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Chiarello LA, Palisano RJ, McCoy SW, Bartlett DJ, Wood A, Chang HJ, Kang LJ, Avery L. Child engagement in daily life: a measure of participation for young children with cerebral palsy. Disabil Rehabil 2014; 36:1804-16. [DOI: 10.3109/09638288.2014.882417] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Bernstein MT, Graff LA, Avery L, Palatnick C, Parnerowski K, Targownik LE. Gastrointestinal symptoms before and during menses in healthy women. BMC WOMENS HEALTH 2014; 14:14. [PMID: 24450290 PMCID: PMC3901893 DOI: 10.1186/1472-6874-14-14] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 01/21/2014] [Indexed: 12/17/2022]
Abstract
Background Little is known as to the extent gastrointestinal (GI) complaints are reported by women around menses. We aimed to describe GI symptoms that occurred premenstrually and during menses in healthy women, and to specifically assess the relationship of emotional symptoms to GI symptoms around menses. Methods We recruited healthy, premenopausal adult women with no indication of GI, gynecologic, or psychiatric disease who were attending an outpatient gynecology clinic for well-woman care. They completed a survey that queried menstrual histories and the presence of GI and emotional symptoms. We compared the prevalence of primary GI symptoms (abdominal pain, diarrhea, constipation, nausea, vomiting), as well as pelvic pain and bloating, in the 5 days preceding menses and during menses, and assessed whether emotional symptoms or other factors were associated with the occurrence of GI symptoms. Results Of 156 respondents, 73% experienced at least one of the primary GI symptoms either pre- or during menses, with abdominal pain (58% pre; 55% during) and diarrhea (24% pre; 28% during) being the most common. Those experiencing any emotional symptoms versus those without were more likely to report multiple (2 or more) primary GI symptoms, both premenstrually (depressed p = 0.006; anxiety p = 0.014) and during menses (depressed p < 0.001; anxiety p = 0.008). Fatigue was also very common (53% pre; 49% during), and was significantly associated with multiple GI symptoms in both menstrual cycle phases (pre p < 0.001; during p = 0.01). Conclusions Emotional symptoms occurring in conjunction with GI symptoms are common perimenstrually, and as such may reflect shared underlying processes that intersect brain, gut, and hormonal pathways.
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Poettcker D, Coupland K, Avery L, Vo M. Chronic Total Occlusion Percutaneous Coronary Intervention: Stenting the Proverbial Mountain. Can J Cardiol 2013. [DOI: 10.1016/j.cjca.2013.07.750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Avery L, Ludwig S, Shaikh N, Minhas K, Rand CE, Throndson K, Kuttnig C, Vo M, Warner T, Friesen M, Tam J. Integrating Canadian Diabetes Standards into the Care of Patients with Acute Myocardial Infarction. Can J Cardiol 2013. [DOI: 10.1016/j.cjca.2013.07.777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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130
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Doern-White N, Stephens E, Nguyen T, Avery L. Hearty Barley: Lipid lowering effects of barley beta-glucan. Can J Cardiol 2013. [DOI: 10.1016/j.cjca.2013.07.778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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131
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Throndson K, Avery L, Duhamel T, Coupland K, Kuttnig C, Nguyen T, Hussain F, Zalnasky J, Mamchuk A. Cardiovascular Care Poverty: Where Do Individuals With Non-Occlusive Cardiac Disease Go? Can J Cardiol 2013. [DOI: 10.1016/j.cjca.2013.07.754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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132
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Avery L, Hasan M. Fecal Bacteriotherapy for Clostridium difficile Infections — Its Time Has Come. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.clinmicnews.2013.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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133
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Tounkara FK, Guédou F, Ahoussinou C, Zannou DM, Kpatchavi A, Kintin FD, Avery L, Bédard E, Bitera R, Alary M. P3.110 Relationship Between Violence and HIV Infection Among Female Sex Workers in Benin. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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134
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King G, Imms C, Palisano R, Majnemer A, Chiarello L, Orlin M, Law M, Avery L. Geographical patterns in the recreation and leisure participation of children and youth with cerebral palsy: a CAPE international collaborative network study. Dev Neurorehabil 2013; 16:196-206. [PMID: 23477429 DOI: 10.3109/17518423.2013.773102] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To examine geographical variation in the leisure participation of children/youth with cerebral palsy (CP), using Children's Assessment of Participation and Enjoyment (CAPE) data from Australia, Canada (Ontario and Quebec) and the U.S. METHOD Data from 1076 children/youth ages 6-20 years with CP were included. Analyses examined CAPE diversity scores in activity types as a function of region, age group and Gross Motor Function Classification System (GMFCS) group, controlling for family income, education and child gender. RESULTS There were only two substantial geographical differences: children/youth from the U.S. took part in the fewest active physical activities; those from Ontario took part in the most self-improvement activities. The youngest age group took part in the most recreational activities, and those in GMFCS level IV/V had the lowest levels of participation in recreational, active physical and self-improvement activities, confirming previous findings. CONCLUSIONS There were more similarities than differences in participation patterns for the three countries.
