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Introduction. Information on the psychosocial distress and needs of sarcoma patients at diagnosis is sparse. The Canadian Problem Checklist (CPC) and Psychosocial Screen for Cancer-Revised (PSSCAN-R) are validated tools to identify cancer patients' distress and are administered to all new patients referred to BC Cancer prior to their consultation. We used the CPC and PSSCAN-R to understand sarcoma patients' needs at the initial oncology consultation in British Columbia, Canada. Materials and Methods. All sarcoma patients who completed the CPC and PSSCAN-R within 6 months of diagnosis between 2011 and 2016 were included. The retrospective chart review identified baseline demographics: age, performance status, disease location, resectability, and histology. Analysis was conducted using descriptive statistics, chi-squared test, Fisher's exact test, and Kaplan–Meier method. Results. 413 sarcoma patients were identified. The majority of patients were over the age of 40 (83.3%) with ECOG performance status 0-1 (82.6%) and lower extremity tumors (55.4%). The most common diagnoses were liposarcoma 21.3%, undifferentiated pleomorphic sarcoma 12.1%, and myxofibrosarcoma 11.1%. At the initial consultation, 42.6% of patients were deemed resectable, 8.5% unresectable/metastatic, and 48.9% required further staging investigations. The top three patient-reported distress symptoms were feeling tense and unable to relax (50%), feeling nervous and shaky (48%), and experiencing repetitive and scary thoughts (42%). 38% of patients had subclinical/clinical anxiety symptoms, and 21% of patients had subclinical/clinical depression symptoms. 5% of patients expressed suicidal ideation. The top three concerns/needs were understanding of illness/treatment (45.5%), fear/worries (45.3%), and worry about family (23%). No differences in overall survival were identified for patients displaying symptoms of depression or anxiety versus no symptoms. Discussion. Up to 45% of sarcoma patients experience some form of psychological distress at disease presentation. Patients desire information about their diagnosis and treatment. Tailored interventions to individual psychological comorbidity and improved patient education resources would be beneficial. [ABSTRACT FROM AUTHOR]

The article discusses a study that obtained sound levels and acoustic characteristic data in classroom serving children who are deaf and hard of hearing in grades K-2 in Canada and the U.S. Study highlights include signal-to-noise ratio recommended by the American Speech-Language-Hearing Association, sources of classroom noise, and the concept of the inverse square law.

Background: Studies assessing the prevalence of depression and anxiety in multiple sclerosis (MS) have used various ascertainment methods that capture different constructs. The relationships between these methods are incompletely understood. Psychiatric comorbidity is associated with lower health-related quality of life (HRQOL) in MS, but the effects of past diagnoses of depression and anxiety on HRQOL are largely unknown. We compared the prevalence of depression and anxiety in persons with MS using administrative data, self-reported physician diagnoses, and symptom-based measures and compared characteristics of persons classified as depressed or anxious by each method. We evaluated whether HRQOL was most affected by previous diagnoses of depression or anxiety or by current symptoms. Methods: We linked clinical and administrative data for 859 participants with MS. HRQOL was measured by the Health Utilities Index Mark 3. We classified participants as depressed or anxious using administrative data, self-reported physician diagnoses, and the Hospital Anxiety and Depression Scale. Multivariable linear regression examined whether diagnosed depression or anxiety affected HRQOL after accounting for current symptoms. Results: Lifetime prevalence estimates for depression were approximately 30% regardless of methods used, but 35.8% with current depressive symptoms were not captured by either administrative data or self-reported diagnoses. Prevalence estimates of anxiety ranged from 11% to 19%, but 65.6% with current anxiety were not captured by either administrative data or self-reported diagnoses. Previous diagnoses did not decrease HRQOL after accounting for current symptoms. Conclusions: Depression and, to a greater extent, anxiety remain underdiagnosed and undertreated in MS; both substantially contribute to reduced HRQOL in MS. [ABSTRACT FROM AUTHOR]

The purpose of this study was to better understand the lived experience of mental illness and factors that contribute to community inclusion, health, and wellbeing. Through the use of Photovoice, a community based participatory research (CBPR) methodology, participants visually represented factors that fostered inclusion. More significantly, however, participants used photography to capture major systemic and structural, or upstream, barriers to their active and meaningful participation in society, such as stigma and social exclusion. The participatory aspect of CBPR was itself empowering while it enabled participants to visually identify and explore upstream factors that profoundly shaped their lived experiences of mental illness. These findings point to the need for recreation therapists and other mental health professionals to expand from biomedical and behavioural interventions for individuals living with mental illness towards looking upstream to address the systemic and structural factors that impede individuals' full participation in their communities. [ABSTRACT FROM AUTHOR]

Objectives To estimate the impact of increased participation in screening, and of the proposed change from Pap to human papillomavirus screening on the incidence of cervical cancer in British Columbia. Methods For invasive cervical cancer cases diagnosed in British Columbia between 2002 and 2011, data were extracted on age and cancer morphology from the British Columbia Cancer Registry, and Pap screening history was obtained from the British Columbia Cervical Cancer Screening Program database. Only screening performed two to seven years prior to diagnosis was assumed to reduce subsequent risk of cancer. Results from randomized trials of human papillomavirus versus cytology screening and population based estimates of cytology screening were used to estimate the effect of a change in screening test and increases in participation. Results Between 2002 and 2011, there were 1663 cases of cervical cancer reported; 660 (367 squamous and 293 non-squamous) were eligible and screened two to seven years prior to diagnosis. The predicted reduction by changing to human papillomavirus screening was 363 (95% confidence interval = 124–496) representing 22% of all cases. If 50% of subjects not screened two to seven years prior had undergone Pap screening, it is projected that a further 268 cases (16%) could have been prevented; if they had undergone human papillomavirus screening, a further 365 cases (22%) could have been prevented. Conclusions For many women who develop cervical cancer, primary human papillomavirus testing could have substantially reduced their cancer risk. Human papillomavirus rather than Pap testing would further increase the gains from any increases in population screening participation. [ABSTRACT FROM AUTHOR]

Background. Mild cognitive impairment (MCI) represents a transition between normal cognitive aging and dementia and may represent a critical time frame for promoting cogni- tive health through behavioral strategies. Current evidence suggests that physical activity (PA) and sedentary behavior are important for cognition. However, it is unclear whether there are differences in PA and sedentary behavior between people with probable MCI and people without MCI or whether the relationships of PA and sedentary behavior with cognitive function differ by MCI status. Objective. The aims of this study were to examine differences in PA and sedentary behavior between people with probable MCI and people without MCI and whether as- sociations of PA and sedentary behavior with cognitive function differed by MCI status. Design. This was a cross-sectional study. Methods. Physical activity and sedentary behavior in adults dwelling in the community (N = 151; at least 55 years old) were measured using a wrist-worn actigraphy unit. The Montreal Cognitive Assessment was used to categorize participants with probable MCI (scores of <26/30) and participants without MCI (scores of ≥26/30). Cognitive function was indexed using the Alzheimer Disease Assessment Scale-Cognitive-Plus (ADAS-Cog Plus). Physical activity and sedentary behavior were compared based on probable MCI status, and relationships of ADAS-Cog Plus with PA and sedentary behavior were examined by probable MCI status. Results. Participants with probable MCI (n = 82) had lower PA and higher sedentary behavior than participants without MCI (n = 69). Higher PA and lower sedentary behavior were associated with better ADAS-Cog Plus performance in participants without MCI (β = -.022 and β = .012, respectively) but not in participants with probable MCI (β < .001 for both). Limitations. This study was cross-sectional and therefore could not establish whether conversion to MCI attenuated the relationships of PA and sedentary behavior with cognitive function. The diagnosis of MCI was not confirmed with a physician; therefore, this study could not conclude how many of the participants categorized as having proba- ble MCI would actually have been diagnosed with MCI by a physician. Conclusions. Participants with probable MCI were less active and more sedentary. The relationships of these behaviors with cognitive function differed by MCI status; associations were found only in participants without MCI. [ABSTRACT FROM AUTHOR]

