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PubMed2004

Social anxiety disorder--beyond shyness.

OBJECTIVES: This article presents prevalence estimates of social anxiety disorder (social phobia) among the Canadian household population aged 15 or older. The relationship between this mental disorder and others is examined. Selected aspects of functional impairment are compared for people with current, past, and no history of the condition. DATA SOURCE: Data are from the 2002 Canadian Community Health Survey: Mental Health and Well-being. ANALYTICAL TECHNIQUES: Cross-tabulations were used to estimate the prevalence of social anxiety disorder, to determine socio-economic factors associated with prevalence, and to examine relationships with other mental disorders. Associations between social anxiety disorder and selected impairment variables were examined using multivariate analysis that controlled for socio-economic factors and other aspects of mental and physical health. MAIN RESULTS: In 2002, 750,000 Canadians aged 15 or older (3%) had social anxiety disorder. These people had a higher risk of having major depressive disorder, panic disorder and substance dependency than the general population. Social anxiety disorder was associated with higher rates of disability, negative perceptions of physical and mental health, and dissatisfaction with life.

Adolescent↗
PubMed1992

The epidemiology of murder-suicide.

OBJECTIVE: To review the epidemiology, patterns, and major determinants of murder-suicide and to discuss the clinical and research strategies for identifying the individuals at greatest risk for this type of violence. DATA SOURCES: Data were obtained from English-language articles based on searches using MEDLINE (from 1966), PsychINFO (from 1967), and EMBASE (from 1974) programs. In addition, relevant articles, books, and monographs identified from the reference list of retrieved articles were reviewed. STUDY SELECTION: Case-control studies, descriptive epidemiologic surveys, and case series were chosen for review. DATA EXTRACTION: Because of the limited scope of the pertinent research literature, all data relevant to the incidence, demographics, circumstances, and precipitants of murder-suicide were summarized by the authors. DATA SYNTHESIS: Murder-suicide occurs with an annual incidence of 0.2 to 0.3 per 100,000 person-years and accounts for approximately 1000 to 1500 deaths yearly in the United States. The annual incidence of these events is relatively constant across industrialized nations and has not significantly changed over several decades. The principal perpetrators are young males with intense sexual jealousy, depressed mothers, or despairing elderly men with ailing spouses. The principal victims are female sexual partners or consanguineous relatives, usually young children. Clinical depression, specific motivations such as male sexual proprietariness or maternal salvation fantasies, and a history of previous suicide attempts are important in explaining underlying psychopathological mechanisms. CONCLUSIONS: Murder-suicide occupies a distinct epidemiological domain that overlaps with suicide, domestic homicide, and mass murder. These events may be categorized into one of only several phenomenologic typologies that share similar demographics, motivations, and circumstances. Despite the disruption of families and communities caused by murder-suicide, there are no standardized operational definitions, validated taxonomic systems, or national surveillance networks for these events, all of which are needed to develop prevention strategies.

Case-Control Studies↗
PubMed2005

The journey to quitting smoking.

OBJECTIVES: This article outlines smoking trends over the past 10 years among the population aged 18 or older. Factors associated with smoking cessation and relapse are examined, as well as factors associated with having no intention of quitting in the next 6 months. DATA SOURCES: Data are from the household cross-sectional and longitudinal components of Statistics Canada's National Population Health Survey (1994/95 to 2002/03) (NPHS) and from the 2000/01 and 2003 Canadian Community Health Survey (CCHS). ANALYTICAL TECHNIQUES: Trends in smoking rates were calculated using cross-sectional data from the NPHS and the CCHS. Factors associated with cessation and relapsing were examined using pooling of repeated observations over two-year periods and logistic regression based on NPHS longitudinal data from 1994/95 to 2002/03. Factors associated with having no plans to quit were examined with logistic regression, based on 2003 CCHS cross-sectional data. MAIN RESULTS: In 2003, 19% of the Canadian population aged 18 or older smoked cigarettes daily, down 7 percentage points from a decade earlier. Smoking cessation, relapsing and having no plans to quit were all associated with addiction levels, notably, cigarettes smoked per day. Smoke-free homes and workplace smoking bans were associated with reduced cigarette consumption.