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Mony PK, Krishnamurthy J, Thomas A, Sankar K, Ramesh BM, Moses S, Blanchard J, Avery L. Availability and distribution of emergency obstetric care services in Karnataka State, South India: access and equity considerations. PLoS One 2013; 8:e64126. [PMID: 23717547 PMCID: PMC3661461 DOI: 10.1371/journal.pone.0064126] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 04/10/2013] [Indexed: 12/02/2022] Open
Abstract
Background As part of efforts to reduce maternal deaths in Karnataka state, India, there has been a concerted effort to increase institutional deliveries. However, little is known about the quality of care in these healthcare facilities. We investigated the availability and distribution of emergency obstetric care (EmOC) services in eight northern districts of Karnataka state in south India. Methods & Findings We undertook a cross-sectional study of 444 government and 422 private health facilities, functional 24-hours-a-day 7-days-a-week. EmOC availability and distribution were evaluated for 8 districts and 42 taluks (sub-districts) during the year 2010, based on a combination of self-reporting, record review and direct observation. Overall, the availability of EmOC services at the sub-state level [EmOC = 5.9/500,000; comprehensive EmOC (CEmOC) = 4.5/500,000 and basic EmOC (BEmOC) = 1.4/500,000] was seen to meet the benchmark. These services however were largely located in the private sector (90% of CEmOC and 70% of BemOC facilities). Thirty six percent of private facilities and six percent of government facilities were EmOC centres. Although half of eight districts had a sufficient number of EmOC facilities and all eight districts had a sufficient number of CEmOC facilities, only two-fifths of the 42 taluks had a sufficient number of EmOC facilities. With the private facilities being largely located in select towns only, the ‘non-headquarter’ taluks and ‘backward’ taluks suffered from a marked lack of coverage of these services. Spatial mapping further helped identify the clustering of a large number of contiguous taluks without adequate government EmOC facilities in northeastern Karnataka. Conclusions In conclusion, disaggregating information on emergency obstetric care service availability at district and subdistrict levels is critical for health policy and planning in the Indian setting. Reducing maternal deaths will require greater attention by the government in addressing inequities in the distribution of emergency obstetric care services.
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Jayanna K, Ramesh, Bhowmik A, Thomas A, Mony P, Shankar K, Schurmann A, Moses S, Avery L, Blanchard J. O338 MANAGEMENT OF ECLAMPSIA AND POSTPARTUM HEMORRHAGE: CHALLENGES AND OPPORTUNITIES TO IMPROVE QUALITY OF CARE IN NORTHERN KARNATAKA, INDIA. Int J Gynaecol Obstet 2012. [DOI: 10.1016/s0020-7292(12)60768-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Avery L, Sawatzky J. N013 Left Ventricular Assist Devices (LVADs): Optimizing Care for the Caregiver. Can J Cardiol 2012. [DOI: 10.1016/j.cjca.2012.07.759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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138
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Estrella-Holder E, Grant R, Perez FC, Avery L, Vaags-Olafson R, Malik A, Zieroth S, Luchik D. NP016 Automatic Cardiac Rehabilitation Referral: A Strategy for Meeting the National Guidelines and Needs of Heart Failure Patients. Can J Cardiol 2012. [DOI: 10.1016/j.cjca.2012.07.831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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139
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Kuttnig C, Nazarevich I, Avery L, Estrella-Holder E, Bowles S. NP027 Supporting Cardiac Sciences Nurses Through Nursing Leadership Council. Can J Cardiol 2012. [DOI: 10.1016/j.cjca.2012.07.842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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140
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Schnell-Hoehn K, Estrella-Holder E, Avery L. N028 Cardiac Nurses' Knowledge of Palliative Care at a Tertiary Care Facility. Can J Cardiol 2012. [DOI: 10.1016/j.cjca.2012.07.774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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141
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Bruce S, Gurav K, Blanchard A, Roy A, Mohan HL, Ramesh BM, Avery L. A qualitative exploration of factors influencing site of delivery (home, public or private hospital) in three North Karnataka districts as described by pregnant women, mothers of neonates, husbands and grandmothers. BMC Proc 2012. [PMCID: PMC3467584 DOI: 10.1186/1753-6561-6-s5-p7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Hasan MS, Avery L, Kerfien JG, Rawling RA, Granato PA. Aspergillus fumigatus Endocarditis Complicating Implantable Cardioverter-Defibrillator Infection. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.clinmicnews.2012.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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143
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Bernstein MT, Graff LA, Targownik LE, Downing K, Shafer LA, Rawsthorne P, Bernstein CN, Avery L. Gastrointestinal symptoms before and during menses in women with IBD. Aliment Pharmacol Ther 2012; 36:135-44. [PMID: 22621660 DOI: 10.1111/j.1365-2036.2012.05155.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Revised: 03/26/2012] [Accepted: 05/07/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND It is believed that women with inflammatory bowel disease (IBD) have heightened symptoms around their menses. However, there is little information regarding normative changes and which symptoms emerge in relation to menses. AIM To determine the relationship between gastrointestinal and other symptoms and menses in a population-based cohort of women with IBD vs. healthy women. METHODS Women enrolled in the University of Manitoba IBD Research Registry who were between 18 and 65 years were mailed a survey. A control group of adult women were recruited through out-patient gynaecology clinics. Participants were asked to consider their menstrual periods in the recent several months and report on symptoms 1-5 days prior to and during the days of their menses. RESULTS There were 151 premenopausal women with Crohn's disease (CD), 87 with ulcerative colitis (UC) and 156 premenopausal controls. Mean age of menses onset was similar in all three cohorts and the percentage in each group with regular menstrual periods was similar. Premenstrually, abdominal pain was less commonly reported in UC (36.8%) than CD (51%, P = 0.034) and controls (57.6%, P = 0.002). Premenstrually, and during menses diarrhoea was more commonly reported in CD (47.7% and 59.6% respectively) than UC (26.4% P = 0.001 and 42.5%, P = 0.01 respectively) and controls (24.4%, P < 0.0001 and 28.2%, P < 0.0001 respectively). Premenstrually, women with CD (46%) vs. UC (26%) were more likely to report worsening of their IBD symptoms (P = 0.0007), but there was no difference between CD (47%) and UC (39%) for reporting worsening during menses (P = 0.24). CONCLUSIONS Compared to healthy women, women with IBD had similar symptom experiences premenstrually, except that those with CD were more likely to have increased diarrhoea premenstrually. During menses, women with CD or UC were more likely to experience diarrhoea than healthy controls.
