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Background: Consideration of sex‐ and gender‐related factors is critical for understanding and supporting health and wellbeing. Although both sex and gender influence people with developmental disabilities, there is relatively little research on these factors and their influences among individuals with fetal alcohol spectrum disorder (FASD), a complex neurodevelopmental disability impacting an estimated 4%–5% of the population. Understanding sex‐ and gender‐related differences in FASD is needed to facilitate evidence‐informed assessment, treatment planning, and advocacy. To begin unpacking these factors, we investigated sex‐based differences in clinical presentation and experiences among individuals assessed for FASD across the lifespan. Methods: We analyzed 2574 clinical records from 29 FASD diagnostic centers in Canada. Participants ranged in age from 1 to 61 years (mean 15.2 years), and more than half (58.3%) were male at birth. Study variables included participant demographics, physical indicators of prenatal alcohol exposure (PAE), neurodevelopmental impairment, FASD diagnosis, co‐occurring physical and mental health diagnoses, and environmental adversity. Results: There were no significant differences between males and females with respect to FASD diagnostic outcome or physical indicators of PAE. However, males experienced significantly more neurodevelopmental impairment. Females experienced higher rates of endocrine problems, anxiety, and depressive/mood disorders, whereas males had higher rates of attention deficit‐hyperactivity disorder, conduct disorder, and oppositional defiant disorder. Adversity also differed by sex, with females experiencing higher rates of trauma and legal problems with victimization/custody, and males having more difficulties with school and offending/incarceration. Sex‐based differences were most apparent in adolescents (13–17 years) and adults (≥25 years). Conclusions: Individuals with PAE/FASD experience notable sex‐related differences in clinical presentation and experiences across the lifespan. Findings from this study should help to guide researchers, service providers, and policy makers to improve FASD screening, diagnosis, and intervention and better address the needs of individuals with PAE/FASD of all genders. [ABSTRACT FROM AUTHOR]

Metabolic diseases, such as obesity, Type II diabetes and hepatic steatosis, are a significant public health concern affecting more than half a billion people worldwide. The prevalence of these diseases is constantly increasing in developed countries, affecting all age groups. The pathogenesis of metabolic diseases is complex and multifactorial. Inducer factors can either be genetic or linked to a sedentary lifestyle and/or consumption of high-fat and sugar diets. In 2002, a new concept of "environmental obesogens" emerged, suggesting that environmental chemicals could play an active role in the etiology of obesity. Bisphenol A (BPA), a xenoestrogen widely used in the plastic food packaging industry has been shown to affect many physiological functions and has been linked to reproductive, endocrine and metabolic disorders and cancer. Therefore, the widespread use of BPA during the last 30 years could have contributed to the increased incidence of metabolic diseases. BPA was banned in baby bottles in Canada in 2008 and in all food-oriented packaging in France from 1 January 2015. Since the BPA ban, substitutes with a similar structure and properties have been used by industrials even though their toxic potential is unknown. Bisphenol S has mainly replaced BPA in consumer products as reflected by the almost ubiquitous human exposure to this contaminant. This review focuses on the metabolic effects and targets of BPA and recent data, which suggest comparable effects of the structural analogs used as substitutes. [ABSTRACT FROM AUTHOR]

When managing older patients with lower-risk hormone-receptor-positive (HR+), HER2 negative (HER2−) early-stage breast cancer (EBC), the harms and benefits of adjuvant therapies should be taken into consideration. A survey was conducted among Canadian oncologists on the definitions of "low risk" and "older", practice patterns, and future trial designs. We contacted 254 physicians and 21% completed the survey (50/242). Most respondents (68%, 34/50) agreed with the definition of "low risk" HR+/HER2− EBC being node-negative and either: ≤3 cm and low histological grade, ≤2 cm and intermediate grade, or ≤1 cm and high grade. The most popular chronological and biological age definition for older patients was ≥70 (45%, 22/49; 45% 21/47). In patients ≥ 70 with low risk EBC, most radiation and medical oncologists would recommend post-lumpectomy radiotherapy (RT) and endocrine therapy (ET). Seventy-eight percent (38/49) felt that trials are needed to evaluate RT and ET's role in patients ≥ 70. The favored design was ET alone, vs. RT plus ET (39%, 15/38). The preferred primary and secondary endpoints were disease-free survival and quality of life, respectively. Although oncologists recommended both RT and ET, there is interest in performing de-escalation trials in patients ≥ 70. [ABSTRACT FROM AUTHOR]