Objective. Identification of the factors that influence sedentary behaviour in older adults is important for the design of appropriate intervention strategies. In this study, we determined the prevalence of sedentary behaviour and its association with physical, cognitive, and psychosocial status among older adults residing in Assisted Living (AL). Methods. Participants (n=114, mean age = 86.7) from AL sites in British Columbia wore waist-mounted activity monitors for 7 consecutive days, after being assessed with the Timed Up and Go (TUG), Montreal Cognitive Assessment (MoCA), Short Geriatric Depression Scale (GDS), and Modified Fall Efficacy Scale (MFES). Results. On average, participants spent 87% of their waking hours in sedentary behaviour, which accumulated in 52 bouts per day with each bout lasting an average of 13 minutes. Increased sedentary behaviour associated significantly with scores on the TUG (r=0.373, p<0.001) and MFES (r=-0.261, p=0.005), but not with the MoCA or GDS. Sedentary behaviour also associated with male gender, use of mobility aid, and multiple regression with increased age. Conclusion. We found that sedentary behaviour among older adults in AL associated with TUG scores and falls-related self-efficacy, which are modifiable targets for interventions to decrease sedentary behaviour in this population. [ABSTRACT FROM AUTHOR]

Background: Our objective was to explore intentional injury disparity between Indigenous populations and the total population in the province of British Columbia (BC), Canada. We focus on hospitalizations, including both self-inflicted injuries and injuries inflicted by others. Methods: We used data from BC's universal health care insurance plan, 1991 to 2010, linked to Vital Statistics databases. Indigenous people were identified through the insurance premium group, and birth and death records. Place of residence was identified through postal code. We calculated crude hospitalization incidence rates and the Standardized Relative Risk (SRR) of hospitalization, standardized by gender, 5-year age group, and Health Service Delivery Area (HSDA). With HSDA populations as the units of observation, linear regression was used to test hypothesized associations of Indigenous ethnicity, geographic, and socio-economic characteristics with SRR of injury. Results: During the period 1991-2010, the crude rate of hospitalization for intentional injuries was 8.4 per 10,000 person-years (95% confidence interval (CI): 8.3 to 8.5) for the total BC population, compared to 45.3 per 10,000 (95% CI: 44.5 to 46.1) for the Indigenous population. For both populations, risk declined over the period for injuries self-inflicted and inflicted by others. The linear regression model predicts that the off-reserve Indigenous population will have SRR of intentional injury 3.98 greater, and the on-reserve Indigenous population 4.17, greater than the total population. The final model was an excellent fit (R² = 0.912, F = 177.632, p < 0.001), and found that three variables - occupational risk, high school diploma, and university degree - each provide independent effects when interacting multiplicatively with Indigenous ethnicity. Conclusions: The observation of substantially declining rates of intentional injury for both the Indigenous and total BC populations is off-set by the high disparity in risk between the two populations, which will likely continue until Canada reduces disparity with respect to discriminatory practices, and physical, social, and economic conditions. [ABSTRACT FROM AUTHOR]

BACKGROUND: Evidence for an association between transportation noise and cardiovascular disease has increased; however, few studies have examined metabolic outcomes such as diabetes or accounted for environmental coexposures such as air pollution, greenness, or walkability. OBJECTIVES: Because diabetes prevalence is increasing and may be on the causal pathway between noise and cardiovascular disease, we examined the influence of long-term residential transportation noise exposure and traffic-related air pollution on the incidence of diabetes using a populationbased cohort in British Columbia, Canada. METHODS: We examined the influence of transportation noise exposure over a 5-y period (1994-1998) on incident diabetes cases in a populationbased prospective cohort study (n=380,738) of metropolitan Vancouver (BC) residents who were 45-85 y old, with 4-y of follow-up (1999-2002). Annual average transportation noise (Lden), air pollution [black carbon, particulate matter with aerodynamic diameter <2:5 lm (PM2.5), nitrogen oxides], greenness [Normalized Difference Vegetation Index (NDVI)], and neighborhood walkability at each participant's residence were modeled. Incident diabetes cases were identified using administrative health records. RESULTS: Transportation noise was associated with the incidence of diabetes [interquartile range (IQR) increase, 6.8 A-weighted decibels (dBA); OR=1:08 (95% CI: 1.05, 1.10)]. This association remained after adjustment for environmental coexposures including traffic-related air pollutants, greenness, and neighborhood walkability. After adjustment for coexposure to noise, traffic-related air pollutants were not associated with the incidence of diabetes, whereas greenness was protective. CONCLUSION: We found a positive association between residential transportation noise and diabetes, adding to the growing body of evidence that noise pollution exposure may be independently linked to metabolic health and should be considered when developing public health interventions. [ABSTRACT FROM AUTHOR]

BACKGROUND: Chikungunya virus (CHIKV) is a reemerging pathogen transmitted by Aedes aegypti and Aedes albopictus mosquitoes. The ongoing Caribbean outbreak is of concern due to the potential for infected travelers to spread the virus to countries where vectors are present and the population is susceptible. Although there has been no autochthonous transmission of CHIKV in Canada, there is concern that both Ae. albopictus and CHIKV will become established, particularly under projected climate change. We developed risk maps for autochthonous CHIKV transmission in Canada under recent (1981-2010) and projected climate (2011-2040 and 2041-2070). METHODS: The risk for CHIKV transmission was the combination of the climatic suitability for CHIKV transmission potential and the climatic suitability for the presence of Ae. albopictus; the former was assessed using a stochastic model to calculate R0 and the latter was assessed by deriving a suitability indicator (SIG) that captures a set of climatic conditions known to influence the ecology of Ae. albopictus. R0 and SIG were calculated for each grid cell in Canada south of 60°N, for each time period and for two emission scenarios, and combined to produce overall risk categories that were mapped to identify areas suitable for transmission and the duration of transmissibility. FINDINGS: The risk for autochthonous CHIKV transmission under recent climate is very low with all of Canada classified as unsuitable or rather unsuitable for transmission. Small parts of southern coastal British Columbia become progressively suitable with short-term and long-term projected climate; the duration of potential transmission is limited to 1-2 months of the year. INTERPRETATION: Although the current risk for autochthonous CHIKV transmission in Canada is very low, our study could be further supported by the routine surveillance of Ae. albopictus in areas identified as potentially suitable for transmission given our uncertainty on the current distribution of this species in Canada. [ABSTRACT FROM AUTHOR]

Copyright of Physiotherapy Canada is the property of University of Toronto Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

BACKGROUND: Climate change has increased the frequency and intensity of extremely hot weather. The health risks associated with extemely hot weather are not uniform across affected areas owing to variability in heat exposure and social vulnerability, but these differences are challenging to map with precision. OBJECTIVES: We developed a spatially and temporally stratified case-crossover approach for delineation of areas with higher and lower risks of mortality on extremely hot days and applied this approach in greater Vancouver, Canada. METHODS: Records of all deaths with an extremely hot day as a case day or a control day were extracted from an administrative vital statistics database spanning the years of 1998 -- 2014. Three heat exposure and 11 social vulnerability variables were assigned at the residential location of each decedent. Conditional logistic regression was used to estimate the odds ratio for a 1°C increase in daily mean temperature at a fixed site with an interaction term for decedents living above and below different values of the spatial variables. RESULTS: The heat exposure and social vulnerability variables with the strongest spatially stratified results were the apparent temperature and the labor nonparticipation rate, respectively. Areas at higher risk had values ≥ 34.4°C for the maximum apparent temperature and ≥ 60% of the population neither employed nor looking for work. These variables were combined in a composite index to quantify their interaction and to enhance visualization of high-risk areas. CONCLUSIONS: Our methods provide a data-driven framework for spatial delineation of the temperature -- mortality relationship by heat exposure and social vulnerability. The results can be used to map and target the most vulnerable areas for public health intervention. CITATION: Ho HC, Knudby A, Walker BB, Henderson SB. 2017. Delineation of spatial variability in the temperature -- mortality relationship on extremely hot days in greater Vancouver, Canada. Environ Health Perspect 125:66-75; http://dx.doi.org/10.1289/EHP224 [ABSTRACT FROM AUTHOR]

