Bruce Reeder

Hospitalization and case-fatality rates for stroke in Canada from 1982 through 1991. The Canadian Collaborative Study Group of Stroke Hospitalizations.

BACKGROUND AND PURPOSE The purpose of this study was to estimate rates of hospitalization and in-hospital case-fatality for cerebral infarction and intracerebral hemorrhage in Canada and to describe variation in rates by age, sex, and calendar period. METHODS Data were obtained from hospitalization databases for each of Canadas 10 provinces for the 10 fiscal years of 1982 through 1991. All hospitalizations of persons 15 years of age or older with a primary diagnosis at discharge coded 431, 434, or 436 according to the International Classification of Disease, 9th Revision, were included. Rates per 100,000 population were calculated for intracerebral hemorrhage and cerebral infarction, for men and women, and for five age groups. Annual age- and sex-specific, 30-day, in-hospital case-fatality rates were also calculated. RESULTS A total of 335,283 discharges for stroke were enumerated over the 10-year period (309,631 cerebral infarctions and 25 652 intracerebral hemorrhages). A significant decline of approximately 1% per year was observed for the rate of cerebral infarctions. For hemorrhages, the reverse was seen. For men there was a 44% increase over the 10-year period, and for women there was a 34% increase. In-hospital case-fatality rates for cerebral infarctions increased with age but did not differ by sex when age was considered. For the five age groups of 15 to 54, 55 to 64, 65 to 74, 75 to 84 and > or = 85 years, rates were 6%, 8%, 12%, 18% and 27%, respectively. For intracerebral hemorrhage, the in-hospital case-fatality rates declined significantly over time from approximately 36% to 29%, 55% to 37%, 49% to 41%, 66% to 45%, and 72% to 59% for the five age groups, respectively. CONCLUSIONS The possibility that these changes are artifactual could not be ruled out, but because there is no obvious risk in assuming that they are not, it would be prudent to investigate their causes further.

Validity of Stroke Diagnosis on Hospital Discharge Records in Saskatchewan, Canada: Implications for Stroke Surveillance

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.

Advancing the future of physical activity guidelines in Canada: an independent expert panel interpretation of the evidence

The Canadian Society for Exercise Physiology, in partnership with the Public Health Agency of Canada, has initiated a review of their physical activity guidelines to promote healthy active living for Canadian children, youth, adults and older adults; previous guidelines were released in 2002, 2002, 1998 and 1999 respectively. Several background papers from this project were published recently and provide foundation evidence upon which to base new guidelines. Furthermore, comprehensive systematic reviews were completed to ensure a rigorous evaluation of evidence informing the revision of physical activity guidelines for asymptomatic populations. The overall guideline development process is being guided and assessed by the AGREE II instrument. A meeting of experts was convened to present the evidence complied to inform the guideline revisions. An independent expert panel was assembled to review the background materials and systematic reviews; listen to the presentations and discussions at the expert meeting; ask for clarification; and produce the present paper representing their interpretation of the evidence including grading of the evidence and their identification of needs for future research. The paper includes also their recommendations for evidence-informed physical activity guidelines.

Actinic prurigo clinical features and prognosis

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.

Body mass index versus waist circumference as predictors of mortality in Canadian adults

Background:Elevated body mass index (BMI) and waist circumference (WC) are associated with increased mortality risk, but it is unclear which anthropometric measurement most highly relates to mortality. We examined single and combined associations between BMI, WC, waist–hip ratio (WHR) and all-cause, cardiovascular disease (CVD) and cancer mortality.Methods:We used Cox proportional hazard regression models to estimate relative risks of all-cause, CVD and cancer mortality in 8061 adults (aged 18–74 years) in the Canadian Heart Health Follow-Up Study (1986–2004). Models controlled for age, sex, exam year, smoking, alcohol use and education.Results:There were 887 deaths over a mean 13 (SD 3.1) years follow-up. Increased risk of death from all-causes, CVD and cancer were associated with elevated BMI, WC and WHR (P<0.05). Risk of death was consistently higher from elevated WC versus BMI or WHR. Ascending tertiles of each anthropometric measure predicted increased CVD mortality risk. In contrast, all-cause mortality risk was only predicted by ascending WC and WHR tertiles and cancer mortality risk by ascending WC tertiles. Higher risk of all-cause death was associated with WC in overweight and obese adults and with WHR in obese adults. Compared with non-obese adults with a low WC, adults with high WC had higher all-cause mortality risk regardless of BMI status.Conculsion:BMI and WC predicted higher all-cause and cause-specific mortality, and WC predicted the highest risk for death overall and among overweight and obese adults. Elevated WC has clinical significance in predicting mortality risk beyond BMI.