Adolescent↗
PubMed2005

Body mass and dependency.

OBJECTIVES: The relationship between body mass index (BMI) category and dependency in men and women aged 45 or older is examined cross-sectionally and prospectively. DATA SOURCES: Data are from the 2003 Canadian Community Health Survey and the 1994/95 through 2002/03 National Population Health Survey, household populations. ANALYTICAL TECHNIQUES: Cross-sectional data were used to produce weighted frequencies, cross-tabulations and multiple logistic regression models to estimate the prevalence of dependency and its relationship to BMI category. Associations between BMI and dependency two years later were also explored. Models were adjusted for potential confounders. MAIN RESULTS: The prevalence of dependency was nearly the same among those who were underweight as among those in obese class III--the highest level of obesity. Even when the effects of potential confounders were controlled, underweight and obese people faced higher odds of coexisting dependency, compared with those in the normal BMI range. Obesity was also predictive of subsequent dependency.

Activities of Daily Living↗
PubMed2005

BRCA1 and BRCA2 pathways and the risk of cancers other than breast or ovarian.

OBJECTIVE: Germline mutations in the tumor suppressor genes BRCA1 and BRCA2 predispose women to breast and ovarian cancer. Female carriers of BRCA1 or BRCA2 gene mutations have very high lifetime risks for breast and ovarian cancers. Genetic abnormalities occur in all cancers, so BRCA-related pathways are critical because they serve to safeguard genetic content. Although protecting genetic information is a general function, BRCA-related pathways seem largely specific to preventing breast and ovarian cancer. The objective of this study was to resolve this difference between the theoretical functions of BRCA genes and their specific clinical effects. DATA SOURCES, DATA EXTRACTION, DATA SYNTHESIS: The author collected data published in > 30 epidemiologic studies on the incidence of cancers other than breast or ovarian in mutation carriers and in large populations eligible for mutation testing. Data were extracted and used directly as published whenever possible with a minimum of statistical manipulation. CONCLUSIONS: Although mutations target breast and ovary, a broader spectrum of cancers also occur with statistically significant elevated frequencies. Risks for "all cancers except breast or ovary" are elevated, with some population subgroups differing with regard to how frequently elevated risks were found at individual sites. Additional sites at risk included stomach, pancreas, prostate, and colon. The increased risk ranged from about 20% to 60%, with the greatest increases in risk in stomach and pancreas. The collected data show BRCA-pathway functions are probably required at multiple sites, not just in breast or ovary. Known interactions and relationships among BRCA-related pathways strongly support the idea that their inactivation provides growth or survival advantages for a variety of cancers. The data suggest applying an increased level of clinical alertness to those with defects in BRCA-related pathways. Identifying molecules that confer growth or survival advantages to BRCA-related cancers may provide broadly useful targets for chemotherapy or chemoprevention.

BRCA1 Protein↗
PubMed1996

Dehydration, hyperthermia, and athletes: science and practice.

OBJECTIVE: To present the recent research that underscores the value of preventing both dehydration and hyperthermia. Such efforts will improve the athlete's capacity to perform physical activity and reduce the risk of heat-related problems. DATA SOURCES: Data were drawn from an extensive review of the scientific literature over the past 50 years with an emphasis on recent research (> 1990) that focuses on the physiological and performance benefits of fluid replacement. DATA SYNTHESIS: Even low levels of dehydration (eg, less than a 2% loss of body weight) impair cardiovascular and thermoregulatory response and reduce the capacity for exercise. Heat exposure also reduces the athlete's ability to train and compete, an effect that can be independent of hydration status. Even if athletes are well hydrated, hot weather alone will reduce their capacity to exercise. Optimal performance is possible only when dehydration and hyperthermia are minimized by ingesting ample volumes of fluid during exercise and by taking common-sense precautions in keeping cool. Recent research has demonstrated that consuming fluid in volumes approximating sweat loss maintains important physiological functions and significantly improves exercise performance, even during exercise lasting only 1 hour. Carbohydrate ingestion also improves exercise performance, an effect that is independent of, and additive to, preventing dehydration. CONCLUSION/APPLICATION: Athletes should follow an aggressive fluid replacement and temperature regulation regimen. Successful implementation of this regimen requires that athletic trainers, coaches, athletes, and support personnel are made aware of the benefits of adequate fluid replacement, that appropriate fluid replacement strategies are developed and implemented, that athletes have the opportunity to train themselves to ingest larger volumes of fluid more frequently, and that other practical steps are taken to keep athletes cool during both training and competition.