Background: People of African descent living in Britain and the United States have higher rates of morbidity from chronic disease than among the general population. We investigated whether the same applied to people of African descent living in a Canadian province. Methods: We used administrative data to calculate 10-year cumulative incidence rate ratios for the period 1996 —2005 for treated circulatory disease, diabetes mellitus and psychiatric disorders in Preston (population 2425), a community of predominantly African Nova Scotians. We used data for the province of Nova Scotia as a whole as the population reference standard. We also calculated 10-year incidence rate ratios for visits to family physicians and specialists and for admissions to hospital. We compared these findings with those in 7 predominantly white communities in Nova Scotia with otherwise similar socio-economic characteristics. Results: In the province as a whole, we identified 787 787 incident cases for the 3 disease groups over the 10-year period. Incidence rate ratios for the community of interest relative to the provincial population were significantly elevated for the 3 diseases: circulatory disease (1.19, 95% CI 1.08—1.29), diabetes (1.43, 95% CI 1.21—1.64) and psychiatric disorders (1.13, 95% CI 1.06—1.20). Incidence rate ratios in the community of interest were also higher than those in the comparison communities. Visits to family physicians and specialists for circulatory disease and diabetes were similarly elevated, but the pattern was less clear for visits for psychiatric disorders and hospital admissions. Interpretation: African Nova Scotians had higher morbidity levels associated with treated disease, which could not be explained by socio-economic haracteristics, recent immigration or language. Apart from psychiatric disorders, use of specialist services was consistent with morbidity. Further study is needed to investigate the relative contribution of genetic, biological, behavioural, psychosocial and environmental factors. [ABSTRACT FROM AUTHOR]

End-stage renal disease (ESRD) is a serious illness with significant health consequences and high-cost treatment options. This study estimates direct and indirect cost associated with ESRD from a societal perspective. A prevalence-based approach was used to estimate direct health-care costs and productivity losses from short- and long-term disability. An incident-based human capital approach was used to estimate mortality costs as the sum of the discounted present value of current and future productivity losses from premature deaths. Less than 0.1% of Canadians have ESRD; however, the disease generated direct health-care costs of $1.3 billion in the year 2000. The amount of direct spending per person with ESRD is much more than the average spending per person for all health-care conditions. Adding indirect morbidity and mortality cost brings the total burden associated with ESRD to $1.9 billion. This economic impact is higher than that for skin or infectious diseases, about the same as for genitourinary or endocrine diseases, but lower than that for conditions such as cancer or stroke. This economic weight is borne by a relatively small number of individuals. With the rapid increase in the incidence of ESRD, these findings may be useful in setting priorities for research, prevention programs, and in the planning of treatments. A better understanding of the scope and magnitude of the total economic burden of ESRD would help to inform those making policy decisions.Kidney International (2007) 72, 1122–1129; doi:10.1038/sj.ki.5002459; published online 15 August 2007 [ABSTRACT FROM AUTHOR]

Aims: To determine if rates of diabetic and non-diabetic end-stage renal disease (ESRD), which had been rising in young and middle-aged adults in all populations up to the mid-1990s, had started to decline, and if so, whether improvement had occurred in respect of each of the principal primary renal diseases causing ESRD. Methods: Poisson regression of age- and sex-standardized incidence of ESRD for persons aged 20–64 years in 18 populations from Europe, Canada and the Asia-Pacific region, for 1998–2002. Results: In persons from 12 European descent (Europid) populations combined, there was a small downward trend in all-cause ESRD (−1.7% per year, P = 0.001), with type 1 diabetic ESRD falling by 7.8% per year ( P < 0.001), glomerulonephritic ESRD by 3.1% per year ( P = 0.001), and ‘all other non-diabetic’ ESRD by 2.5% per year ( P = 0.02). The reductions in ESRD attributed to hypertensive (−2.2% per year) and polycystic renal disease (−1.5% per year) and unknown diagnosis (−0.2% per year) were not statistically significant. On the other hand, the incidence of type 2 diabetic ESRD rose by 9.9% per year ( P < 0.001) in the combined Europid population, although that of (principally type 2) diabetic ESRD remained unchanged in the pooled data from the four non-Europid populations. Conclusion: Recent preventive strategies, probably chiefly modern renoprotective treatment, appear to have been effective for tertiary prevention of ESRD caused by the proteinuric nephropathies other than type 2 diabetic nephropathy, for which the continuing increase in Europid populations represents a failure of prevention and/or a change in the nephropathic potential of type 2 diabetes. [ABSTRACT FROM AUTHOR]

