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Background: Surgical resection of the primary tumor in patients with stage IV colorectal cancer (CRC) remains controversial. Survival benefit reported in the literature has been attributed to the selection of younger and healthier patients with good performance status. We have recently reported that resection of the primary tumor improved survival of patients with stage IV CRC. In this study we examined survival benefit of surgery in patients with asymptomatic or minimally symptomatic primary tumor., Patients and Methods: A cohort of patients with stage IV CRC and asymptomatic or minimally symptomatic primary tumor, who were diagnosed during the period of 1992 to 2005, in the province of Saskatchewan Canada, was evaluated. The Kaplan-Meier method was used to determine survival. A multivariate Cox proportional hazard regression analysis was performed to determine prognostic importance of resection of primary tumor. A test for interaction was performed for resection of primary tumor and other important clinicopathological variables., Results: A total of 834 patients with a median age of 70 years (range, 22-93) and male:female ratio of 58:42 were identified. Among them 521 (63%) patients underwent surgery and 361 (43.3%) received chemotherapy. Patients who underwent surgery and received any chemotherapy had a median overall survival of 19.7 months (95% confidence interval [CI], 16.9-22.6) compared with 8.4 months (95% CI, 6.9-10.0) if they did not have surgery (P < .0001). In multivariate analysis, 5-fluorouracil-based chemotherapy (hazard ratio [HR], 0.43; 95% CI, 0.36-0.53), surgical resection of the primary tumor (HR, 0.47; 95% CI, 0.39-0.57), metastasectomy (HR, 0.48; 95% CI, 0.38-0.62), and second-line chemotherapy (HR, 0.72; 95% CI, 0.58-0.92) were correlated with superior survival. A test for interaction between ≥ 1 metastatic sites and surgery was significant, which suggests a larger benefit of surgery in patients with stage IVA disease., Conclusion: Results of this large population-based cohort study suggest that resection of the primary tumor in asymptomatic or minimally symptomatic patients with stage IV CRC improved survival independent of other prognostic variables. The benefit was more pronounced in stage IVA disease., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Background: Chemotherapy improves survival in patients with stage IV colorectal cancer (CRC). Although in a clinical trial setting, strict eligibility criteria are used for chemotherapy, little is known about the use of chemotherapy in the general population. The study aims to assess clinicopathological variables that correlate with the use of chemotherapy in patients with stage IV CRC., Methods: A retrospective cohort study involving patients with stage IV CRC, diagnosed between 1992 and 2005, in the province of Saskatchewan was carried out. A logistic regression analysis was performed to assess the correlation of various clinicopathological factors with the use of chemotherapy., Results: A total of 1,237 eligible patients were identified. Their median age was 70 years (range: 22-98) and the male:female ratio was 1.3:1. 23.8% had an ECOG performance status (PS) of ≥2 and 61.8% of the patients had a comorbid illness. 46.8% of the patients received chemotherapy. The multivariate logistic regression analysis revealed that an age of <65 years [odds ratio (OR) 3.82, 95% CI: 2.59-5.63], metastasectomy (OR 3.60, 95% CI: 1.82-7.10), normal albumin (OR 3.26, 95% CI: 2.44-4.36), no comorbid illness (OR 2.87, 95% CI: 1.34-6.16), ECOG PS of <2 (OR 2.72, 95% CI: 1.94-3.82), normal blood urea nitrogen (OR 2.24, 95% CI: 1.40-3.59), palliative radiation (OR 2.03, 95% CI: 1.38-2.99), primary tumor resection (OR 2.00, 95% CI: 1.47-2.73), and the time period (OR 1.85, 95% CI: 1.41-2.42) were significantly correlated with the use of chemotherapy., Conclusions: The use of chemotherapy appears to be increasing in stage IV CRC. Patients treated with curative intention or who underwent primary tumor resection were more likely to receive chemotherapy. Despite a known benefit of chemotherapy in elderly patients, a differential use of chemotherapy was noted in this population., (2015 S. Karger AG, Basel)