We evaluated a patient education pamphlet on vaginal birth after cesarean (VBAC). Focus groups with 17 women in 4 communities involved a 5-item knowledge pretest and question on intention to plan VBAC, reading the pamphlet, a knowledge posttest, and a moderated discussion. Forming a preference for birth after cesarean was characterized by (a) consolidating information from social sources, (b) seeking certainty in your next birth, and (c) questioning your ability to have a vaginal birth. Participants preferred vaginal birth, but all feared the uncertainty of labor. Knowledge scores increased for all participants, but intentions to plan a VBAC did not change. Our findings may encourage the development of interventions to reduce women's fear of vaginal birth. [ABSTRACT FROM AUTHOR]

Objective To assess the relative risk of myocardial infarction (MI) and ischemic stroke in patients with newly diagnosed granulomatosis with polyangiitis (Wegener's) (GPA) compared with that in controls from the general population. Methods Using a population-based database from the province of British Columbia, Canada, we conducted a matched cohort study in which each patient with incident GPA was matched for age, sex, and entry time with up to 10 individuals from the general population. Patients in the GPA cohort were required to have received at least 1 prescription for oral glucocorticoids, methotrexate, cyclophosphamide, leflunomide, azathioprine, cyclosporine, mycophenolate mofetil, or rituximab within 1 month before or 6 months after the index date. We compared the incidence rates of MI and ischemic stroke between the 2 groups and calculated hazard ratios (HRs), adjusting for confounders. Results Among 504 patients with incident GPA (53.4% female, mean age 57.4 years), MI developed in 23 patients, and ischemic stroke developed in 18 patients (incidence rates of 11.7 per 1,000 person-years and 8.9 per 1,000 person-years, respectively). The incidence rates among 5,222 subjects without GPA were 5.2 per 1,000 person-years and 4.3 per 1,000 person-years, respectively. The multivariable HRs among GPA patients were 1.86 (95% confidence interval [95% CI] 1.05-3.31) for MI and 1.50 (95% CI 0.78-2.89) for ischemic stroke. The age-, sex-, and entry time-matched HR for cardiovascular disease (composite outcome of MI or stroke) was highest during the first year after GPA diagnosis (HR 2.88, 95% CI 1.37-6.08). Conclusion Patients with GPA have a significantly increased risk of MI and a non-statistically significant trend toward an increased risk of ischemic stroke. Monitoring for this complication and vigilance in modifying risk factors are particularly warranted in this patient population, especially early after the diagnosis of GPA. [ABSTRACT FROM AUTHOR]

Introduction/Purpose: Over the last decade, much attention has been paid to the fractures of the posterior malleolus as it became obvious that the mere presence of a posterior tibial fragment is associated with a less favorable prognosis in malleolar fractures. It seems logical to pay the anterior restraints of the ankle joint a similar attention as to the posterior ones. The anteriolateral distal tibia may be considered a 'fourth' or anterior malleolus. Here, we present a technique of fixation of trimalleolar fractures with additional fracture of the anterior tibial tubercle ('quadrimalleolar') or anterior fibular rim ('quadrimalleolar equivalent'). Methods: Twenty-four patients with a mean age of 60 years were treated with open reduction and internal fixation of all 4 malleoli. There were 17 quadrimalleolar and 6 quadrimalleolar equivalent fractures. One patient had both anterior tibial and fibular avulsion fractures in addition to a trimalleolar ankle fracture. Surgical approaches and internal fixation were tailored individually. Twenty patients were operated in prone position with direct fixation of the posterior malleolus and 4 patients in supine position with indirect anterior to posterior screw fixation of the posterior malleolus under transfibular control of reduction. Results: After fixation of al 4 malleoli, only one patient (4%) required a syndesmotic screw for residual syndesmotic instability on intraoperative testing. There were no infections, and no wound healing problems. All patients went on to solid union. No late fusions were needed. Nineteen patients (79%) could be reevaluated after a mean of 77 months (range, 15 to 156 months) followup. The Foot Function Index averaged 15 (range, 50 to 0), the Olerud and Molander Score averaged 79 (range, 45 to 100) and the AOFAS Ankle and Hindfoot Scale averaged 87 (range, 39 to 100). Conclusion: Fixation of the anterior and posterior tibial fragments increases syndesmotic stability by providing a bone-to-bone fixation. Reduction of displaced anterior and posterior tibial rim fractures restores the physiological shape of the tibial incisura and therefore facilitates fibular reduction. In the majority of cases, this also restores articular congruity of the lateral tibial plafond. Anatomic reduction of the anterior and posterior malleolus in addition to medial and lateral malleolar fixation leads to favourable functional results despite a complex (quadrimalleolar) fracture pattern. [ABSTRACT FROM AUTHOR]

Introduction: Outdoor workers are at high risk of exposure to solar ultraviolet radiation (UVR), a known human carcinogen. In Canada, no objective measures of UVR exposure are available for occupational settings. Methods: The Outdoor Workers Project collected UVR exposure data among outdoor workers in Vancouver, Canada during the summer of 2013. Objective measures of exposure were taken for one week using calibrated electronic UVR dosimeters. Additional data was collected from workers on skin cancer risk factors, family history of skin cancer, and job type; as well as meteorological data for sampling days. Marginal models were constructed to examine the worker, job and meteorological determinants of UVR exposure levels, as measured in standard erythemal dose (SED). Results: Seventy-eight workers were recruited, of which 73 had at least 1 day of measured UVR exposure for this analysis. Participants were mostly male, young and Caucasian. Mean exposure (corrected for repeated measures) was 1.08 SED. Exposure measures were highly variable even in the same workplace, ranging from 0.01 SED to 19.2 SED. Younger age, working in land-based construction, and sunnier weather forecasts led to higher levels of UVR exposure. Conclusions: Exposure levels capable of causing sunburn were common in this study of outdoor workers, in a location not typically associated with high sun exposure. [ABSTRACT FROM AUTHOR]

Objectives: to measure sex differences in the risk of receiving potentially inappropriate prescription drugs and to examine what are the factors that contribute to these differences. Design: a retrospective cohort study. Setting: community setting of British Columbia, Canada. Participants: residents of British Columbia aged 65 and older (n = 660,679). Measurements: we measured 2013 period prevalence of prescription dispensations satisfying the American Geriatrics Society's 2012 version of the Beers Criteria for potentially inappropriate medication use in older adults. We used logistic regressions to test for associations between this outcome and a number of clinical and socioeconomic factors. Results: a larger share of women (31%) than of men (26%) filled one or more potentially inappropriate prescription in the community. The odds of receiving potentially inappropriate prescriptions are associated with several clinical and socioeconomic factors. After controlling for those factors, community-dwelling women were at 16% higher odds of receiving a potentially inappropriate prescription than men (adjusted odds ratio = 1.16, 95% confidence interval = 1.12-1.21). Much of this sex difference stemmed from women's increased odds of receiving potentially inappropriate prescriptions for benzodiazepines and other hypnotics, for tertiary tricyclic antidepressants and for non-selective NSAIDs. Conclusion: there are significant sex differences in older adults' risk of receiving a potentially inappropriate prescription as a result of complex intersections between gender and other social constructs. Appropriate responses will therefore require changes in the information, norms and expectations of both prescribers and patients. [ABSTRACT FROM AUTHOR]