To compare the health and economic outcomes of using acarbose, an intensive lifestyle modification programme, metformin or no intervention to prevent progression to diabetes in Canadian individuals with impaired glucose tolerance (IGT).A model was developed to simulate the course of individuals with IGT under each treatment strategy. Patients remain in the IGT state or transition from IGT to diabetes, to normal glucose tolerance (NGT) or to death. Effectiveness and resource use data were derived from published intervention trials. A comprehensive health-care payer perspective incorporating all major direct costs, reported in 2000 Canadian dollars, was adopted.Over a decade, 70 of the 1000 untreated patients are expected to die and 542 develop diabetes. Intensive lifestyle modification is estimated to prevent 117 cases of diabetes, while metformin would prevent 52 and acarbose 74 cases. The proportion of those who return to NGT also increases with any treatment. While lifestyle modification is more effective, it can increase overall costs depending on how it is implemented, whereas acarbose and metformin reduce costs by nearly$1000 per patient. Lifestyle modification was cost effective, varying from$749/life year gained (LYG) vs. no treatment to about$10 000/LYG vs. acarbose. Acarbose costs somewhat more than metformin, but is more effective:$1798/LYG.The results of this model suggest that the treatment of IGT in Canada is a cost-effective way to prevent diabetes and may generate savings. While pharmacological treatments tended to be less costly, intensive lifestyle modification, if maintained, led to the greatest health benefits at reasonable incremental costs.Diabet. Med. (2004) [ABSTRACT FROM AUTHOR]

High prevalences of gonadal intersex have been observed in wild fish populations in areas affected by domestic and industrial effluents. For this study, fish were collected in 1998 from the Cootes Paradise region of Hamilton Harbour in western Lake Ontario, Canada, to determine whether gonadal abnormalities, including intersex, were present in young of the year (YOY) fish. No gonadal abnormalities were observed in goldfish (Carassius auratus), common carp (Cyprinus carpio), gizzard shad (Dorosoma cepedianum), brown bullhead (Ictalurus ameiurus), pumpkinseed (Lepomis gibbosus), and bluegill (Lepomis macrochirus). However, intersex gonads were observed in 8 of 16 male white perch (Morone americana) examined in this survey. Subsequently, in 1999 and 2000 white perch estimated to be YOY to approximately 2 years of age were collected from Cootes Paradise and from two other sites in the lower Great Lakes region. Gonadal intersex was observed in male white perch collected from the Bay of Quinte (22–44%) and Lake St. Clair (45%), although the prevalence and the extent of the intersex condition were lower relative to the 83% prevalence in white perch collected in Cootes Paradise. Intersex was not observed in hatchery-reared white perch or in white perch collected from an uncontaminated reference site (i.e., Deal Lake) in the United States. An analysis of plasma collected in the spring of 2002 from male adult white perch in Cootes Paradise revealed high concentrations of vitellogenin, ranging from 49 to 1,711 μg/mL. These observations indicate that male white perch are exposed to estrogenic endocrine-disrupting substances that may be responsible for the induction of gonadal intersex. [ABSTRACT FROM AUTHOR]

Provides information on treatment gaps and opportunities for improvement in complying with clinical practice guidelines for type 2 diabetes in rural patients in Alberta, Canada. Indicators of diabetes; Basis for the clinical practice guidelines for the management of diabetes mellitus; Benefits from the aggressive management of diabetes.

The ecological risk assessment of commercial chemicals in Canada by the regulatory programs of the Commercial Chemicals Evaluation Branch, Environment Canada, are based on results from traditional toxicity data (e.g., lethality, effects to growth or reproduction). Some of the chemicals under consideration are known to alter endocrine systems in exposed organisms; however, effects to the endocrine system are used only as additional supporting information. Presently, there are no internationally accepted methodologies or tests for endocrine disrupting substances that can be used by these regulatory programs. The need for research with respect to hormone disrupting substances has been recognized in the revised Canadian Environmental Protection Act, 1999 (CEPA 1999). This paper describes the framework for the ecological risk assessment of new and existing substances and identifies issues and research needs in both screening level and in-depth ecological risk assessments with respect to the identification and assessment of potentially endocrine disrupting substances. [ABSTRACT FROM AUTHOR]