Journal Article↗
PubMed2006

Healthy living among seniors.

OBJECTIVES: This article investigates good health among Canadian seniors in relation to health behaviours and psychosocial factors. DATA SOURCES: Data are from the 2003 Canadian Community Health Survey and the 1994/95 through 2002/03 National Population Health Survey, household components. ANALYTICAL TECHNIQUES: Multiple logistic regression modeling was used to study associations between being in good health and behavioural risk and psychosocial factors in 2003. Proportional hazards modelling and logistic regression were used to examine health-related characteristics and psychosocial factors in relation to maintaining and recovering health. MAIN RESULTS: Seniors who exercised frequently, had a body mass index in the normal range, were high consumers of fruit and vegetables and moderate consumers of alcohol were more likely to be in good health. Low levels of stress and feeling connected to the community were also associated with good health. Healthy behaviours were related to maintaining good health over time, as well as increased likelihood of recovery. These findings persisted when controlling for socio-demographic factors and chronic conditions.

Activities of Daily Living↗
PubMed2006

Seniors' health care use.

OBJECTIVES: This article describes the use of health care by Canada's senior population: consultations with selected health care providers, medication use, hospitalization and home care. DATA SOURCES: Data are from the 2003 Canadian Community Health Survey and the 2002/03 Hospital Morbidity Database. ANALYTICAL TECHNIQUES: Cross-tabulations were used to estimate the proportion of seniors who consulted health care professionals, took medications, were hospitalized, and used home care. Linear and multivariate logistic regression models were used to examine associations between health and the number of physician consultations in the past year, the number of medications taken in the past month, and hospitalization and home care use in the past year. MAIN RESULTS: In 2003, nearly 90% of seniors reported that they had consulted a general practitioner or family doctor in the past year, 92% reported taking at least one type of medication in the past month, 14% had been hospitalized in the past year and 15% had received home care in the past year. Chronic conditions, poor health and severe injury were strongly associated with health care use. In multivariate analysis, socio-economic status was generally not related to seniors' use of health care services.

Aged↗
PubMed2006

Predictors of death in seniors.

OBJECTIVES: This article updates information on the leading causes of death for people aged 65 or older, and examines factors associated with death in seniors over an eight-year period. The analysis focuses on psychosocial factors--psychological distress, financial and family stress--in relation to mortality. DATA SOURCES: Data are from the Canadian Mortality Database and the 1994/95 to 2002/03 National Population Health Survey (NPHS), longitudinal file. The NPHS sample analysed contains records for 955 men and 1,445 women. ANALYTICAL TECHNIQUES: Death certificate information for 2002 and Census population estimates were used to calculate death rates and rank causes of death. NPHS data were cross-tabulated to examine selected characteristics reported in 1994/95 in relation to vital status (dead or alive) by 2002/03. Cox regression was used to calculate hazards ratios for psychological distress, financial and family-related stress in relation to subsequent mortality, while controlling for the effects of age, chronic diseases, and other potential confounders. MAIN RESULTS: In senior women, psychological distress in 1994/95 was positively associated with mortality over the next eight years, even when controlling for the effects of other variables. The statistical significance of this relationship in senior men disappeared when controlling for chronic conditions.

Aged↗
PubMed2006

Survival from cancer--up-to-date predictions using period analysis.