Background: Currently, there is very low-quality evidence available regarding benefit of surgical resection of the primary tumor (SRPT), in patients with stage IV colorectal cancer (CRC). In the absence of randomization, the reported benefit may reflect selection of younger and healthier patients with good performance status. A large population-based cohort study was undertaken to determine the survival benefit of SRPT in advanced CRC by eliminating various biases reported in the literature., Methods: A retrospective cohort study involving patients with stage IV CRC, diagnosed between 1992 and 2005, in the province of Saskatchewan, Canada. Survival was estimated by using the Kaplan-Meier method. Survival distribution was compared by log-rank test. Cox proportional multivariate regression analysis was performed to determine survival benefit of SRPT by controlling other prognostic variables., Results: A total of 1378 eligible patients were identified. Their median age was 70 years (range, 22-98 years) and male:female ratio was 1.3:1; 944 (68.5%) of them underwent SRPT. Among 1378 patients, 42.3% received chemotherapy and 19.1% received second-generation therapy. Patients who underwent SRPT and received chemotherapy had median overall survival of 18.3 months (95% confidence interval [CI] = 16.6-20 months) compared with 8.4 months (95% CI = 7.1-9.7 months) if they were treated with chemotherapy alone (P < .0001). Cox proportional analysis revealed that use of chemotherapy (hazard ratio [HR] = 0.47, 95% CI = 0.41-0.54), SRPT (HR = 0.49, 95% CI = 0.41-0.58), second-line chemotherapy (HR = 0.47, 95% CI = 0.45-0.64), and metastasectomy (HR = 0.54, 95% CI = 0.45-0.64) were correlated with superior survival., Conclusions: SRPT improves survival in patients with stage IV CRC, independent of other prognostic variables including age, performance status, comorbid illness and chemotherapy., (© 2013 American Cancer Society.)

Background: While the benefits of physical activity are generally recognized, over half of adult Canadians are not active enough to receive those benefits. Physicians may influence patient activity through counselling; however, research is inconsistent regarding their effectiveness in doing so. Increasing patients' use of self-regulatory skills in managing their activity and additional telephone support are suggested as two means of improving physician counselling. When assessing the effectiveness of physician counselling, it may be important to measure both outcome and treatment adherence. We compared physician-directed activity counselling (modified PACE protocol) with a modified PACE protocol augmented with telephone-based counselling for patient support for both outcome and treatment adherence., Methods: Physicians counselled 90 patients using a modified PACE protocol that included self-regulatory skills. Physical activity was assessed by questionnaire at baseline (prior to counselling) and one month later. Participants were divided into two groups: counselling (modified PACE counselling) and enhanced counselling (modified PACE counselling plus telephone support)., Results: The main outcome (mean energy expenditure) and secondary outcomes of treatment adherence (frequency, frequency of moderate activity, and duration) significantly increased over time (p < 0.05). No significant interactions between group and time were found., Interpretation: Our results support the effectiveness of physician counselling for activity that included the use of self-regulation skills. The effectiveness of telephone support over and above that of physician counselling was not supported. Our results demonstrate that assessing treatment adherence provides a means of discerning whether the counselling intervention was delivered as intended.

Background: In Saskatoon in 2002, as one of the key strategies for the in motion health promotion strategy, the Forever...in motion program was developed with the general goal of increasing opportunities for physical activity among older adults living in congregate housing. The three components of the program were a low-intensity exercise program, informal socialization and educational sessions. The objective of the present study was to examine whether participation in this program positively influenced participants' physical, emotional, psychological and social well-being., Methods: A quasi-experimental, pretest/post-test design was employed to examine the impact of the program on various aspects of participant well-being. Thirty-six program participants and a comparison group of 22 non-participants from two congregate housing facilities took part in the study. The pretest was administered to the study and comparison groups before or shortly after the 12-week session commenced, and the post-test was administered after the 12-week session had concluded. Pretest and post-test assessment consisted of self-report measures of (1) vitality, (2) self-rated health, 3) mental health, (4) social functioning, (5) role limitations due to emotional problems, 6) physical activity-related knowledge, and (7) self-efficacy for exercise. A multivariate analysis of covariance (MANCOVA) was conducted using the seven post-test scores as dependent variables and the pretest scores as covariates., Results: After adjusting for differences in baseline characteristics, the findings revealed statistically significant improvements in self-reported health and self-efficacy for exercise in the program participant group as compared with non-participants., Conclusion: The results of this study suggest that a relatively low-cost, low-intensity exercise program such as the Forever...in motion program may positively influence the well-being of older adults living in congregate housing. However, additional research with a larger number of participants and a more rigorous study design is needed to further elucidate the health benefits of the Forever...in motion program.

This study examines the validity of the diagnosis of stroke on hospital discharge records in Saskatchewan, Canada. In total, 1,494 records with a discharge diagnosis of 'stroke' or a 'stroke-related condition' were reviewed. The clinical algorithm of the 1980 USA National Survey of Stroke was considered the 'gold standard'. The positive predictive value of a primary diagnosis of stroke in the tertiary-care hospitals was about 90%. In community hospitals the majority of stroke cases were coded as ICD9 436 in which the positive predictive value was 78%. The variation between regions would limit the use of hospital discharge data for stroke surveillance.

