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Background: Physical activity (PA) is an important contributor to the health of Canadians. However, the extent that PA is included in family medicine residents' education is largely unknown. This study surveyed curriculum experts in Canadian family medicine residency programs to understand what residents learn about PA and to what extent this varies across programs. Methods: Seventeen family medicine residency program websites were reviewed for information pertaining to their PA curriculum. Additionally, curriculum experts were invited to complete a cross-sectional survey to better understand the extent that PA curriculum is included in their programs. Results: Most (82.4%) of the eligible programs responded to the survey; of which, the majority (92.9%) indicated that residents learn that: physical inactivity is a risk factor for chronic conditions, to incorporate PA into patient care plans, and to recommend PA as prevention for chronic diseases. However, only half (50.0%) of the programs stated that they believe residents will be sufficiently prepared to incorporate PA in the care they provide patients. Less than half (42.9%) of the programs teach PA guidelines, and few (21.4%) teach about PA-related referral to an allied health care provider or community program. Conclusions: The instruction about PA that family physicians receive in Canadian residency programs varies depending on the program. A standard to ensure residents are sufficiently and competently prepared to recommend and advise PA as treatment and prevention is needed. Additional studies are needed to understand the opinions and teachings of preceptors who may have an influence over the residency training of Canadian family physicians. [ABSTRACT FROM AUTHOR]

Background: The dementias are long-term, chronic conditions caused by progressive neurological degeneration. Current literature suggests that cardiovascular disease risk factors may contribute to the onset of dementia; however, evidence of these associations is inconsistent.Objectives: This study aimed to examine the impact of risk factors on dementia onset in older adults diagnosed and managed in Canadian primary care settings.Methods: A retrospective cohort study was employed utilizing electronic medical records data in the Canadian Primary Care Sentinel Surveillance Network (CPCSSN). Patients aged 65+ years with no dementia diagnosis at baseline who were followed from 2009 to 2017 with a run-in year to exclude existing undiagnosed dementia cases. Multivariate Cox proportional hazard models were used to estimate risk.Results: Age was associated with an increased incidence risk of dementia in both examined age groups: 65-79 years (13%) and 80+ years (5%). History of depression increased dementia risk by 38% and 34% in the age groups. There were significant associations with lower social deprivation area quintile, smoking history, osteoarthritis, and diabetes mellitus in patients aged 65-79 years but not in those aged 80+ years. Sex, hypertension, obesity, dyslipidemia, and the use of antihypertensive medications and statins were not associated with risk of incident dementia diagnosis.Conclusions: The association between chronic health conditions and dementia onset is complicated. Primary care electronic medical record data might be useful for research in this topic, though follow-up time is still relatively short to observe a clear causal relationship. Future studies with more complete data may provide evidence for dementia preventive strategies within primary care practice. [ABSTRACT FROM AUTHOR]

Background: Menopause is a normal transition in a woman's life. For some women, it is a stage without significant difficulties; for others, menopause symptoms can severely affect their quality of life. This study developed and validated a case definition for problematic menopause using Canadian primary care electronic medical records, which is an essential step in examining the condition and improving quality of care. Methods: We used data from the Canadian Primary Care Sentinel Surveillance Network including billing and diagnostic codes, diagnostic free-text, problem list entries, medications, and referrals. These data formed the basis of an expert-reviewed reference standard data set and contained the features that were used to train a machine learning model based on classification and regression trees. An ad hoc feature importance measure coupled with recursive feature elimination and clustering were applied to reduce our initial 86,000 element feature set to a few tens of the most relevant features in the data, while class balancing was accomplished with random under- and over-sampling. The final case definition was generated from the tree-based machine learning model output combined with a feature importance algorithm. Two independent samples were used: one for training / testing the machine learning algorithm and the other for case definition validation. Results: We randomly selected 2,776 women aged 45–60 for this analysis and created a case definition, consisting of two occurrences within 24 months of International Classification of Diseases, Ninth Revision, Clinical Modification code 627 (or any sub-codes) OR one occurrence of Anatomical Therapeutic Chemical classification code G03CA (or any sub-codes) within the patient chart, that was highly effective at detecting problematic menopause cases. This definition produced a sensitivity of 81.5% (95% CI: 76.3-85.9%), specificity of 93.5% (91.9-94.8%), positive predictive value of 73.8% (68.3-78.6%), and negative predictive value of 95.7% (94.4-96.8%). Conclusion: Our case definition for problematic menopause demonstrated high validity metrics and so is expected to be useful for epidemiological study and surveillance. This case definition will enable future studies exploring the management of menopause in primary care settings. [ABSTRACT FROM AUTHOR]

Background: Polypharmacy, often defined as the concomitant use of ≥ 5 medications, has been identified as a significant global public health threat. Aging and multimorbidity are key drivers of polypharmacy and have been linked to a broad range of adverse health outcomes and mortality. Patients with chronic kidney disease (CKD) are particularly at high risk of polypharmacy and use of potentially inappropriate medications given the numerous risk factors and complications associated with CKD. The aim of this systematic review will be to assess the prevalence of polypharmacy among adult patients with CKD, and the potential association between polypharmacy and adverse health outcomes within this population. Methods/design: We will search empirical databases such as MEDLINE, Embase, Cochrane Library, CINAHL, Web of Science, and PsycINFO and grey literature from inception onwards (with no language restrictions) for observational studies (e.g., cross-sectional or cohort studies) reporting the prevalence of polypharmacy in adult patients with CKD (all stages including dialysis). Two reviewers will independently screen all citations, full-text articles, and extract data. Potential conflicts will be resolved through discussion. The study methodological quality will be appraised using an appropriate tool. The primary outcome will be the prevalence of polypharmacy. Secondary outcomes will include any adverse health outcomes (e.g., worsening kidney function) in association with polypharmacy. If appropriate, we will conduct random effects meta-analysis of observational data to summarize the pooled prevalence of polypharmacy and the associations between polypharmacy and adverse outcomes. Statistical heterogeneity will be estimated using Cochran’s Q and I2 index. Additional analyses will be conducted to explore the potential sources of heterogeneity (e.g., sex, kidney replacement therapy, multimorbidity). Discussion: Given that polypharmacy is a major and a growing public health issue, our findings will highlight the prevalence of polypharmacy, hazards associated with it, and medication thresholds associated with adverse outcomes in patients with CKD. Our study will also draw attention to the prognostic importance of improving medication practices as a key priority area to help minimize the use of inappropriate medications in patients with CKD. Systematic review registration: PROSPERO registration number: []. [ABSTRACT FROM AUTHOR]

The online version of the original article can be found at https://doi.org/10.1186/s12911-023-02298-x. References 1 Pham AN, Cummings M, Yuksel N. Development and validation of a case definition for problematic menopause in primary care electronic medical records. [Extracted from the article]