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Background: Although laparoscopic sleeve gastrectomy (LSG) has been shown to be a safe and effective treatment for severe obesity (body mass index [greater than or equal to] 35), staple line [...]

Abstract Background Childhood obesity is a public health problem in Canada. Accurate measurement of a health problem is crucial in defining its burden. The objective of this study is to compare the prevalence estimates of overweight and obesity in preschool children using three growth references. Methods Weights and heights were measured on 1026 preschool children born in Newfoundland and Labrador (NL), Canada, and body mass index calculated. The prevalence of overweight and obesity was determined and statistical comparisons conducted among the three growth references; the Centres for Disease Control (CDC), the International Obesity Task Force (IOTF) and the World Health Organization (WHO). Results CDC and IOTF produced similar estimates of the prevalence of overweight, 19.1% versus 18.2% while the WHO reported a higher prevalence 26.7% (p < .001). The CDC classified twice as many children as obese compared to the IOTF 16.6% versus 8.3% (p < .001) and a third more than the WHO 16.6% versus 11.3% (p < .01). There was variable level of agreement between methods. Conclusions The CDC reported a much higher prevalence of obesity compared to the other references. The prevalence of childhood obesity is dependent on the growth reference used.

Asthma is a prevalent disease that affects many Canadians. Persistent asthma can affect quality of life, and has multiple health implications. Maternal age at birth has been associated with many adverse health outcomes in children. Conflicting study results exist regarding maternal age at birth and childhood asthma. The association between maternal age at birth and persistent asthma in children is still unknown. To investigate the relationship between maternal age at birth and persistent asthma in children at ten years of age. This is a prospective cohort study including all children aged 0-2 years who took part in the first cycle of the National Longitudinal Survey of Children and Youths (NLSCY) and were followed every two years until eight to ten years of age in Cycle 5. An interaction term between maternal age at birth and maternal asthma history was introduced in a multivariate model to examine modification effects of maternal asthma history on the association. Multivariate logistic regression demonstrated that older maternal age at birth was significantly associated with an increased risk of childhood persistent asthma in mothers with a history of asthma (OR = 1.20, 95% CI: 1.04–1.40, p =.016). No relationship was found in mothers without a history of asthma. Maternal history of asthma has an impact on the association between maternal age at birth and childhood persistent asthma in children by age ten. The finding may help explain the inconsistent results in the literature regarding the risk of asthma associated with maternal age at birth. [ABSTRACT FROM AUTHOR]

Background: Maternal attitudes to infant feeding are predictive of intent and initiation of breastfeeding. Objectives: The Iowa Infant Feeding Attitude Scale (IIFAS) has not been validated in the Canadian population. This study was conducted in Newfoundland and Labrador, a Canadian province with low breastfeeding rates. Objectives were to assess the reliability and validity of the IIFAS in expectant mothers; to compare attitudes to infant feeding in urban and rural areas; and to examine whether attitudes are associated with intent to breastfeed. Methods: The IIFAS assessment tool was administered to 793 pregnant women. Differences in the total IIFAS scores were compared between urban and rural areas. Reliability and validity analysis was conducted on the IIFAS. The receiver operating characteristic (ROC) of the IIFAS was assessed against mother’s intent to breastfeed. Results: The mean ± SD of the total IIFAS score of the overall sample was 64.0 ± 10.4. There were no significant differences in attitudes between urban (63.9 ± 10.5) and rural (64.4 ± 9.9) populations. There were significant differences in total IIFAS scores between women who intend to breastfeed (67.3 ± 8.3) and those who do not (51.6 ± 7.7), regardless of population region. The high value of the area under the curve (AUC) of the ROC (AUC = 0.92) demonstrates excellent ability of the IIFAS to predict intent to breastfeed. The internal consistency of the IIFAS was strong, with a Cronbach’s alpha greater than .80 in the overall sample. Conclusion: The IIFAS examined in this provincial population provides a valid and reliable assessment of maternal attitudes toward infant feeding. This tool could be used to identify mothers less likely to breastfeed and to inform health promotion programs. [ABSTRACT FROM AUTHOR]

Objective: Bariatric surgery results in significant weight loss in the majority of patients. Improvement in health-related quality of life (HRQoL) is an equally important outcome; however, there are few studies reporting long-term (≥5 years) HRQoL outcomes. This study assesses the quality of evidence and effectiveness of surgery on HRQoL ≥ 5 years.Methods: PubMed, Cochrane Review, EmBase, CINANL, PsycInfo, obesity conference abstracts, and reference lists were searched. Keywords were bariatric surgery, obesity, and quality of life. Studies were included if (1) there was ≥5 years follow-up, (2) patients had class II or III obesity, (3) individuals completed a validated HRQoL survey, and (4) there was a nonsurgical comparison group with obesity. Two reviewers independently assessed each study.Results: From 1376 articles, 9 studies were included in the systematic review (SR) and 6 in the meta-analysis (MA). Inconsistent results for long-term improvements in physical and mental health emerged from the SR. In contrast, the MA found significant improvements in these domains ≥5 years after surgery.Conclusions: Study findings provide evidence for a substantial and significant improvement in physical and mental health favoring the surgical group compared with controls spanning 5 to 25 years after surgery. [ABSTRACT FROM AUTHOR]

