[show abstract][hide abstract] ABSTRACT: Based on promising results from laboratory studies, we hypothesized that pneumococcal vaccination would protect patients from myocardial infarction.
We conducted a hospital-based case-control study that included patients considered to be at risk of myocardial infarction. We used health databases to obtain hospital diagnoses and vaccination status. We compared patients who had been admitted for treatment of myocardial infarction with patients admitted to a surgical department in the same hospital for a reason other than myocardial infarction between 1997 and 2003.
We found a total of 43 209 patients who were at risk; of these, we matched 999 cases and 3996 controls according to age, sex and year of hospital admission. Cases were less likely than controls to have been vaccinated (adjusted odds ratio [OR] 0.53, 95% confidence interval [CI] 0.40-0.70). This putative protective role of the vaccine was not observed for patients who had received the vaccine up to 1 year before myocardial infarction (adjusted OR 0.85, 95% CI 0.54-1.33). In contrast, if vaccination had occurred 2 years or more before the hospital admission, the association was stronger (adjusted OR 0.33, 95% CI 0.20-0.46).
Pneumococcal vaccination was associated with a decrease of more than 50% in the rate myocardial infarction 2 years after exposure. If confirmed, this association should generate interest in exploring the putative mechanisms and may offer another reason to promote pneumococcal vaccination.
Canadian Medical Association Journal 11/2008; 179(8):773-7. · 6.47 Impact Factor
[show abstract][hide abstract] ABSTRACT: To document breastfeeding rates from birth to six months as well as the factors facilitating and constraining the continuation of breastfeeding in women in the Eastern Townships of Quebec and to compare these to the results obtained in 1999.
Postal questionnaire sent to 374 mothers who had breastfed and analysis of archival data.
Breastfeeding rates were 86.3% at birth and 75% at discharge from hospital in all mothers who gave birth to a child in 2004-2005. Breastfeeding rates in the 272 mothers who answered the questionnaire were reported to be 67.3% and 47.4% at three and six months respectively. Results indicate that 8.9% of infants were still receiving breast milk exclusively after the third month. However, 27.9% of the mothers had stopped breastfeeding during the infant's first week. Support from the nurses was the primary factor facilitating breastfeeding. The main reasons the mothers gave for stopping breastfeeding were problems with breastfeeding and fatigue.
Breastfeeding rates in this area of Quebec have increased significantly in the past five years and are comparable with those in the rest of Canada. Breastfeeding exclusively up to six months is rare, and initiatives to support breastfeeding mothers in the hospital and in the community are having success.
Canadian journal of public health. Revue canadienne de santé publique 01/2008; 99(3):212-5. · 1.02 Impact Factor
[show abstract][hide abstract] ABSTRACT: A series of measures were implemented, in a secondary/tertiary-care hospital in Quebec, to control an epidemic of nosocomial Clostridium difficile-associated disease (n-CDAD) caused by a virulent strain; these measures included the development of a nonrestrictive antimicrobial stewardship program. Interrupted time-series analysis was used to evaluate the impact of these measures on n-CDAD incidence. From 2003-2004 to 2005-2006, total and targeted antibiotic consumption, respectively, decreased by 23% and 54%, and the incidence of n-CDAD decreased by 60%. No change in n-CDAD incidence was noted after strengthening of infection control procedures (P=.63), but implementation of the antimicrobial stewardship program was followed by a marked reduction in incidence (P=.007). This suggests that nonrestrictive measures to optimize antibiotic usage can yield exceptional results when physicians are motivated and that such measures should be a mandatory component of n-CDAD control. The inefficacy of infection control measures targeting transmission through hospital personnel might be a result of their implementation late in the epidemic, when the environment was heavily contaminated with spores.
[show abstract][hide abstract] ABSTRACT: Cerebral metastases are clinically significant in 10% to 30% of patients with neoplasia. Multiple cerebral metastases are typically treated with palliative radiotherapy. There is no consensus on the role of enhanced chemotherapy delivery as an adjuvant treatment modality in this disease. In this report, the authors detailed their experience with intraarterial (IA) chemotherapy infusion with and without blood-brain barrier disruption (BBBD) in patients with multiple cerebral metastases.
From November 1999 to May 2005, 38 patients with multiple cerebral metastases were enrolled in a prospective study. Patients were treated with IA carboplatin, except for those with cerebral metastases of systemic lymphoma, who were administered IA methotrexate. Osmotic BBBD was offered to patients without the presence of a significant mass effect. These regimens were coupled with intravenous etoposide and cyclophosphamide. Cycles were repeated every 4 weeks.
Survival was calculated from study entry and radiologic response was based on MacDonald criteria. Kaplan-Meier estimates were generated for all subgroups. Mean and median survival obtained was as follows: 34 and 29.6 months for the whole group; 33.6 and 42.3 months for ovarian carcinoma; 15.3 and 13.5 months for lung adenocarcinomas; 8.3 and 8.8 months for small cell lung carcinoma; 8.9 and 8.1 months for breast carcinoma; and 24.8 and 16.3 months, respectively, for cerebral metastasis from systemic lymphoma.
Even with a small number of patients in each subgroup, the results obtained seem promising for multiple brain metastasis of ovarian carcinoma, adenocarcinoma of lung, small cell lung carcinoma, and systemic lymphoma.
Cancer 03/2007; 109(4):751-60. · 5.20 Impact Factor