Many psychological scales written in the Likert format include reverse worded (RW) items in order to control acquiescence bias. However, studies have shown that RW items often contaminate the factor structure of the scale by creating one or more method factors. The present study examines an alternative scale format, called the Expanded format, which replaces each response option in the Likert scale with a full sentence. We hypothesized that this format would result in a cleaner factor structure as compared with the Likert format. We tested this hypothesis on three popular psychological scales: the Rosenberg Self-Esteem scale, the Conscientiousness subscale of the Big Five Inventory, and the Beck Depression Inventory II. Scales in both formats showed comparable reliabilities. However, scales in the Expanded format had better (i.e., lower and more theoretically defensible) dimensionalities than scales in the Likert format, as assessed by both exploratory factor analyses and confirmatory factor analyses. We encourage further study and wider use of the Expanded format, particularly when a scale’s dimensionality is of theoretical interest. [ABSTRACT FROM AUTHOR]

Background: Children diagnosed with cancer often require extensive care for medical, psychosocial and educational problems during and after therapy. Part of this care is provided by family physicians and non-cancer specialists, but their involvement in the first years after diagnosis has barely been studied. Studying non-oncology physician visits may provide insight into the roles of different health care providers. Methods: We included 757 children diagnosed with cancer under age 15 between 1991 and 2001 from a Canadian provincial registry, and matched each to 10 controls of the same birth year and sex. We determined the number of family physician and non-cancer specialist visits in the 5 years after diagnosis (for patients) or inclusion (for controls) using data from the provincial health insurance plan. Results: In the first year after diagnosis, almost all patients visited both a family physician and non-cancer specialist. Although after 5 years percentages decreased to 85 and 76 %, respectively, these were still significantly higher than in controls. In the first year after diagnosis, both family physicians and non-cancer specialists were often consulted for neoplasms (62 and 90 %, respectively) and to discuss results of lab tests. In addition, family physicians were often consulted for general symptoms and non-cancer specialists for nervous system problems and complications of medical care. Conclusions: Family physicians and non-cancer specialists are highly involved in the care for children with cancer in the first years after diagnosis, including for health problems related to cancer or its treatment. This necessitates good communication among all physicians. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Dental Hygiene is the property of Canadian Dental Hygienists Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

In the present study, we sought to identify rates, causes, and predictors of death among male and female injection drug users (IDUs) in Vancouver, British Columbia, Canada, during a period of expanded public health interventions. Data from prospective cohorts of IDUs in Vancouver were linked to the provincial database of vital statistics to ascertain rates and causes of death between 1996 and 2011. Mortality rates were analyzed using Poisson regression and indirect standardization. Predictors of mortality were identified using multivariable Cox regression models stratified by sex. Among the 2,317 participants, 794 (34.3%) of whom were women, there were 483 deaths during follow-up, with a rate of 32.1 (95% confidence interval (CI): 29.3, 35.0) deaths per 1,000 person-years. Standardized mortality ratios were 7.28 (95% CI: 6.50,8.14) for men and 15.56 (95% CI: 13.31,18.07) for women. During the study period, mortality rates related to infection with human immunodeficiency virus (HIV) declined among men but remained stable among women. In multivariable analyses, HIV seropositivity was independently associated with mortality in both sexes (all P< 0.05). The excess mortality burden among IDUs in our cohorts was primarily attributable to HIV infection; compared with men, women remained at higher risk of HIV-related mortality, indicating a need for sex-specific interventions to reduce mortality among female IDUs in this setting. [ABSTRACT FROM AUTHOR]

Purpose A nurse navigator (NN) pilot project for patients with lung cancer was implemented in British Columbia, a publicly funded health-care system. The purpose was to improve referral practices, timelines, and availability of molecular testing for patients with advanced non-small-cell lung cancer (NSCLC). Methods Patients with stage IIIB/IV NSCLC referred to the BC Cancer Agency, Vancouver, in 2011 and 2014, pre- and post-implementation of an NN, were included. Referral patterns, systemic therapy, radiotherapy (XRT) timelines, and molecular testing practices were compared. Results The study included 408 patients: 212 in 2011 and 196 in 2014. Medical oncology (MO) end points comparing 2011 data with 2014 findings revealed that referral rates remained stable, and the proportion of patients who received systemic therapy increased from 57% to 69% (P = .05). Time from referral to MO consult was 18 days in 2011 versus 15.5 days in 2014 (P = .11); referral to systemic treatment was reduced from 48 to 38 days (P = .016). Comparison of molecular testing showed time between referral and the epidermal growth factor (EGFR) result was reduced from 34 days in 2011 to 20 days in 2014 (P < .001); rates of testing increased from 62% to 91%, respectively (P < .001); and EGFR mutation-positive rates were 19% versus 26%, respectively (P = .26). The radiation oncology (RO) end point results were as follows: 87% of patients were referred for RO consults in 2011 versus 80% in 2014 (P = .05), and the same proportion of patients received XRT (91% v87%, respectively). Time from referral to RO consult decreased from 10 days in 2011 to 8 days in 2014 (P = .005); and referral toXRT in 2011 and 2014 was 18 days versus 11.5 days, respectively (P < .001). Conclusion Implementation of an NN was associated with reduced wait times and increased molecular testing, improving appropriate delivery of first-line targeted therapy. NN involvement facilitates correct allocation of physician and clinical resources. [ABSTRACT FROM AUTHOR]

Objective. Limited data are available on the risk of cardiovascular disease in DM and PM. The purpose of this study was to estimate the risk of incident myocardial infarction (MI) and ischaemic stroke in adults with incident PM/DM at the general population level. Methods. We assembled a retrospective cohort of all adults with incident PM/DM in British Columbia, and we matched up to 10 adults randomly selected from the general population. We estimated the incidence rates (IRs) per 1000 person-years for MI and stroke. We calculated hazard ratios (HRs), adjusting for potential confounders. Results. Among 774 new cases of inflammatory myopathies, 424 had PM (59% female, mean age 60 years) and 350 had DM (65% female, mean age 56 years). IRs for MI and stroke in PM were 22.52 and 10.15 events per 1000 person-years, respectively, vs 5.50 and 5.58 events in the comparison cohort, respectively. Fully adjusted HRs (95% CI) were 3.89 (95% CI: 2.28, 6.65) for MI and 1.76 (95% CI: 0.91, 3.40) for stroke. The age-, sex- and entry time-matched HRs for MI and stroke were highest in the first year after PM diagnosis (6.51, [95% CI: 3.15, 13.47] and 3.48 [95% CI: 1.26, 9.62], respectively). Similar trends were seen for DM. Conclusion. Our study demonstrates that PM and DM are both associated with an increased risk of MI but not ischaemic stroke. Our findings support increased vigilance in cardiovascular prevention, surveillance and risk modification in adults with PM and DM. [ABSTRACT FROM AUTHOR]

In 2013 Health Canada conducted a national survey of computed tomography (CT) radiation usage. We analysed contributions from all 7 public health authorities in the province of British Columbia, which covered scanner age, number of slices, and common adult protocols (≥19 years: 70 ± 20 kg, head, chest, abdomen/pelvis, and trunk). Patient doses were recorded for common protocols. Diagnostic reference levels (DRLs) was calculated using scanner data with >10 patient doses recorded for each protocol. Data was analysed based on image reconstruction (filtered backprojection vs iterative reconstruction [IR] vs IR available but not in use). Provincial response was 92%, with 59 of 64 CT data used for analysis. The average scanner age was 5.5 years old, with 39% of scanners installed between 2008-2013; 78.5% of scanners were multislice (>64 slices), and 44% of scanners had IR available. Overall British Columbia DRLs were: head = 1305, chest = 529, abdomen/pelvis = 819, and trunk = 1225. DRLs were consistent with Health Canada recommendations and other Canadian published values, but above international standards. For sites with IR available, less than 50% used this technology routinely for head, chest and trunk exams. Overall, use of IR reduced radiation usage between 11%-32% compared to filtered backprojection, while sites using IR vs IR available used 30%/43% less radiation for head/chest exams ( P < .05). No significant difference was observed for abdomen/pelvis exams ( P = .385). With the fast pace of CT technical advancement, DRLs should reflect the technology used, instead of just globally applied to anatomical regions. Federal guidelines should be updated at a higher frequency to reflect new technology. In addition, new technologies must be utilised to optimize image quality vs radiation usage. [ABSTRACT FROM AUTHOR]