OBJECTIVES: This period analysis provides Canadian predictions of the short- and long-term relative survival of people recently diagnosed with cancer. Long-term period and cohort-based estimates are also compared. DATA SOURCES: Data are from the Canadian Cancer Registry, the Canadian Mortality Data Base, and Statistics Canada life tables. ANALYTICAL TECHNIQUES: Relative survival analyses were conducted using the life-table method; expected survival proportions were derived using the Ederer II approach. Period analysis estimates were based on the survival experience of cancer cases followed up in 2002. The cohort analyses involved people diagnosed in 1997 (5-year survival) or 1992 (10-year survival). National estimates exclude Quebec. MAIN RESULTS: Relative survival ratios were highest for thyroid (5-year, 97.7%) and prostate (95.2%) cancer and lowest for pancreatic cancer. Survival for many forms of cancer is higher than previously estimated by cohort-based analysis. The largest increases in 10-year relative survival were predicted for cancers of the prostate (13.0%) and rectum (9.7%). The largest predicted increases for 5-year survival were for cancers of the cervix uteri (5.4%) and rectum (4.5%), and for leukemia (3.7%).

Adolescent↗
PubMed2006

Adult obesity.

OBJECTIVES: Based on direct measures of height and weight, this article compares the prevalence of obesity among adults aged 18 or older in 1978/79 and 2004. Prevalence by demographic, socio-economic and lifestyle characteristics is presented, along with associations between obesity and selected chronic conditions. Canadian and US data are also compared. DATA SOURCES: Data are from the 2004 Canadian Community Health Survey: Nutrition, the 1978/79 Canada Health Survey and the 1986 to 1992 Canadian Heart Health Surveys. US data are from the 1999-2002 National Health and Nutrition Examination Survey. ANALYTICAL TECHNIQUES: Descriptive statistics were used to estimate the proportion of adults who were obese in 2004 in relation to selected characteristics. Logistic regression models were used to examine relationships between obesity and high blood pressure, diabetes and heart disease, controlling for socio-economic status and other risk factors such as smoking and physical activity. MAIN RESULTS: In 2004, 23% of adults, 5.5 million people aged 18 or older, were obese--up substantially from 14% in 1978/79. An additional 36% (8.6 million) were overweight. Obese individuals tended to have sedentary leisure-time pursuits and to consume fruit and vegetables infrequently. As body mass index (BMI) increased, so did an individual's likelihood of reporting high blood pressure, diabetes and heart disease.

Adolescent↗
PubMed2006

Overweight and obesity among children and youth.

OBJECTIVES: This article describes the prevalence of overweight and obesity among Canadian children and youth aged 2 to 17, based on direct measurements of their height and weight. Data from 1978/79 and 2004 are compared, and trends by sex and age groups are presented. DATA SOURCES: Data based on direct measurements are from the 2004 Canadian Community Health Survey (CCHS): Nutrition. Other information is from the 1978/79 Canada Health Survey and the 1999-2002 National Health and Nutrition Examination Survey, conducted in the US. ANALYTICAL TECHNIQUES: The estimated prevalence of overweight and of obesity, including an overall rate reflecting both, was based on 2004 CCHS data for 8,661 children and youth whose height and weight were measured. MAIN RESULTS: In 2004, 26% of Canadian children and adolescents aged 2 to 17 were overweight or obese, and 8% were obese. Over the past 25 years, the prevalence of overweight and obesity combined has more than doubled among youth aged 12 to 17, while the prevalence of obesity alone has tripled. Children and youth who ate fruit and vegetables at least five times a day were substantially less likely to be overweight or obese than were those who ate these foods less often. The likelihood of being overweight/obese rose as "screen time" (watching TV, playing video games or using a computer) increased.

Adolescent↗
PubMed1991

[Factual databanks of the International Register of Potentially Toxic Chemicals].

The computerized IRPTC data bank will cover the needs for factual information of the Toxicological Information System established in the Institute of Occupational Medicine. The conception and principles of the International Register of Potentially Toxic Chemicals (IRPTC) have been discussed. The main aim of the data bank is providing its users with information necessary to assess the potential threat posed by chemicals to man and his environment. The structure of the data bank, the rules for selection, extraction and presentation of data have been discussed as well as data sources, data management and dissemination of information.

Databases, Factual↗
PubMed1991

The safety and cost-effectiveness of low osmolar contrast media. Can economic analysis determine the real worth of a new technology?