Objective: To determine the population distribution of apolipoproteins A-I and B, and the relationship of apolipoprotein B to lipid risk factors for coronary artery disease., Design: A stratified random sample of men and women aged 18 to 74 years selected from the provinces of Saskatchewan and Quebec in 1989 and 1990., Outcome Measures: Plasma concentrations of apolipoproteins A-I and B, triglycerides, low density lipoprotein cholesterol, high density lipoprotein cholesterol and nonhigh density lipoprotein cholesterol for subjects who provided a fasting blood sample., Main Results: Apolipoprotein B mean values increased with age from 0.80 g/L at age 18 to 24 years to a maximum of 1.16 g/L in the 45 to 54 year age group for men. For women, the values increased more gradually from 0.81 g/L for ages 18 to 24 to 1.19 g/L at ages 65 to 74 years. The distribution of apolipoprotein A-I was unrelated to age. Means for men varied from 1.35 g/L to 1.42 g/L and for women from 1.50 g/L to 1.61 g/L. Apolipoprotein B was strongly correlated with nonhigh density lipoprotein cholesterol (r2=0.89), and this was used to define apolipoprotein B concentrations less than 1.04 g/L as indicating low risk for coronary artery disease, from 1.04 g/L to less than 1.22 g/L as moderate risk, from 1.22 g/L to less than 1.40 g/L as high risk, and 1.40 g/L or greater as very high risk. The prevalence of high risk plasma apolipoprotein B levels was higher in men and women with triglycerides greater than 2.3 mmol/L. Apolipoprotein A-I was strongly correlated with high density lipoprotein cholesterol (r2=0.67), and this was use to identify apolipoprotein A-I concentrations of less than 1.20 g/L as a risk factor and 1.65 g/L or greater as an antirisk factor for coronary artery disease. The prevalence of apolipoprotein A-I of less than 1. 20 g/L was 19% in men and 6% in women, whereas the prevalence of apolipoprotein AI 1.65 g/L or greater was 9% in men and 28% in women., Conclusion: Reference values for plasma apolipoproteins A-I and B in a Canadian population random sample are given. Plasma apolipoprotein B and apolipoprotein A-I provide information that is complementary to that provided by low density lipoprotein and high density lipoprotein cholesterol levels.

This study compares physical, laboratory and anthropometric measurements from each of two groups (leute) of Hutterites (N = 846) with a population of non-Hutterites from rural Saskatchewan (N = 750). Marked interleute differences were observed in the comparative analysis with the non-Hutterite population. Dariusleut males had significantly greater mean diastolic and systolic blood pressures, total cholesterols, LDL cholesterols and Body Mass Indexes (BMI) than non-Hutterites. Compared with non-Hutterite women, the Dariusleut females had significantly greater mean diastolic and systolic blood pressure, HDL cholesterols, BMIs and waist-hip ratios. In contrast, the only significant difference between non-Hutterites and Lehrerleut males was in BMI. Lehrerleut females had significantly greater mean systolic blood pressures, HDL cholesterol levels and BMIs. While the surprising inter-leute differences may be due to subtle variations in lifestyle, the genetic isolation of the groups suggests heredity may offer a more likely explanation for the differences.

The Saskatchewan Clinical Stroke Prevention Project aims to examine the process and impact of incorporating enhanced stroke prevention into the routine clinical practice of family physicians. Twenty-four physicians in three practices in Saskatchewan are participating in a staged series of educational interventions over two years to enhance their management of smoking, transient ischemic attack/stroke, atrial fibrillation and hypertension. The components of each intervention include a seminar, printed materials, a one-to-one case discussion or "academic detailing," a self-documented chart audit and changes to the office system. Patients for whom this intervention is targeted are those 55 to 75 years of age presenting for a periodic health examination with one or more of the four main risk factors for stroke. Intervention will consist of counselling on relevant risk factors by the doctor and nurse teams, supported by appropriate patient education materials. Patient follow-up will be carried out according to clinical indications and will be done at least 3, 6, 12 and 24 months after entry into the study. Evaluation comprises measures of the process of implementing change in preventive practice as well as of the impact of such change. The former includes semi-structured interviews and focus groups with physicians, support staff and patients. The latter includes an assessment of knowledge, attitudes and charted practice before and after intervention.

Background: Actinic prurigo, an idiopathic familial photodermatosis, has been described in Amerindians in Manitoba, Canada, as well as in the United States, Mexico, and South America., Objective: Our purpose was to describe the clinical features and prognosis of actinic prurigo in Amerindians in Saskatchewan, Canada., Methods: Clinical examinations, questionnaires, phototesting, and laboratory tests were used., Results: We present a series of 93 Amerindian patients. The face is the most commonly involved area. A hereditary tendency, cheilitis, and pruritus are prominent features. One third of patients report some lesions, often minor, during the winter. The majority of patients phototested were sensitive to ultraviolet A light., Conclusion: We find the age of onset of actinic prurigo to be the most important feature in determining the type of eruption and the prognosis for the patient. In general the younger ages of onset (up to 20 years of age) are associated with cheilitis and more acute eruptions and are more likely to improve over 5 years. Those who develop actinic prurigo as adults (21 years of age and older) tend to have a milder and more persistent dermatosis.