Purpose Atypical femoral fractures (AFF) are recently described events related to osteoporosis and, potentially, a rare result of antiresorptive treatment. Methods We set out to audit the diagnosis of AFF in an acute hospital. Charts and radiographs were reviewed retrospectively from patients diagnosed with subtrochanteric femoral fractures according to hospital discharge coding at Vancouver General Hospital (VGH), Canada, from January 2005 to March 2013. Results A total of 3084 patients were discharged from the hospital with a diagnosis of hip fracture between 2005 and 2013. Of these, 204 were coded as having had subtrochanteric fractures; 178 of the patients thus coded had radiographic evidence of other fracture types—usually intertrochanteric fractures. Eleven patients did not have available radiographs. Of the remaining 193 patients whose radiographs were reviewed, 24 (12.4%) fulfilled the published criteria for AFF. Our observations were 1) laterality: 13 of 24 AFF (54.2%) were right-sided; 2) there was only one incomplete AFF in this series: a completed fracture was an inclusion criterion, but 1 patient with an AFF had both that fracture and an incomplete fracture and further foci of periosteal or endosteal foci of new bone (PENB) involving the contralateral femur; 3) radiologists had only diagnosed AFF in only 1 of the 24 patients with characteristic radiographic signs of AFF; 4) all but 1 patient had a focus of periosteal and/or endosteal new bone (PENB) through which the fracture line invariably passed, and in the 1 exception the radiography was too poor to be sure of this but there was a symmetrical contralateral focus of PENB; 5) in 19 of 24 patients there was an adequate image of part of the contralateral femur and of these 12 (63%) had a contralateral focus of PENB situated ±2.5 cm from the index lesion site when measured from the upper aspect of the greater trochanter, and in another patient a prior fracture of the contralateral femur had been treated surgically and it was at a symmetrical contralateral location from the index fracture.; 6) in 3 of the 19 patients multiple foci of PENB were detected on the lateral aspect of the contralateral femur even though the examination was of limited extent; and 7) AFFs were associated with bisphosphonate medication in 75% of the patients studied. Conclusions Hospital discharge coding misclassified a great majority of femoral fractures as subtrochanteric. As an essential criteria for diagnosing AFF is their subtrochanteric location, this misclassification impaired our ability to retrospectively search for AFF patients. Radiologists tended not to report AFF when typical radiographic characteristics were present. Bilateral and multifocal disease is of interest in pointing to the diagnosis and in suggesting that the mechanism of injury in respect of these unusual fractures is more complex than simple low-energy trauma. [ABSTRACT FROM AUTHOR]

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The purpose of this quality improvement project was to evaluate the effectiveness of breast cancer care support provided by breast cancer care navigators (BCCN)for women attending the breast health clinic (BHC). This evaluative process examined patients' satisfaction with the nurse navigator program that focused on addressing breast cancer patients' informational needs, emotional support, and guidance through the cancer trajectory. A survey approach using Likert-type scales and open-ended questions was utilized to gather data. Patients seen at the BHC between July 2011 and July 201 J were sent the surveys by mail. The 154 responses constituted a 69% response rate. More than go% of participants understood the information provided by the BCCN and were satisfied with the information that had been received. Psychosocial support from patient/family counselling services at the agency and in the community were among the most common request for resources. Recommendations include contacting patients directly after their initial meeting at the clinic and at least once after their treatments began, to ensure continuity and support. BCCN role was identified as being valuable with a positive effect on patients' experience. [ABSTRACT FROM AUTHOR]

Objective. There is a concern that cost-effectiveness analysis using quality-adjusted life years does not capture all valuable benefits of treatments. The objective of this study was to determine the value society places on aspects of RA treatment to inform policymaking. Methods. A discrete choice experiment was administered to a representative sample of the Canadian general population. The discrete choice experiment, developed using focus groups, had seven attributes (route and frequency of administration, chance of benefit, chance of serious and minor side effects, confidence in evidence and life expectancy). A conditional logit regression model was used to estimate the significance and relative importance of attributes in influencing preferences on the quality-adjusted life years scale. Results. Responses from 733 respondents who provided rational responses were analysed. Six attribute levels within four attributes significantly influenced preferences for treatments: a willingness to trade a year of life expectancy over a 10-year period to increase the probability of benefiting from treatment, or two-thirds of a year to reduce minor or serious side effects to the lowest level or improve the confidence in benefit/side-effect estimates. There was also some evidence of a preference for oral drug delivery, though a subgroup analysis suggested this preference was restricted to injection-naive respondents. Conclusion. Our results suggest society values the degree of confidence in the estimates of risks and benefits of RA treatments and the route of administration, as well as benefits and side effects. This study provides important evidence to policymakers determining the cost-effectiveness of treatments in arthritis. [ABSTRACT FROM AUTHOR]

Background: Across Canada, pharmacists have expanded their scope of practice by performing medication management (MM) services. However, little is currently known about the opinions and attitudes of patients and the general population toward MM services. Methods: A cross-sectional online survey, including a best-worst scaling task, was designed to understand the general public’s opinions, preferences and willingness-to-pay with respect to MM services in British Columbia. Results: Of 977 individuals contacted, 819 responded to the questionnaire (84% response rate). The mean age was 45 years (standard deviation [SD] 16 years), and 37% were male. Overall, 93% of respondents felt that the medication advice from their pharmacist resulted in improvement in patient outcomes and/or medication use. This was also selected as the “best” attribute of MM, while other preferred attributes of MM included being able to obtain an appointment with the pharmacist on the same day or via walk-in, improved patient-physician relationships and MM sessions able to be completed in 15 minutes with the pharmacist. The average willingness to pay for MM was $24.55 (SD $21.44). Younger males with higher household income and those who had had MM in the past were willing to pay more for MM services out of pocket. Discussion and Conclusion: The accessibility of pharmacists was valued highly by respondents who, overall, were supportive of MM services and recognized the potential of pharmacists’ involvement in drug therapy management to improve patient outcomes and medication use. Alternative models of funding are worth considering for the sustainability of MM service provision. [ABSTRACT FROM AUTHOR]

People are required to adapt their basic walking pattern to turn and change directions safely for activities of daily living. This case study describes the changes in neuromuscular control among individuals with stroke on walking paths of different curvatures. Two men with hemiparetic stroke and one control subject walked along a straight, wide curved, and tight curved pathway while muscle activation of the medial and lateral gastrocnemius was recorded, along with the trajectory of the center of pressure (COP) during the single support phase. Balance, sensorimotor control, and functional ambulation were also evaluated. The subject with greater lower-limb sensorimotor impairment displayed a larger difference in the anterior-posterior COP displacement between limbs, which exacerbated as the path curvature increased. In addition, while the control subject demonstrated a lateral shift in the mediallateral COP position, this person was unable to adapt the COP position on the nonparetic side. The second participant with a stroke demonstrated better balance and lateral shifting of the COP position. Modulation of the COP trajectory is required to safely perform curved walking. Further study is required to confirm the role of stroke-related gait deficits in the ability to adapt to curved walking. [ABSTRACT FROM AUTHOR]

Reasoned action approaches have primarily been applied to understand exercise behaviour for the past three decades, yet emerging findings in unconscious and Dual Process research show that behavior may also be predicted by automatic processes such as habit. The purpose of this study was to: (1) investigate the behavioral requirements for exercise habit formation, (2) how Dual Process approach predicts behaviour, and (3) what predicts habit by testing a model (Lally and Gardner in Health Psychol Rev 7:S137-S158, ). Participants (n = 111) were new gym members who completed surveys across 12 weeks. It was found that exercising for at least four bouts per week for 6 weeks was the minimum requirement to establish an exercise habit. Dual Process analysis using Linear Mixed Models (LMM) revealed habit and intention to be parallel predictors of exercise behavior in the trajectory analysis. Finally, the habit antecedent model in LLM showed that consistency (β = .21), low behavioral complexity (β = .19), environment (β = .17) and affective judgments (β = .13) all significantly ( p < .05) predicted changes in habit formation over time. Trainers should keep exercises fun and simple for new clients and focus on consistency which could lead to habit formation in nearly 6 weeks. [ABSTRACT FROM AUTHOR]

Purpose: A study was performed to evaluate the ACR Select software in determining the level of appropriateness of computed tomography (CT) and magnetic resonance imaging (MRI) in Island Health in British Columbia. Methods: A total of 1228 consecutive CT and MRI studies performed in a 3-day period were entered into a software program provided by the National Decision Support Company based on the ACR Appropriateness Criteria. The program was able to analyze 93% (1141) of these studies. A subset of these requisitions was manually reviewed. Results: The software program demonstrated a very low 2.5% inappropriate rate and manual review showed an even lower number of 0.6%. In a sample of studies deemed to be appropriate by the software, manual review agreed with this ranking in all cases. In addition, in 20% of cases where CT was done, the software program suggested that MRI would be a more appropriate choice. Conclusions: First, the ACR Select software is a useful tool to assess appropriateness of CT and MRI, although it may underestimate the level of appropriateness of studies labeled as inappropriate. Second, CT and MRI are being ordered appropriately in Island Health in British Columbia. The software recommendation of MRI as more appropriate in 20% of cases where CT was done suggests a lack of MRI resources in Island Health. [ABSTRACT FROM AUTHOR]

Background: Vitamin D supplementation is recommended for breastfed infants. Maternal supplementation beginning in gestation is a potential alternative, but its efficacy in maintaining infant 25-hydroxyvitamin D [25(OH)D] concentration after birth is unknown. Objectives: We determined the effect of 3 doses of maternal vitamin D supplementation beginning in gestation and continued in lactation on infant serum 25(OH)D and compared the prevalence of infant serum 25(OH)D cutoffs (>30, >40, >50, and >75 nmol/L) by dose at 8 wk of age. Design: Pregnant women (n = 226) were randomly allocated to receive 10, 25, or 50 µg vitamin D3/d from 13 to 24 wk of gestation until 8 wk postpartum, with no infant supplementation. Mother and infant blood was collected at 8 wk postpartum. Results: At 8 wk postpartum, mean [nmol/L (95% CI)] infant 25(OH)D at 8 wk was higher in the 50-µg/d [75 (67, 83)] than in the 25-µg/d [52 (45, 58)] or 10-µg/d [45 (38, 52)] vitamin D groups (P < 0.05). Fewer infants born to mothers in the 50-µg/d group had a 25(OH)D concentration,30 nmol/L (indicative of deficiency) than infants in the 25- and 10-µg/d groups, respectively (2% compared with 16% and 43%; P< 0.05). Fewer than 15% of infants in the 10-or 25-µg/d groups achieved a 25(OH)D concentration .75 nmol/L compared with 44% in the 50-µg/d group (P < 0.05). Almost all infants (w98%, n = 44) born to mothers in the 50-µg/d group achieved a 25(OH)D concentration .30 nmol/L. At 8 wk postpartum, mean maternal 25(OH)D concentration was higher in the 50-µg/d [88 (84, 91)] than in the 25-µg/d [78 (74, 81)] or 10-µg/d [69 (66, 73)] groups (P< 0.05). Conclusions: Maternal supplementation beginning in gestation with 50 µg vitamin D3/d protects 98% of unsupplemented breastfed infants against 25(OH)D deficiency (<30 nmol/L) to at least 8 wk, whereas 10 or 25 µg vitamin D/d protects only 57% and 84% of infants, respectively. This trial was registered at clinicaltrials.gov as NCT01112891. [ABSTRACT FROM AUTHOR]

Background: Because little is known about food insecurity in people with mental health conditions, we investigated relationships among food insecurity, nutrient intakes, and psychological functioning in adults with mood disorders. Methods: Data from a study of adults randomly selected from the membership list of the Mood Disorder Association of British Columbia (n = 97), Canada, were analyzed. Food insecurity status was based on validated screening questions asking if in the past 12 months did the participant, due to a lack of money, worry about or not have enough food to eat. Nutrient intakes were derived from 3-day food records and compared to the Dietary Reference Intakes (DRIs). Psychological functioning measures included Global Assessment of Functioning, Hamilton Depression scale, and Young Mania Rating Scale. Using binomial tests of two proportions, Mann-Whitney U tests, and Poisson regression we examined: (1) food insecurity prevalence between the study respondents and a general population sample from the British Columbia Nutrition Survey (BCNS; n = 1,823); (2) differences in nutrient intakes based on food insecurity status; and (3) associations of food insecurity and psychological functioning using bivariate and Poisson regression statistics. Results: In comparison to the general population (BCNS), food insecurity was significantly more prevalent in the adults with mood disorders (7.3% in BCNS vs 36.1%; p < 0.001). Respondents who were food-insecure had lower median intakes of carbohydrates and vitamin C (p < 0.05). In addition, a higher proportion of those reporting food insecurity had protein, folate, and zinc intakes below the DRI benchmark of potential inadequacy (p < 0.05). There was significant association between food insecurity and mania symptoms (adjusted prevalence ratio = 2.37,95% Cl 1.49-3.75, p< 0.05). Conclusions: Food insecurity is associated with both nutritional and psychological health in adults with mood disorders. Investigation of interventions aimed at food security and income can help establish its role in enhancing mental health. [ABSTRACT FROM AUTHOR]

Background: Some patients receiving treatment in conventional health care systems access therapeutic yoga outside their mainstream care to improve cancer symptoms. Given the current knowledge gap around patient preferences and documented experiences of yoga in adult cancer, this study aimed to describe patient-reported benefits, barriers and characteristics of programming for yoga practice during conventional treatment. Methods: In depth semi-structured interviews (n = 10) were conducted in men and women recruited from cancer care clinics in Vancouver, Canada using a purposive sampling technique. The exploratory interviews were audio-recorded, transcribed and analyzed using Interpretive Description methodology and constant comparative analysis methods. Results: Four themes emerged from the data to address our research objectives: patient-perceived benefits of yoga, reasons and motivations for practising yoga, hurdles and barriers to practising yoga, and advice for effective yoga program delivery in adult cancer. Several patients reported yoga reduced stress and other symptoms associated with cancer treatment. Thematic analysis found the social dimension of group yoga was important, as well as yoga's ability to encourage personal empowerment and awareness of physical body and self. Barriers to yoga adherence from the patient perspective included lack of time, scheduling conflicts and worries about financial burden. Conclusion: This small, diverse sample of patients reported positive experiences and no adverse effects following yoga practice for management of cancer and its symptoms. Results of this qualitative study identified patient-reported preferences, barriers and characteristics of yoga intervention optimal during adult cancer treatment. [ABSTRACT FROM AUTHOR]

Purpose: In July 2012, in response to residents' concerns regarding the impact of the traditional 24-hour call system on their personal wellbeing and educational experience, the University of British Columbia Radiology residency program adopted a 12-hour night float system. This shift takes place in the context of increasing concerns, both across Canada and internationally, about resident well-being and the impact of prolonged duty hours on patient care. Methods: An anonymous survey was distributed to all 25 postgraduate years 2-5 University of British Columbia radiology residents 12 months after the introduction of night float. This study sought to solicit residents' feedback about these changes and to identify potential future changes to optimize the call system. Results: The response rate was 100%; 96% of residents were in favor of continuing with night float rather than the traditional call system; 72% of residents reported that their judgement was affected secondary to being on night float. Although most residents described varying degrees of impairment, the rate of acute discrepancies between resident preliminary and attending radiologist final reports decreased by more than half, from 2% to less than 1%. Conclusions: The vast majority of our residents were in favor of maintaining the night float call system. Night float had a beneficial effect on the resident educational experience: by eliminating the pre-call morning and post-call day off rotation, residents gained an additional 24 days per year on other clinical rotations. [ABSTRACT FROM AUTHOR]