OBJECTIVES: To estimate the reduction in mortality associated with a reduced adverse reaction rate following the substitution of older high osmolar radiocontrast media (HOCM) by the newer and more expensive low osmolar contrast media (LOCM), and to assess the cost-effectiveness of switching from HOCM to LOCM in patients with and without underlying risk factors for adverse reactions from radiocontrast agents. DATA SOURCES: Data from large prospective studies of adverse reactions to HOCM and LOCM were used to estimate the expected number of deaths and severe non-fatal reactions in a hypothetical population receiving one million intravenous radiocontrast injections with HOCM, and the expected reduction in the frequency of these outcomes after substitution by LOCM in high-risk and low-risk groups respectively. Life-years lost with each radiocontrast-related death were estimated from an audit of fatal adverse reaction reports submitted to the Adverse Drug Reactions Advisory Committee. The direct costs considered in the study were the increased costs of LOCM and the hospital costs of treating radiocontrast reactions which were estimated from an audit of cases admitted to public hospitals in Newcastle. STUDY SELECTION: The literature search included Medline (1966-1989) and bibliographies of original and review articles. We included only studies which were prospective, monitored patients in a formal way, described a mechanism for the recording of adverse events and were of sufficient size to have been capable of detecting severe reactions to radiocontrast agents. DATA EXTRACTION: Data were extracted independently by two investigators, unblinded, with disagreements resolved by consensus. DATA SYNTHESIS: Mortality data from individual reports were pooled and exact confidence intervals were calculated on the assumption of a Poisson distribution. In the case of comparative studies the relative risks of severe reactions in low-risk versus high-risk patients and with LOCM compared with HOCM were treated for homogeneity, and pooled odds ratios and 95% confidence intervals (CI) were calculated by combining the logarithms of the odds ratios weighted by their variances. RESULTS: The mortality after intravenous administration of HOCM was estimated from all studies to be 23.3 (95% CI, 2.4-33.1) per million injections. However, the mortality was 11.7 per million (95% CI, 2.4-34.1) in studies published since 1986. The mortality after the use of LOCM was estimated as 3.9 per million (95% CI, 0.1-21.7).(ABSTRACT TRUNCATED AT 400 WORDS)

Australia↗
PubMed1995

Which physicians limit their Medicaid participation, and why.

OBJECTIVE: This study identifies factors differentiating Medicaid participating physicians who accept all Medicaid patients from those limiting their Medicaid participation. DATA SOURCES: Data come from periodic telephone surveys of random samples of physicians conducted by the American Medical Association (AMA). STUDY DESIGN: Surveys conducted in 1990-1993 were pooled to form a sample of 4,188 Medicaid-participating office-based physicians. Respondents were classified as accepting all Medicaid patients or as limiting their Medicaid participation. Descriptive statistics are used to examine differences between these groups with respect to selected personal, practice, community, and reimbursement variables. Logistic regression analysis is used to identify factors associated with physicians accepting all Medicaid patients or limiting their Medicaid participation in some way. DATA COLLECTION METHODS: Survey data were supplemented with 1990 census data, 1990 AMA Physician Masterfile data, and 1989 data on physician payment levels. PRINCIPAL FINDINGS: Less than half of Medicaid-participating physicians and only about one-third of participating primary care physicians accept all Medicaid patients. Higher Medicaid fees are associated with physicians participating fully, but the marginal effects of changes in fees on the probability of physicians participating fully is small. CONCLUSIONS: Increases in Medicaid reimbursement aimed at primary care physicians or those in underserved areas may convert limited participants into full participants and, in so doing, improve the access of Medicaid eligibles to care. The increases in payment level needed to increase the proportion of physicians participating fully would be substantial, however, and may not be politically feasible.

Data Collection↗
PubMed1994

Management of heart failure. I. Pharmacologic treatment.

OBJECTIVE: This review of the pharmacologic treatment of heart failure due to left ventricular systolic dysfunction summarizes the recommendations of the expert panel for the Agency for Health Care Policy and Research Heart Failure Guideline. It provides specific advice to help guide practitioners through clinical decision making. DATA SOURCES: Data were obtained from English-language studies and referenced in MEDLINE or EMBASE between 1966 and 1993. We used the search terms heart failure, congestive; congestive heart failure; heart failure; cardiac failure; and dilated cardiomyopathy in conjunction with terms for the specific treatments. Where data were lacking, we relied on opinions of panel members and peer reviewers. STUDY SELECTION: Only large prospective trials were used to estimate treatment efficacy. Smaller trials, case series, and case reports were reviewed for the incidence of adverse effects. DATA EXTRACTION AND SYNTHESIS: Randomized clinical trials were reviewed for inclusion and exclusion criteria, patient outcomes, adverse effects, and eight categories of study quality using a defined list of study flaws. CONCLUSION: Angiotensin-converting enzyme (ACE) inhibitors should be given to all patients unless specific contraindications exist. Diuretics should be used judiciously early in treatment to prevent excessive diuresis that could prevent titration of ACE inhibitors to target doses. Digoxin has not been shown to affect the natural history of heart failure and should be reserved for patients who remain symptomatic after treatment with ACE inhibitors and diuretics. Isosorbide dinitrate and hydralazine hydrochloride should be tried in patients who cannot tolerate ACE inhibitors or who have refractory symptoms.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1994

Cough with angiotensin converting enzyme inhibitors: how much of a problem?

PURPOSE: To review the occurrence of angiotensin converting enzyme (ACE) inhibitor-related cough, and to examine its impact on the quality of life. DATA SOURCES: Data from published reports, postmarketing surveillance studies, hospital case series and randomly allocated controlled trials were reviewed. Data are presented from a nested case-control study examining the effects of ACE inhibitor-related cough in 36 subjects compared with 69 controls on various measures of quality of life. RESULTS: Low rates of ACE inhibitor-related cough were found in postmarketing studies, ranging from 0.1% (early studies) to 3%. Much higher figures were reported from double-blind randomly allocated controlled trials using self-administered questionnaires; the net increase over baseline was between 13 and 25% compared to 2% with the comparator drug. The nested case-control study suggested that the ACE inhibitor-related cough is associated with some deterioration in well-being. During ACE inhibitor treatment the patients tended to be more fatigued (P = 0.1) and depressed (P < 0.05) than controls. Reports of a sore throat increased by 27% (P < 0.01). CONCLUSIONS: Cough is a common side effect of ACE inhibitor treatment, with conservative estimates suggesting that around one in 10 patients treated with an ACE inhibitor will develop a dry persistent cough. Half of these may be withdrawn from treatment. This cough is probably associated with some deterioration in well-being, but larger studies are required to confirm this.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1994

The cost-effectiveness of voluntary counseling and testing of hospital inpatients for HIV infection.

OBJECTIVE: To evaluate the cost-effectiveness of voluntary counseling and testing of US hospital inpatients for the human immunodeficiency virus (HIV). DATA SOURCES: Data for entry into the model were derived from a review of the literature, consultation with experts, and consensus of the authors. DATA EXTRACTION: We rated our confidence in these probabilities and costs by grading the data inputs using methods adapted from those of the US Preventive Services Task Force. DATA SYNTHESIS: Decision analysis models were developed to evaluate two outcomes: (1) cost per health care worker (HCW) HIV infection averted if measures are taken by the HCW to reduce his or her risk of acquiring HIV; and (2) cost per inpatient HIV infection detected. Sensitivity analyses were also conducted. Using baseline input values, testing to avert HCW infection may prevent 3.6 HIV infections per year at a total program cost of $2.7 billion, or a cost of $753 million per infection averted. At baseline assumptions (seroprevalence = 1%), testing to detect inpatient HIV infection would cost $16,104 per year per infection detected. Cost-effectiveness at baseline drops to $8353 per HIV infection detected if the seroprevalence is 10%. If testing is limited to hospitals with inpatient seroprevalences of at least 1%, approximately 5400 persons per year will be falsely labeled HIV-positive. CONCLUSIONS: This analysis provides no justification for testing inpatients to prevent HIV infection of HCWs. Screening inpatients to detect HIV infection may be justified at seroprevalences exceeding 1%, but issues of medical or social discrimination, false-positive results, informed consent, and logistics must be resolved first.

AIDS Serodiagnosis↗