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Becker ML, Mishra S, Satyanarayana, Gurav K, Doshi M, Buzdugan R, Pise G, Halli S, Moses S, Avery L, Washington RG, Blanchard JF. Rates and determinants of HIV-attributable mortality among rural female sex workers in Northern Karnataka, India. Int J STD AIDS 2012; 23:36-40. [PMID: 22362685 DOI: 10.1258/ijsa.2011.011017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Female sex workers (FSWs) have among the highest rates of HIV infection in India. However, little is known about their HIV-specific mortality rates. In total, 1561 FSWs participated in a cohort study in Karnataka. Outcome data (mortality) were available on 1559 women after 15 months of follow-up. To gather details on deaths, verbal autopsy (VA) questionnaires were administered to key informants. Two physicians reviewed the VA reports and assigned underlying causes of death. Forty-seven deaths were reported during the follow-up (overall mortality rate was 2.44 per 100 person-years), with VA data available on 45 women. Thirty-five (75.6%) of these women were known to be HIV-positive, but only 42.5% were on antiretroviral therapy (ART). Forty deaths were assessed to be HIV-related, for an HIV-attributable mortality rate of 2.11 deaths per 100 person-years. Absence of a current regular partner (incidence rate ratio: 2.79; 95% confidence interval [CI]: 1.39-5.60) and older age (1.06; 1.01-1.11) were associated with increased HIV-attributable mortality. Reported duration in sex work was not related to HIV-attributable mortality. We found a high HIV-related mortality rate among this cohort of FSWs; nearly 10 times that of national mortality rates among women of a similar age group. Older age, but not reported duration in sex work, was associated with increased mortality, and suggests HIV acquisition prior to self-reported initiation into sex work. Despite significant efforts, there remain considerable gaps in HIV prevention near or before entry into sex work, as well as access and uptake of HIV treatment among FSWs.
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Shaw SY, Lorway RR, Deering KN, Avery L, Mohan HL, Bhattacharjee P, Reza-Paul S, Isac S, Ramesh BM, Washington R, Moses S, Blanchard JF. Factors associated with sexual violence against men who have sex with men and transgendered individuals in Karnataka, India. PLoS One 2012; 7:e31705. [PMID: 22448214 PMCID: PMC3308942 DOI: 10.1371/journal.pone.0031705] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Accepted: 01/18/2012] [Indexed: 11/21/2022] Open
Abstract
Objectives There is a lack of information on sexual violence (SV) among men who have sex with men and transgendered individuals (MSM-T) in southern India. As SV has been associated with HIV vulnerability, this study examined health related behaviours and practices associated with SV among MSM-T. Design Data were from cross-sectional surveys from four districts in Karnataka, India. Methods Multivariable logistic regression models were constructed to examine factors related to SV. Multivariable negative binomial regression models examined the association between physician visits and SV. Results A total of 543 MSM-T were included in the study. Prevalence of SV was 18% in the past year. HIV prevalence among those reporting SV was 20%, compared to 12% among those not reporting SV (p = .104). In multivariable models, and among sex workers, those reporting SV were more likely to report anal sex with 5+ casual sex partners in the past week (AOR: 4.1; 95%CI: 1.2–14.3, p = .029). Increased physician visits among those reporting SV was reported only for those involved in sex work (ARR: 1.7; 95%CI: 1.1–2.7, p = .012). Conclusions These results demonstrate high levels of SV among MSM-T populations, highlighting the importance of integrating interventions to reduce violence as part of HIV prevention programs and health services.