Endocrine disruptors are a complex issue that continues to evolve. From a government perspective, the issue of endocrine disruptors is complicated by the inclusion of several related issues, making it difficult to deal with in an effective manner. The sub-issues probably need to be dealt with through different regulatory mechanisms. The endocrine disruptor issues can be divided into three main categories: a) issues associated with subtle responses to compounds that are persistent, lipophilic and capable of biomagnification; b) issues associated primarily with non-persistent and relatively hydrophilic substances in industrial and municipal effluents; and c) issues associated with screening existing and new chemicals for their capability of interacting with the endocrine system in an adverse manner. This paper discusses options for dealing with chemicals found in complex mixtures such as pulp mill effluents, sewage effluents and in-use agricultural chemicals. When studies documented potential concerns about the potential for pulp mill effluents to cause reproductive and endocrine changes in fish, the Government of Canada developed an Environmental Effects Monitoring program as part of the new regulatory package. The EEM program is designed to provide information on whether effects are present in the environment when industry complies with their regulated discharge requirements. Endocrine disruptors have the potential to cause environmental effects with other regulated effluents, and an EEM-type of approach would be capable of identifying situations where effects are present and need to be dealt with. [ABSTRACT FROM AUTHOR]

Concern over the potential effects of exposure to endocrine disrupting substances (EDS) has resulted in recommendations for the development of specific endocrine and reproductive tests for assessment and regulation of industrial chemicals and effluents. This document consolidates and summarizes the current approaches taken by international agencies and scientific organizations for testing and screening EDS in mammals and wildlife. The material has been gathered from the Organization for Economic Cooperation and Development meeting reports, U.S. Environmental Protection Agency's Endocrine Disruptor Screening and Testing Advisory Committee and Endocrine Disruptor Screening Program reports, and summaries of various meetings prepared by Canadian and U.S. representatives. There are commonalties between programs of individual countries and the international scientific groups in which they participate. In general, these international scientific organizations have envisioned tiered groups of tests. The first tier is composed of less complex tests and short-term assays (acute exposures) that are very responsive to EDS (and have a low 'false-negative' rate). Higher tiers contain longer tests encompassing partial and full lifecycles of organisms with assessment of functional reproductive and developmental endpoints. Compounds are less expensively screened in the first tier, and move on to more complex and expensive higher-tier tests only if necessary. We document the proposed EDS tests in mammals and wildlife (birds, fish, amphibians and invertebrates) and overview the European Union's approach to EDS research, monitoring and risk assessment. We conclude with a summary of the main recommendations from Canada's interagency workshop to develop priorities and proposed actions for EDS. [ABSTRACT FROM AUTHOR]

Offers a study that estimates the incidence of diabetes mellitus among elderly people in Canada and the relative risks of death and admission to an institution among elderly diabetic patients. Methods; Results; Interpretation.

Comments on the management of type two diabetes mellitus in Canada. Importance of the social determinants of population health; Focus of prevention activities on biomedical and lifestyle risk factors; Exploration of the issues of management and control.

The article reports on the need for an aggressive team-based treatment and prevention strategies to reverse the upward trend in diabetes rates across Canada, according to the Health Council of Canada. The process will require a shifty in health care attitudes from the current "find-it-and-fix-it" approach to a more comprehensive "prevent it" strategy.

The article focuses on the benefits of early intensive glycemic control to patients with diabetes in Canada. During a symposium for health care practitioners, professor Lawrence Leiter presents many studies depicting that intensive glycemic control can reduce the risk of diabetes complications. Leiter stresses the importance of reducing the risk for hypoglycemia as well as in controlling weight in patients with type 2 diabetes.

This article reports on the decision of Health Canada to review a proposal by the Canadian Diabetes Association for a catastrophic drug plan. The diabetes plan will aid Canadians with diabetes relieve the overwhelming personal out-of-pocket costs for medications, supplies and devices. The proposed national drug plan has an estimated price tag of 500 million U.S. dollars a year.

Presents a study that suggests that the absence of diabetes-associated autoantibodies supports the clinical impression of type-2 diabetes in the affected members of the Canadian aboriginal population. Increase of type-2 diabetes in aboriginal children and adolescents; Importance of distinguishing type-2 from type-1 diabetes.