Background. We examined (1) patient characteristics and disease-modifying drug (DMD) exposure in late-onset (LOMS, ≥50 years at symptom onset) versus adult-onset (AOMS, 18–<50 years) MS and (2) the association between interferon-beta (IFNβ) and disability progression in older relapsing-onset MS adults (≥50 years). Methods. This retrospective study (1980–2004, British Columbia, Canada) included 358 LOMS and 5627 AOMS patients. IFNβ-treated relapsing-onset MS patients aged ≥50 (regardless of onset age, 90) were compared with 171 contemporary and 106 historical controls. Times to EDSS 6 from onset and from IFNβ eligibility were examined using survival analyses. Results. LOMS patients (6%) were more likely to be male, with motor onset and a primary-progressive course, and exhibit faster progression and were less likely to take DMDs. Nonetheless, 57% were relapsing-onset, of which 31% were prescribed DMDs, most commonly IFNβ. Among older relapsing-onset MS adults, no significant association between IFNβ exposure and disability progression was found when either the contemporary (hazard ratio [HR]: 0.46; 95% CI: 0.18–1.22) or historical controls (HR: 0.54; 95% CI: 0.20–1.42) were considered. Conclusion. LOMS differed clinically from AOMS. One-third of older relapsing-onset MS patients were prescribed a DMD. IFNβ exposure was not significantly associated with reduced disability in older MS patients. [ABSTRACT FROM AUTHOR]

Soft ripened cheese (SRC) caused over 130 foodborne illnesses in British Columbia (BC), Canada, during two separate listeriosis outbreaks. Multiple agencies investigated the events that lead to cheese contamination with Listeria monocytogenes (L.m.), an environmentally ubiquitous foodborne pathogen. In both outbreaks pasteurized milk and the pasteurization process were ruled out as sources of contamination. In outbreak A, environmental transmission of L.m. likely occurred from farm animals to personnel to culture solutions used during cheese production. In outbreak B, birds were identified as likely contaminating the dairy plant’s water supply and cheese during the curd-washing step. Issues noted during outbreak A included the risks of operating a dairy plant in a farm environment, potential for transfer of L.m. from the farm environment to the plant via shared toilet facilities, failure to clean and sanitize culture spray bottles, and cross-contamination during cheese aging. L.m. contamination in outbreak B was traced to wild swallows defecating in the plant’s open cistern water reservoir and a multibarrier failure in the water disinfection system. These outbreaks led to enhanced inspection and surveillance of cheese plants, test and release programs for all SRC manufactured in BC, improvements in plant design and prevention programs, and reduced listeriosis incidence. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to determine whether general practitioner visits for alcohol-attributed diseases increased in a decade when several regulatory changes were made to the distribution and price of alcohol in British Columbia Canada. Methods: General practitioner consultations for alcohol-attributed diseases were examined using data from British Columbia’s Medical Services Plan database. Negative binomial regression was used to measure the significance of yearly variations using incidence rate ratios by disease type per year. Results: From 2001 to 2011, 690,401 visits were made to general practitioners by 198,623 persons with alcoholattributed diseases. Most visits (86.2%) were for alcohol dependency syndrome (N = 595,371). General practitioner visits for alcohol-attributed diseases increased significantly (p < .001) by 53.3% from 14,882 cases in 2001 to 22,823 cases in 2011. While the number of cases increased from 2001-2011, the frequency of visits to general practitioners significantly decreased from 3.9 in 2001 to 2.7 visits per case in 2011 (F = 428.1, p < .001). Conclusion: From 2001 to 2011 there were significant increases in the number of persons presenting to general practitioners with alcohol-attributed diseases in British Columbia. The results of this study demonstrate the need to provide enhanced support to general practitioners in the treatment of patients with substance use disorders given the increasing number of primary health care patients with alcohol-attributed diseases. [ABSTRACT FROM AUTHOR]

Purpose: Today’s youths spend close to 60% of their waking hours in sedentary activities; however, we know little about the potentially deleterious effects of sedentary time on bone health during this key period of growth and development. Thus, our objective was to determine whether sedentary time is associated with bone architecture, mineral density, and strength in children, adolescents, and young adults. Methods: We used high-resolution peripheral quantitative computed tomography (Scanco Medical) to measure bone architecture (trabecular and cortical microstructure and bone macrostructure) and cortical and total bone mineral density (BMD) at the distal tibia (8% site) in 154 males and 174 females (9-20 yr) who were participants in the University of British Columbia Healthy Bones III study. We applied finite element analysis to high-resolution peripheral quantitative computed tomography scans to estimate bone strength. We assessed self-reported screen time in all participants using a questionnaire and sedentary time (volume and patterns) in a subsample of participants with valid accelerometry data (89 males and 117 females; ActiGraph GT1M). We fit sex-specific univariate multivariable regression models, controlling for muscle cross-sectional area, limb length, maturity, ethnicity, dietary calcium, and physical activity. Results: We did not observe independent effect of screen time on bone architecture, BMD, or strength in either sex (P > 0.05). Likewise, when adjusted for muscle cross-sectional area, limb length, maturity, ethnicity, dietary calcium, and physical activity, accelerometry-derived volume of sedentary time and breaks in bouts of sedentary time were not a determinant of bone architecture, BMD, or strength in either sex (P > 0.05). Conclusions: Further study is warranted to determine whether the lack of association between sedentary time and bone architecture, BMD, and strength at the distal tibia is also present at other skeletal sites. [ABSTRACT FROM AUTHOR]

Study design:Diagnostic study.Objectives:The objective of this study was to compare patterns of electromyography (EMG) recordings of abdominal muscle function in persons with motor-complete spinal cord injury (SCI) above T6 and in able-bodied controls, and to determine whether manual examination or ultrasound measures of muscle activation can be accurate alternatives to EMG.Setting:Research center focused on SCI and University laboratory, Vancouver, Canada.Methods:Thirteen people with SCI (11 with American Spinal Injury Association Impairment Scale (AIS) A and 2 AIS B; C4-T5), and 13 matched able-bodied participants volunteered for the study. Participants completed trunk tasks during manual examination of the abdominal muscles and then performed maximal voluntary isometric contractions, while EMG activity and muscle thickness changes were recorded. The frequency of muscle responses detected by manual examination and ultrasound were compared with detection by EMG (sensitivity and specificity).Results:All individuals with SCI were able to elicit EMG activity above resting levels in at least one abdominal muscle during one task. In general, the activation pattern was task specific, confirming voluntary control of the muscles. Ultrasound, when compared with EMG, showed low sensitivity but was highly specific in its ability to detect preserved abdominal muscle function in persons with SCI. Conversely, manual examination was more sensitive than ultrasound but showed lower specificity.Conclusion:The results from this study confirm preserved voluntary abdominal muscle function in individuals classified with motor-complete SCI above T6 and highlight the need for further research in developing more accurate clinical measures to diagnose the level of trunk muscle preservation in individuals with SCI. [ABSTRACT FROM AUTHOR]

Background: The objective of this study was to assess the financial implications of the continuity of care, for patients with high care needs, by examining the cost of government-funded health care services in British Columbia, Canada. Methods: Using British Columbia Ministry of Health administrative databases for fiscal year 2010-2011 and generalized linear models, we estimated cost ratios for 10 cost-related predictor variables, including patients' attachment to the practice. Patients were selected and divided into groups on the basis of their Resource Utilization Band (RUB) and placement in provincial registries for 8 chronic conditions (1,61 9,941 patients). The final dataset included all high- and very-high-care-needs patients in British Columbia (ie, RUB categories 4 and 5) in 1 or more of the 8 registries who met the screening criteria (222,779 patients). Results: Of the 10 predictors, across 8 medical conditions and both RUBs, patients' attachment to the practice had the strongest relationship to costs (correlations = -0.168 to -0.322). Higher attachment was associated with lower costs. Extrapolation of the findings indicated that an increase of 5% in the overall attachment level, for the selected high-care-needs patients, could have resulted in an estimated cost avoidance of $142 million Canadian for fiscal year 2010-2011. Conclusions: Continuity of care, defined as a patient's attachment to his/her primary care practice, can reduce health care costs over time and across chronic conditions. Health care policy makers may wish to consider creating opportunities for primary care physicians to increase the attachment that their high-care-needs patients have to their practices. [ABSTRACT FROM AUTHOR]

