Background In laboratory animals, exposure to most general anaesthetics leads to neurotoxicity manifested by neuronal cell death and abnormal behaviour and cognition. Some large human cohort studies have shown an association between general anaesthesia at a young age and subsequent neurodevelopmental deficits, but these studies are prone to bias. Others have found no evidence for an association. We aimed to establish whether general anaesthesia in early infancy affects neurodevelopmental outcomes. Methods In this international, assessor-masked, equivalence, randomised, controlled trial conducted at 28 hospitals in Australia, Italy, the USA, the UK, Canada, the Netherlands, and New Zealand, we recruited infants of less than 60 weeks' postmenstrual age who were born at more than 26 weeks' gestation and were undergoing inguinal herniorrhaphy, without previous exposure to general anaesthesia or risk factors for neurological injury. Patients were randomly assigned (1:1) by use of a web-based randomisation service to receive either awake-regional anaesthetic or sevoflurane-based general anaesthetic. Anaesthetists were aware of group allocation, but individuals administering the neurodevelopmental assessments were not. Parents were informed of their infants group allocation upon request, but were told to mask this information from assessors. The primary outcome measure was full-scale intelligence quotient (FSIQ) on the Wechsler Preschool and Primary Scale of Intelligence, third edition (WPPSI-III), at 5 years of age. The primary analysis was done on a per-protocol basis, adjusted for gestational age at birth and country, with multiple imputation used to account for missing data. An intention-totreat analysis was also done. A difference in means of 5 points was predefined as the clinical equivalence margin. This completed trial is registered with ANZCTR, number ACTRN12606000441516, and ClinicalTrials.gov, number NCT00756600. Findings Between Feb 9, 2007, and Jan 31, 2013, 4023 infants were screened and 722 were randomly allocated: 363 (50%) to the awake-regional anaesthesia group and 359 (50%) to the general anaesthesia group. There were 74 protocol violations in the awake-regional anaesthesia group and two in the general anaesthesia group. Primary outcome data for the per-protocol analysis were obtained from 205 children in the awake-regional anaesthesia group and 242 in the general anaesthesia group. The median duration of general anaesthesia was 54 min (IQR 41-70). The mean FSIQ score was 99•08 (SD 18•35) in the awake-regional anaesthesia group and 98•97 (19•66) in the general anaesthesia group, with a difference in means (awake-regional anaesthesia minus general anaesthesia) of 0•23 (95% CI-2•59 to 3•06), providing strong evidence of equivalence. The results of the intention-to-treat analysis were similar to those of the per-protocol analysis. Interpretation Slightly less than 1 h of general anaesthesia in early infancy does not alter neurodevelopmental outcome at age 5 years compared with awake-regional anaesthesia ...

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This paper examines the association between neighborhood active living potential and walking among middle-aged and older adults. A sample of 2,614 (61.1% women) persons aged 45 years or older and living in one of 112 census tracts in Montreal, Canada, were recruited between February and May of 2005 to participate in a 20-minute telephone survey. Data were linked to observational data on neighborhood active living potential in the 112 census tracts and analyzed through multilevel modeling. Greater density of destinations in the census tract was associated with greater likelihoods of walking for any reason at least 5 days per week for at least 30 minutes (odds ratio = 1.53, 95% confidence interval: 1.21, 1.94). Associations were attenuated but remained statistically significant after controlling for socioeconomic, health, lifestyle, and other physical activity characteristics. Sensitivity analyses showed that associations were robust across smaller and larger volumes of walking. No associations were found between dimensions of neighborhood active living potential and walking for recreational reasons. The authors conclude that a larger number and variety of neighborhood destinations in one's residential environment are associated with more walking and possibly more utilitarian walking among middle-aged or older adults.

25 52Research I n the province of Quebec, as elsewhere, HIV and hepatitis C virus (HCV) infections in incarcerated populations are of concern to public health and correctional service authorities. 1-3 Many studies have shown that the prevalence of HIV infection is higher in the incarcerated population than in the general population, 4-7 and more recently other studies have shown that a greater proportion of inmates are infected with HCV than with HIV. [8][9][10][11][12][13][14] People admitted to correctional facilities often have a history of injection drug use, needle-sharing and high-risk sexual behaviours. 5,7,9,15 The practice of such risky behaviours is frequently continued during incarceration, 5,9,10,15-17 along with other potentially risky activities, such as being tattooed. 5,7,8,16 To date, there has been limited information regarding the burden of HCV infection among inmates of provincial prisons in Quebec, where HIV and HCV testing is available to inmates only on request. Better knowledge of infection rates would help disease prevention and management program planning.We sought to determine the prevalence of HIV and HCV infections among inmates in 7 provincial prisons in Quebec and to identify risk factors associated with prevalent HCV infection in this population. Methods BackgroundWe selected 7 provincial prisons from a total of 17 in the province of Quebec, to represent a diversity of settings. Of the 5 men's prisons, 1 was in Montréal, 1 was in Québec City, and 3 were in smaller cities in the eastern, western and northern regions of the province. The 2 women's prisons were both in urban settings (Québec City and Montréal). The total capacity of the participating prisons was 2077 beds for men and 162 beds for women, thus representing 52% of all 4303 beds in the Quebec network of provincial detention centres. On admission, information such as name, length of sentence and date of release is recorded in each prison's computer database.