This chapter provides an introduction to the concept of Evidence-based Medicine (EBM) including its history, rooted in Canada and its important role in modern medicine. The chapter introduces EBM and explains the process of conducting EBM . The chapter starts with a description of the traditional hierarchy of evidence that exists in research with reference to the critical appraisal tools often used to assess the quality or credibility of individual studies. It includes a section on assessing risk of bias in randomized clinical trials and non-randomized studies and guidelines for reporting study findings now fully captured in the EQUATOR Network. In addition, a section on GRADE (Grades of Recommendation Assessment, Development and Evaluation) and the process used to determine the quality of evidence when guiding clinical decisions or developing clinical practice guidelines is included. In response to the substantial number of research syntheses being published, AMSTAR2, a tool used to critically appraise the quality and reporting of systematic reviews is described. The main focus of the chapter remains on how to critically appraise the medical literature, as one step in the EBM process. However, this process also includes an assessment of study bias and an understanding of reporting guidelines. At its basic level, critical appraisal requires an understanding of the strengths and weaknesses of study design and how these in turn impact the validity and applicability of research findings. Strong critical appraisal skills are critical to evidence-based decision-making .

Engaging with patients and families is largely routine at the healthcare service or provision level. The concept of patient engagement in health research has a more recent history but is now often endorsed by leading journals and funders. Often described as research being done with patients, rather than "to" or "about" them, patient-oriented research is distinguished by patients serving as research partners rather than passive study subjects. It is generally accepted that patient engagement in health research is worthwhile and can contribute to better quality research. However, questions remain about how to do it, what values underlie it, and how patients can be engaged as partners in health research. In this chapter, we attempt to answer these questions and provide tangible examples of patient-oriented research in our province of Newfoundland and Labrador (NL), Canada. While there is no single approach to patient engagement in health research, we hope the examples provided herein help demonstrate how it might be done and assist research teams to better integrate and utilize patients' valuable input.

The delay in turning research into practice for the benefit of patient care has been compared to a "leaky pipeline." In the early 2000s, this delay raised concerns among governmental agencies and other sponsors of health services in many countries. Facilitating the translation of basic and clinical research into clinical practice through evidence-based decision-making and improving population health is now a major goal of health research investment agencies. Translational research or knowledge translation has emerged to bridge the gaps between basic and clinical research, and between clinical research and clinical practice. Various frameworks and definitions of translational research are presented. We present an example of an Integrated Knowledge Translation Team in Bariatric Care, and explain how an integrated knowledge translation (iKT) approach was created at the program's inception. This led to evidence-based decision-making and subsequent practice change in one area of the health care system. Real-world successes and challenges in moving research to practice are discussed.

This chapter provides an introduction to the concept of Evidence-based Medicine (EBM) including its history, rooted in Canada and its important role in modern medicine. The chapter both defines EBM and explains the process of conducting EBM. It includes a discussion of the hierarchy of evidence that exists with reference to common methods used to assess the levels of quality inherent in study designs. The focus of the chapter is on how to critically appraise the medical literature, as one step in the EBM process. Critical appraisal requires an understanding of the strengths and weaknesses of study design and how these in turn impact the validity and applicability of research findings. Strong critical appraisal skills are critical to evidence-based decision-making.

Background: The prevalence of obesity has increased over the past 3 decades, with a disproportionate growth in excessive weight categories (body mass index [BMI] 35.0-39.9 and BMI ≥ 40.0). The objective of this paper is to present the data for the past and current prevalence of adult obesity in Canada, together with future estimates., Methods: We calculated BMIs for adults aged 18 years and older who were not in long-term care using data from Canadian health surveys administered between 1985 and 2011. Calculation of the BMIs was based on self-reported heights and weights. The weight categories were as follows: normal (BMI 18.5-24.9), overweight (25.0-29.9), obese class I (30.0-34.9), obese class II (35.0-39.9) and obese class III (≥ 40.0). Outcome measures were prevalence of adult obesity according to BMI categories, nationally and provincially. We used regression analysis models to predict future prevalence of adult obesity up to 2019., Results: Between 1985 and 2011, the prevalence of adult obesity in Canada increased from 6.1% to 18.3%. Furthermore, since 1985, the prevalence of obesity in classes I, II and III increased from 5.1% to 13.1%, from 0.8% to 3.6%, and from 0.3% to 1.6%, respectively. Taking into account regional variations, we predict that, by 2019, the prevalence of obesity in classes I, II and III will increase to 14.8%, 4.4% and 2.0%, respectively, and that half of the Canadian provinces will have more overweight or obese adults than normal-weight adults., Interpretation: We found significant increases in the excessive weight categories of obesity, with continued increases predicted for all provinces up to 2019. Provincial variations in obesity prevalence were also significant. To address these projected increases and any subsequent burden on the health care system, a concerted effort must be made by the provinces to focus on the prevention, management and treatment of obesity in Canada.