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Simon L, Avery L, Braden TD, Williams CS, Okumu LA, Williams JW, Goyal HO. Exposure of neonatal rats to anti-androgens induces penile mal-developments and infertility comparable to those induced by oestrogens. ACTA ACUST UNITED AC 2011; 35:364-76. [PMID: 22150386 DOI: 10.1111/j.1365-2605.2011.01232.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
We previously reported that oestrogen exposure in neonatal rats induced permanent infertility and malformed penis characterized by fat accumulation, which replaced most of the smooth muscle cells and cavernous spaces in the body of the penis, structures essential for erection. The objective of this study was to determine if reduced androgen production/action in the neonatal period, in the absence of exogenous oestrogen exposure, induces penile deformities similar to those caused by oestrogen. Male rats were treated from postnatal days 1-6 with GnRH antagonist antide (A, 10 mg/kg) or androgen receptor (AR) antagonist flutamide (F, 50 mg/kg) or F + A, with or without AR agonist dihydrotestosterone (DHT, 20 mg/kg). For comparison, pups received diethylstilbestrol (DES, 0.1 mg/kg), with or without DHT. Tissues were collected at ages 7 and 12 days and at adulthood. Flutamide alone decreased penile length and weight significantly (p < 0.05), but it caused neither fat accumulation, nor affected fertility (80% vs. 87% in controls). Antide alone reduced penile length and weight significantly, and induced fat accumulation in 4/11 rats and infertility in 13/14 rats. Conversely, all 11 F + A-treated rats, similar to all nine DES-treated rats, had fat accumulation and loss of smooth muscle cells and cavernous spaces in the body of the penis and were infertile. In addition, reductions in penile length and weight were higher than in rats treated with F or A alone. DHT co-administration mitigated penile deformities in the DES group, but did not in the F + A group. Testicular testosterone was reduced by 70-95% at 7 or 12 days of age in all treated groups, except in the F group, which had threefold higher testosterone than controls. Collectively, data unequivocally show that reduced androgen production/action in the neonatal period, in the absence of oestrogen exposure, induces permanent infertility and malformed penis similar to that caused by oestrogen.
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147
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Estrella-Holder E, Avery L, Malik A. N063 Isolated ventricular non-compaction: A rare form of cardiomyopathy. Can J Cardiol 2011. [DOI: 10.1016/j.cjca.2011.08.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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148
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Avery L, Estrella-Holder E, Deckert C, Boreskie S, Luchik D, Lake D, Vaags-Olafson R, Schnell-Hoehn K. NP007 The role of cardiac sciences' clinical nurse specialists in the referral of cardiac patients to a local cardiac rehabilitation program (CRP). Can J Cardiol 2011. [DOI: 10.1016/j.cjca.2011.08.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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149
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Avery L, Lazdane G. What do we know about sexual and reproductive health of adolescents in Europe? EUR J CONTRACEP REPR 2010; 15 Suppl 2:S54-66. [DOI: 10.3109/13625187.2010.533007] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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150
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Mahmud SM, Becker M, Keynan Y, Elliott L, Thompson LH, Fowke K, Avery L, Van Caeseele P, Harlos S, Blanchard J, Dawood M. Estimated cumulative incidence of pandemic (H1N1) influenza among pregnant women during the first wave of the 2009 pandemic. CMAJ 2010; 182:1522-4. [PMID: 20823167 DOI: 10.1503/cmaj.100488] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Hospitalization and lab confirmed cases of H1N1 have been reported during the first wave of the 2009 pandemic but these are not accurate measures of influenza incidence in the population. We estimated the cumulative incidence of pandemic (H1N1) influenza among pregnant women in the province of Manitoba during the first wave of the 2009 pandemic. METHODS Two panels of stored frozen serum specimens collected for routine prenatal screening were randomly selected for testing before (March 2009, n = 252) and after (August 2009, n = 296) the first wave of the pandemic. A standard hemagglutination inhibition assay was used to detect the presence of IgG antibodies against the pandemic (H1N1) 2009 virus. The cumulative incidence of pandemic (H1N1) influenza was calculated as the difference between the point prevalence rates in the first and second panels. RESULTS Of the specimens collected in March, 7.1% were positive for the IgG antibodies (serum antibody titre ≥ 1:40). The corresponding prevalence was 15.7% among the specimens collected in August. The difference indicated a cumulative incidence of 8.6% (95% confidence interval [CI] 3.2%-13.7%). The rate differed geographically, the highest being in the northern regions (20.8%, 95% CI 7.9%-31.8%), as compared with 4.0% (95% CI 0.0%-11.9%) in Winnipeg and 8.9% (95% CI 0.0%-18.8%) in the rest of the province. INTERPRETATION We estimated that the cumulative incidence of pandemic (H1N1) influenza among pregnant women in Manitoba during the first wave of the 2009 pandemic was 8.6%. It was 20.8% in the northern regions of the province.
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