Iris Weller

Population trends in BMD testing, treatment, and hip and wrist fracture rates: are the hip fracture projections wrong?

A worldwide epidemic of hip fractures has been predicted. Time trends in BMD testing, bone‐sparing medications and hip and wrist fractures in the province of Ontario, Canada, were examined. From 1996 to 2001, BMD testing and use of bone‐sparing medications increased each year, whereas despite the aging of the population, wrist and hip fracture rates decreased.

Major depressive episodes and work stress: results from a national population survey.

OBJECTIVES We determined the proportion of workers meeting criteria for major depressive episodes in the past year and examined the association between psychosocial work-stress variables and these episodes. METHODS Data were derived from the Canadian Community Health Survey 1.2, a population-based survey of 24324 employed, community-dwelling individuals conducted in 2002. We assessed depressive episodes using the Composite International Diagnostic Interview. RESULTS Of the original sample, 4.6% (weighted n=745948) met criteria for major depressive episodes. High job strain was significantly associated with depression among men (odds ratio [OR]=2.38; 95% confidence interval [CI]=1.29, 4.37), and lack of social support at work was significantly associated with depression in both genders (men, OR=2.70; 95% CI=1.55, 4.71; women, OR=2.37; 95% CI=1.71, 3.29). Women with low levels of decision authority were more likely to have depression (OR=1.59; 95% CI=1.06, 2.39) than were women with high levels of authority. CONCLUSIONS A significant proportion of the workforce experienced major depressive episodes in the year preceding our study. Gender differences appear to affect work-stress factors that increase risk for depression. Prevention strategies need to be developed with employers and employee organizations to address work organization and to increase social support.

The Canadian Home Fitness Test. 1991 update

The Canadian Home Fitness Test (CHFT) was developed in the mid-1970s (Bailey et al. 1974. 1976) as a simple home tool for the screening of fitness. Subjects were encouraged to climb and descend the domestic staircase at an age and sex-specific rate set by the music from a long-playing gramophone or tape recording, and to make an approximate classification of their fitness status from the attained speed of stepping and the immediate recovery heart rate. It was reasoned that the initial testing (with associated recommendations on an appropriate exercise prescription) should create an awareness of fitness, and that gains of fitness seen at repetition of the test might help to sustain an interest in exercise, Because of the simplicity of the test protocol. many Canadian investigators believed that the procedure had potential for the field-testing of cardiorespiratory fitness, and on this basis it became one element of the Canadian Standard Test of Fitness (CSFT) [Fitness Canada 1986], with subjects climbing standardised double 8-inch (20.3cm) steps, and heart rates being counted more precisely by electrocardiogram or observer palpation. In this modified format, the CHFT was used in a large survey of occupational fitness (Canadian Public Health Association 1979), in the Canada Fitness Survey of 1981 (Canadian Fitness and Lifestyle Institute 1983; Shephard 1986) and in surveys of Canadian Forces personnel (Bell & Allen 1983; CF Expres 1983). Early criticisms of the procedure on counts of safety, lack of precision in speed of the recorded music, difficulties in maintaining the stepping rhythm or counting the recovery heart rate accurately were considered and answered in a comprehensive review of the test (Shephard 1980). Practical evidence of the value of the CHFT concept is that several individuals have since marketed music-paced fitness tests, apparently without acknowledgement of prior Canadian work. The present paper considers new information on the safety, motivational value and accuracy of the CHFT.

Psychosocial and clinical correlates of suicidal acts: results from a national population survey

BACKGROUND Clinical samples have identified a number of psychosocial risk factors for suicidal acts but it is unclear if these findings relate to the general population. AIMS To describe the prevalence of and psychosocial risk factors for suicidal acts in a general adult population. METHOD Data were obtained from a Canadian epidemiological survey of 36,984 respondents aged 15 years and older (weighted sample n=23,662,430). RESULTS Of these respondents, 0.6% (weighted n=130,143) endorsed a 12-month suicidal act. Female gender (OR=4.27, 95% CI 4.05-4.50), being separated (OR=37.88, 95% CI 33.92-42.31) or divorced (OR=7.79, 95% CI 7.22-8.41), being unemployed (OR=1.70, 95% CI 1.50-1.80), experiencing a chronic physical health condition (OR=1.70, 95% CI 1.67-1.86) and experiencing a major depressive episode in the same 12-month period as the act (OR=9.10, 95% CI 8.65-9.59) were significantly associated with a suicidal act. CONCLUSIONS The psychosocial correlates of suicidal acts in this sample are consistent with those previously reported in clinical and general population samples. These findings reinforce the importance of the determination of suicide risk and its prevention not only of psychiatric illness but of physical and psychosocial factors as well.

A study of the reliability of the Canada Fitness Survey questionnaire

PURPOSE The purposes of this study are to assess the reliability of the physical activity components of the Canada Fitness Survey (CFS) questionnaire (N = 64 males, N = 63 females) and the Canadian Aerobic Fitness Test (N = 44 males, N = 52 females) in a sample of subjects between 15 and 80 yr. RESULTS The intraclass correlation (rI) for the fitness scores was 0.98. The activity variables showed low to moderate correlations (rI = 0.48-0.53). Correlations were higher for males (rI = 0.38-0.65) than females (rI = 0.28-0.60) for most of the activity variables reported. Males generally report leisure activity more reliably than nonleisure activity, whereas the opposite was true for females. Males reported strenuous activity with higher reliability (rI = 0.86) than females (rI = 0.31). There was considerable variation in the reliability of specific activities. Of the components of physical activity (time, intensity, duration) that comprise the energy expenditure (EE) variable, the least reliably reported is intensity for both males (rI = 0.43) and females (rI = 0.55). CONCLUSIONS The CFS questionnaire is moderately reliable for most measures of physical activity. Estimates of reliability vary considerably among the various activities and components of these activities and between males and females.

Management of congestive heart failure: a gender gap may still exist. Observations from a contemporary cohort

BackgroundUnlike other cardiovascular diseases the incidence and prevalence of congestive heart failure (CHF) continues to increase. While gender differences in coronary artery disease have been well described, to date, there has been a relative paucity of similar data in patients with CHF. We conducted a pilot study to evaluate the profile and management of patients with CHF at a tertiary care centre to determine if a gender difference exists.MethodsA chart review was performed at a tertiary care centre on consecutive patients admitted with a primary diagnosis of CHF between June 1997 and 1998. