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Purpose To inform recommendations by the Canadian Task Force on Preventive Health Care by systematically reviewing direct evidence on the effectiveness and acceptability of screening adults 40 years and older in primary care to reduce fragility fractures and related mortality and morbidity, and indirect evidence on the accuracy of fracture risk prediction tools. Evidence on the benefits and harms of pharmacological treatment will be reviewed, if needed to meaningfully influence the Task Force’s decision-making. Methods A modified update of an existing systematic review will evaluate screening effectiveness, the accuracy of screening tools, and treatment benefits. For treatment harms, we will integrate studies from existing systematic reviews. A de novo review on acceptability will be conducted. Peer-reviewed searches (Medline, Embase, Cochrane Library, PsycINFO [acceptability only]), grey literature, and hand searches of reviews and included studies will update the literature. Based on pre-specified criteria, we will screen studies for inclusion following a liberal-accelerated approach. Final inclusion will be based on consensus. Data extraction for study results will be performed independently by two reviewers while other data will be verified by a second reviewer; there may be some reliance on extracted data from the existing reviews. The risk of bias assessments reported in the existing reviews will be verified and for new studies will be performed independently. When appropriate, results will be pooled using either pairwise random effects meta-analysis (screening and treatment) or restricted maximum likelihood estimation with Hartun-Knapp-Sidnick-Jonkman correction (risk prediction model calibration). Subgroups of interest to explain heterogeneity are age, sex, and menopausal status. Two independent reviewers will rate the certainty of evidence using the GRADE approach, with consensus reached for each outcome rated as critical or important by the Task Force. Discussion Since the publication of other guidance in Canada, new trials have been published that are likely to improve understanding of screening in primary care settings to prevent fragility fractures. A systematic review is required to inform updated recommendations that align with the current evidence base.

POINTS CLES En 2019, on a estime a 6 par 100 000 le nombre de nouveaux cas de cancer de l’œsophage diagnostiques chez les Canadiens[1][1]. Evalue a 15 %, le taux de survie net a 5 ans est parmi les plus faibles de tous les pronostics de cancer[1][1]. Les hommes presentent une incidence

[See related article at [www.cmaj.ca/lookup/doi/10.1503/cmaj.200697][2]][2] KEY POINTS In 2019, an estimated 6 new cases of esophageal cancer were diagnosed per 100 000 Canadians.[1][2] The 5-year net survival rate, estimated at 15%, is among the poorest of all cancer prognoses. [1][2] Men have a

Background A recent United Kingdom (UK) report found that breast and colorectal cancers were more common in people with severe mental illness (SMI) and recommended targeted screening. Epidemiological evidence is however inconsistent. Objectives To estimate relative incidence rates for colorectal, breast and lung cancer, and the overall incidence of the commonest other UK cancers, in people with SMI compared with people without SMI. Method Cohort study in the UK using The Health Improvement Network (THIN) primary care database between 1990 and June 2008. Poisson regression was used to obtain adjusted incidence rate ratios (IRRs) for cancer, comparing two cohorts of people over 18; with and without a diagnosis of SMI. Results We identified 20,632 people with SMI and 116,152 people without, with median follow up of over 6 years. No significant associations were observed between SMI and cancers of the breast (adjusted IRR 1.17; 95% confidence interval 0.95–1.45), colon (0.70; 0.46–1.05), rectum (1.05; 0.65–1.69) or lung (0.84; 0.65–1.10). The adjusted IRR for an aggregate cancer outcome in SMI was 0.95; 0.85–1.06. Results were similar for schizophrenia and bipolar disorder. Conclusions In a cohort analysis within a large UK primary care database, the incidence of colo-rectal, breast and lung cancer, and of all common cancers, did not differ significantly in people with SMI, including schizophrenia, compared with people without SMI. Our results do not support enhanced screening procedures for cancer in people with SMI.

Background People with severe mental illnesses (SMI), including schizophrenia, are at increased risk of cardiovascular disease (CVD). Guidelines recommend regular CVD screening and in the United Kingdom, since 2004, General Practitioners are remunerated for annual reviews. Objectives To compare annual rates of CVD screening provision in people with and without SMI between 2000 and 2008. Method We identified 18,696 people with SMI and 95,512 people without SMI in the UK The Health Improvement Network (THIN) primary care database. We compared the rates of measurement of blood pressure (BP), glucose, cholesterol and body mass index (BMI). Results Prior to 2004, all people with SMI, were significantly less likely to receive each measurement, (including people above and below 60 years of age). In 2003; adjusted incidence rate ratios (95% CI) for screening in people with SMI under 60 years compared to people without SMI were: BMI: 0.62 (0.58–0.65); BP: 0.59 (0.56–0.62); glucose: 0.66 (0.61–0.70) and cholesterol: 0.54 (0.49–0.59). By 2007 people with SMI under 60 were equally likely receive a measurement of BMI: 1.00 (0.96–1.04), glucose: 1.00 (0.96–1.05) and cholesterol: 0.95 (0.90–1.0); the gap in screening for BP had narrowed 0.87 (0.83–0.90). However people with SMI over 60 years of age remained significantly less likely to be screened. There was little difference in screening according to social deprivation. Conclusions In UK primary care, people with SMI over 60 years of age remain less likely than the general population to receive annual CVD screening despite higher risk of developing CVD.

Background Loss of income and out of pocket expenses related to childhood cancer care can account for over 25% of a family's total disposable income, adding to the stress of facing a life-threatening disease. The objective of this pilot study was to assess the impact of childhood cancer on employment and sources of income within families. Procedure A retrospective postal-administered questionnaire was used to collect information from parents of children diagnosed with cancer before 20 years of age between 1990 and 1996 in the province of British Columbia (n = 111). Results Among full or part-time employed parents, 64% of mothers and 16% of fathers left their job after their child's diagnosis. The large majority of parents who left their jobs were away for less than 1 year (65% of mothers; 78% of fathers) and nearly all were able to return to the same job if they chose to do so (80% of mothers; 89% of fathers). Parents with children

People with severe mental illnesses (SMI), including schizophrenia, are at increased risk of cardiovascular disease (CVD). Guidelines recommend regular CVD screening and in the United Kingdom, since 2004, General Practitioners are remunerated for annual reviews.To compare annual rates of CVD screening provision in people with and without SMI between 2000 and 2008.We identified 18,696 people with SMI and 95,512 people without SMI in the UK The Health Improvement Network (THIN) primary care database. We compared the rates of measurement of blood pressure (BP), glucose, cholesterol and body mass index (BMI).Prior to 2004, all people with SMI, were significantly less likely to receive each measurement, (including people above and below 60 years of age). In 2003; adjusted incidence rate ratios (95% CI) for screening in people with SMI under 60 years compared to people without SMI were: BMI: 0.62 (0.58-0.65); BP: 0.59 (0.56-0.62); glucose: 0.66 (0.61-0.70) and cholesterol: 0.54 (0.49-0.59). By 2007 people with SMI under 60 were equally likely receive a measurement of BMI: 1.00 (0.96-1.04), glucose: 1.00 (0.96-1.05) and cholesterol: 0.95 (0.90-1.0); the gap in screening for BP had narrowed 0.87 (0.83-0.90). However people with SMI over 60 years of age remained significantly less likely to be screened. There was little difference in screening according to social deprivation.In UK primary care, people with SMI over 60 years of age remain less likely than the general population to receive annual CVD screening despite higher risk of developing CVD.

Loss of income and out of pocket expenses related to childhood cancer care can account for over 25% of a family's total disposable income, adding to the stress of facing a life-threatening disease. The objective of this pilot study was to assess the impact of childhood cancer on employment and sources of income within families.A retrospective postal-administered questionnaire was used to collect information from parents of children diagnosed with cancer before 20 years of age between 1990 and 1996 in the province of British Columbia (n = 111).Among full or part-time employed parents, 64% of mothers and 16% of fathers left their job after their child's diagnosis. The large majority of parents who left their jobs were away for less than 1 year (65% of mothers; 78% of fathers) and nearly all were able to return to the same job if they chose to do so (80% of mothers; 89% of fathers). Parents with children10 years of age at diagnosis and those with leukemia were most likely to take leave from their jobs. There was considerable change in sources of income between the time of diagnosis and survey with more families relying on employment insurance, social assistance or other financial support at diagnosis. Reliance on sources of income other than salary decreased with time since diagnosis.It appears that the diagnosis of childhood cancer may cause an important but short-term impact on the employment and income sources of affected families.