Quality-of-life issues in patients with ovarian cancer and their caregivers: a review.

Significant progress has been made towards the treatment of ovarian cancer resulting in longer median survival despite a persistent low cure rate. Relatively few studies have examined the impact of the cancer and its treatment on the patients and their caregivers due to the difficulty in the definition and measurement of the Quality of Life (QOL) concept. A review of the literature revealed significant alterations in the quality of life of ovarian cancer patients during treatment and long term follow ups. For the caregivers, it is important for health care providers to realize that: 1) caregivers are being asked to assume an increasing number of complex care giving tasks at home, 2) there exists a high proportion of unmet caregiver needs, 3) the care giving experience includes both positive and negative elements and, 4) perception of caregivers’ burden is positively linked to negative reactions to care giving. Supportive programs for patients and caregivers should be designed with these needs in mind. Future research should study the best way to incorporate results of quality of life assessments into routine treatment decision-making. Target Audience: Obstetricians & Gynecologists, Family Physicians Learning Objectives: After completion of this article, the reader should be able to outline the current data on QOL issues in patients with ovarian cancer, and to describe potential working definitions of QOL.

Should noncurative resection of the primary tumour be performed in patients with stage IV colorectal cancer? A systematic review and meta-analysis

PURPOSE Surgical resection of the primary tumour in patients with advanced colorectal cancer (crc) remains controversial. This review compares survival in patients with advanced crc who underwent surgical resection of the primary tumour with that in patients not undergoing resection, and determines rates of post-operative mortality and nonfatal complications, the primary tumour complication rate, the non-resection surgical procedures rate, and quality of life (qol). METHODS Reports in the central, medline, and embase databases were searched for relevant studies, which were selected using pre-specified eligibility criteria. The search was also restricted to publication dates from 1980 onward, the English language, and studies involving human subjects. Screening, evaluation of relevant articles, and data abstraction were performed in duplicate, and agreement between the abstractors was assessed. Articles that met the inclusion criteria were assessed for quality using the Newcastle-Ottawa Scale. Data were collected and synthesized per protocol. RESULTS From among the 3379 reports located, fifteen retrospective observational studies were selected. Of the 12,416 patients in the selected studies, 8620 (69%) underwent surgery. Median survival was 15.2 months (range: 10-30.7 months) in the resection group and 11.4 months (range: 3-22 months) in the non-resection group. Hazard ratio for survival was 0.69 [95% confidence interval (ci): 0.61 to 0.79] favouring surgical resection. Mean rates of postoperative mortality and nonfatal complications were 4.9% (95% ci: 0% to 9.7%) and 25.9% (95%ci: 20.1% to 31.6%) respectively. The mean primary tumour complication rate was 29.7% (95% ci: 18.5% to 41.0%), and the non-resection surgical procedures rate in the non-resection group was 27.6% (95 ci: 15.4% to 39.9%). No study provided qol data. CONCLUSIONS Although this review supports primary tumour resection in advanced crc, the results have significant biases. Randomized trials are warranted to confirm the findings.

Survival impact of surgical resection of primary tumor in patients with stage IV colorectal cancer: Results from a large population‐based cohort study

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.

Physical activity level, waist circumference, and mortality

This study predicted all-cause mortality based on physical activity level (active or inactive) and waist circumference (WC) in 8208 Canadian adults in Alberta, Manitoba, Nova Scotia, and Saskatchewan, surveyed between 1986-1995 and followed through 2004. Physically inactive adults had higher mortality risk than active adults overall (hazard ratio, 95% confidence interval = 1.20, 1.05-1.37) and within the low WC category (1.51, 1.19-1.92). Detrimental effects of physical inactivity and high WC demonstrate the need for physical activity promotion.

The Relationship of Chronic Disease and Demographic Variables to Physical Activity in a Sample of Women Aged 65 to 79 Years

This study explored the relationship between physical activity, marital status, income, education, and chronic disease in older women to determine which individuals are at risk of being inactive and to identify potential moderators of physical activity behavior. This was an analysis of cross-sectional data from a convenience sample of 271 community-dwelling women aged 65 to 79 years. Self-reported physical activity was measured using the Physical Activity Scale for the Elderly. Socio-demographic characteristics (including age, gender, marital status, education, employment, and income) and self-reported health were measured using previously validated instruments. To avoid seasonal variations in physical activity, data were collected during the summer months. Physical activity was negatively associated with age and the presence of cardio-respiratory disease and positively associated with income greater than