well as barriers to creating AVFs.

Methods: We conducted a survey of Canadian and American nephrologists to assess the patient variables considered to determine the timing and type of access requested.

Risk of pregnancy-related hypertension within five years of exposure to bacteria-contaminated drinking water.

Exposure to Escherichia coli O157:H7 may result in subclinical kidney injury manifesting as hypertension during pregnancy. We evaluated the risk of pregnancy-related hypertension (PRH) among previously healthy females from the Walkerton Health Study, Canada (2002-6), who conceived within five years of exposure to bacteria-contaminated drinking water. Ontario Ministry of Health Antenatal forms were used to determine outcomes and risk factors.

Elevated blood pressure in relation to overweight and obesity among children in a rural Canadian community.

Objective: Childhood overweight and obesity may result in premature onset of cardiovascular risk factors such as hypertension. Rural populations in North America may be at increased risk for overweight. We evaluated whether overweight and obesity were associated with prehypertension and hypertension in a well-characterized population of children in rural Canada.

Treating TTP/HUS with plasma exchange: a single centre's 25-year experience.

Thrombotic thrombocytopenic purpura/Haemolytic uremic syndrome (TTP/HUS) is a thrombotic microangiopathy with a 6-month mortality rate of 16-29%. The present study described the clinical features, treatment regime and 6-month all-cause mortality rate of TTP/HUS patients at the London Health Sciences Centre (LHSC), Canada. Data for this retrospective cohort study were obtained from inpatient and outpatient records for all patients referred for plasma exchange therapy at LHSC, Canada between 1981 and 2006.

Evaluation of GFR estimating equations in the general community: implications for screening.

The Kidney Disease Outcomes Quality Initiative has recommended the use of GFR estimating equations to detect silent chronic kidney disease (CKD) in the community. The benefit of general reporting of CKD must be balanced with the harm of mislabeling people who do not have CKD. The popular Cockcroft-Gault (CG) and Modification of Diet in Renal Disease (MDRD) GFR estimating equations were compared with the recently devised Rule equation in a representative community population sample (2166) divided into subsamples with (385) and without (1781) previous renal impairment.

Developing an instrument to measure bias in CME.

Introduction: The pharmaceutical industry, by funding over 60% of programs in the United States and Canada, plays a major role in continuing medical education (CME), but there are concerns about bias in such CME programs. Bias is difficult to define, and currently no tool is available to measure it.

Methods: Representatives from industry and academia collaborated to develop a tool to illuminate and measure bias in CME.

Advancing rehabilitation research: an interactionist perspective to guide question and design.

The purpose of this position statement is to propose an interactionist framework to bring together the existing literature and provide a unifying direction for rehabilitation research. The framework comprises three components: the conceptual model, the research question, and the research design. The interactionist conceptual model has been adapted from the World Health Organization International Classification of Functioning, Disability, and Health.

A gradient of acute gastroenteritis was characterized, to assess risk of long-term health sequelae after drinking bacterial-contaminated water.

Objective: A municipal water system became contaminated with Escherichia coli O157:H7 and Campylobacter spp. Beginning 2 years after an outbreak, all residents from the region were invited to participate in a cohort study assessing the risk of long-term sequelae. We aimed to develop a method to grade the accuracy and severity of self-reported acute symptoms.

Influential observations in weighted analyses: examples from the National Longitudinal Survey of Children and Youth (NLSCY).

This paper highlights the impact of survey weights on model fit in multiple linear regression with specific reference to the National Longitudinal Survey of Children and Youth (NLSCY) and provides recommendations for the treatment of influential observations. Multiple linear regression was used to estimate the association between child and family factors in the preschool years and vocabulary development at school age. Analyses were performed with and without survey weights.

Long-term health sequelae following E. coli and campylobacter contamination of municipal water. Population sampling and assessing non-participation biases.

Background: Following bacterial contamination of a municipal water system in the rural town of Walkerton, Ontario, over 2,300 cases of acute gastroenteritis were documented. The Walkerton Health Study is currently underway to assess for long-term health sequelae among consenting inhabitants of Walkerton, related to the original outbreak. We explored whether the association between the acute exposure and preliminary long-term health outcomes may have been biased through differences between early- and late-recruited study participants.

Microalbuminuria three years after recovery from Escherichia coli O157 hemolytic uremic syndrome due to municipal water contamination.

Background: Knowledge of the long-term renal prognosis of diarrhea associated hemolytic uremic syndrome (HUS) is important for patient counseling and follow-up. However, estimates of long-term risk are highly variable, with previous studies not using a healthy control group.

Methods: A municipal water system in the small rural town of Walkerton, Ontario, became contaminated with Escherichia coli O157:H7 in 2000.