Introduction: We sought to assess awareness of, exposure to and interest in general practitioner (GP) surgery and enhanced surgical skills (ESS) among family practice residents in British Columbia, Alberta and Saskatchewan. Methods: We distributed a survey to all family practice residents at 4 universities in BC, Alberta and Saskatchewan. The survey assessed demographic information, awareness of and exposure to GP surgery or ESS during training, and interest in pursuing formal ESS training. Results: We received 174 responses (27.2% response rate). Numerous respondents were unaware of GP surgery (9.9% ± 4.5%) and ESS (17.9% ± 5.7%). Awareness was higher among respondents from rural hometowns (GP surgery and ESS awareness 100% and 94.1%, respectively), and with prior exposure to GP surgery (GP surgery and ESS awareness 96.9% and 95.4%, respectively). A minority (38.2%) had been exposed to GP surgery, with exposure higher in respondents from rural training sites and in their second postgraduate year (72.5% and 47.4%, respectively). A quarter (25.1%) of respondents were considering ESS training. Factors encouraging training included increased procedures, challenging medicine and impact on patient outcomes. The importance of ESS training opportunities and service was rated highly. Conclusion: Many respondents were unaware of ESS as a career option. Exposure to GP surgery during training was associated with increased awareness. Furthermore, exposure fostered interest in this important field. These results may be helpful in the development of formal ESS training programs and in curricula for family practice residency programs. [ABSTRACT FROM AUTHOR]

Purpose: To determine the comparative effectiveness of consistent cooling using an icing device (DonJoy Iceman, DJO Canada, Mississauga, ON) versus intermittent cooling using an ice bag (usual care) for the first 48 hours after total knee arthroplasty (TKA). Method: A sample of 78 patients (intervention group, n=37; control group, n=34) undergoing primary TKA were randomized to intervention (device) or control (ice) groups. The primary outcome was pain intensity, measured by numerical pain rating scale (NPRS). Secondary outcomes were passive range of motion (PROM), nausea or vomiting, opioid use, blood loss, lower limb function, hospital length of stay, and patient-reported compliance and satisfaction. Results: No significant differences in the primary outcome (pain intensity measured via NPRS) were observed between control and intervention groups. Patients in the intervention group were significantly more satisfied (8.4 vs. 6.0, p=0.002); used the device more consistently, day and night (85.7% vs. 29.6% and 87.6% vs. 30.8%, respectively, p<0.001); and were more likely to recommend this method of cooling (96.8% vs. 68.0%, p=0.004). Conclusion: The study found no additional benefit of consistent cryotherapy using the icing device over intermittent ice bags on postoperative pain, PROM, nausea or vomiting, opioid use, blood loss, lower limb function, or length of stay, despite significant differences in patient-reported compliance and satisfaction. [ABSTRACT FROM AUTHOR]

Background The use of palliative radiotherapy (PRT) is variable in advanced cancer. Little is known about PRT utilization by end-of-life (EOL) cancer patients in Canada. This study examined the PRT utilization rates and factors associated with its use in a cohort of cancer patients who died in British Columbia (BC). Methods BC residents with invasive cancer who died between April 1, 2010 and March 31, 2011 were included in the study. Their cancer registry and radiotherapy treatment records were extracted from the BC Cancer Agency information systems and linked for the analysis. The PRT utilization rates by age, sex, primary cancer diagnosis, geographic region, survival time and travel time to the cancer centre were examined. Multivariable logistic regression was used to determine the factors that influenced the PRT utilization rates. Results Of the 12,300 decedents in the study 2,669 (21.7%) had received at least one course of PRT in their last year of life. The utilization rates dropped to 5.0% and 2.2% in the last 30 and 14 days of life, respectively. PRT utilization varied across diagnosis and was highest for lung cancer (45.7%) and lowest for colorectal cancer (8.9%). The rates also varied by age, survival time and travel time to the nearest radiotherapy centre. There was a greater odds of receiving PRT for those with primary lung cancer, survival time between 1.5-26 months from diagnosis or living within 2 hours from a cancer centre. The 85+ age group was least likely to receive PRT in their last year of life. Conclusions This study found PRT utilization rates of EOL cancer decedents to be variable across the province of BC. Age, diagnosis, survival time and travel time to the nearest radiotherapy centre were found to influence the odds of PRT treatment. Further work is still needed to establish the appropriate PRT utilization rates for the EOL cancer population. [ABSTRACT FROM AUTHOR]

BACKGROUND: Subject recruitment is essential for conducting clinical research; however, there are very few studies evaluating research uptake by families in a paediatric setting. OBJECTIVES: To determine how frequently paediatric patients and their families receiving care at a tertiary paediatric hospital participated in research. The secondary objectives were to explore factors that influence patient families' decisions to participate in research and how they perceived their experiences. METHODS: A cross-sectional study surveying families of children receiving care in a sample of clinical areas at a tertiary care paediatric hospital in British Columbia was conducted. A self-administered questionnaire was used, and was facilitated by trained interviewers. Descriptive statistics were used to report the proportion of patient families that have previously been invited to participate in research and, among these, the proportion who had agreed to participate. Patient families' perceptions of research and their past experiences therein were also reported. RESULTS: A total of 657 families were approached, of which 543 were enrolled (82.6% response rate). Among the 439 families that had visited the hospital previously, 114 (26.0%) had been invited to participate in research and 99 (87%) had consented to participate. Of these 99 families, only one had a negative experience, and 84 (85%) of these participant families were at least somewhat likely to participate in research again in the future. CONCLUSIONS: Only one-quarter of families that had previously visited the hospital had been invited to participate in a research project. Of the families approached previously, there was a high rate of participation and willingness to participate in future research. [ABSTRACT FROM AUTHOR]

The article presents a study to determine the cost-effectiveness of annual versus biennial screening mammography among women with dense breast tissue. Topics discussed under study include use of Markov model to analyze cancer care programme in British Columbia and Canada, calculation of costs based on treatment data and use of probabilistic sensitivity analysis. The result concluded benefits for women undergoing annual screening mammography as compared to biennial screening.

Question: What are typical values of physical function for women diagnosed with breast cancer and how do these compare to normative data? Design: Systematic review with meta-analysis. Participants: Women diagnosed with breast cancer who were before, during or after treatment. Outcome measures: Physical function was divided into three categories: aerobic capacity, upper and lower extremity muscular fitness, and mobility. Measures of aerobic capacity included field tests (6-minute walk test, 12-minute walk tests, Rockport 1-mile test, and 2-km walk time) and submaximal/maximal exercise tests on a treadmill or cycle ergometer. Measures of upper and lower extremity muscular fitness included grip strength, one repetition maximum (bench, chest or leg press), muscle endurance tests, and chair stands. The only measure of mobility was the Timed Up and Go test. Results: Of the 1978 studies identified, 85 were eligible for inclusion. Wide ranges of values were reported, reflecting the range of ages, disease severity, treatment type and time since treatment of participants. Aerobic fitness values were generally below average, although 6-minute walk time was closer to population norms. Upper and lower extremity strength was lower than population norms for women who were currently receiving cancer treatment. Lower extremity strength was above population norms for women who had completed treatment. Conclusion : Aerobic capacity and upper extremity strength in women diagnosed with breast cancer are generally lower than population norms. Assessment of values for lower extremity strength is less conclusive. As more research is published, expected values for sub-groups by age, treatment, and co-morbidities should be developed. [Neil-Sztramko SE, Kirkham AA, Hung SH, Niksirat N, Nishikawa K Campbell KL (2014) Aerobic capacity and upper limb strength are reduced in women diagnosed with breast cancer: a systematic review. Journal of Physiotherapy 60: 189–200] [ABSTRACT FROM AUTHOR]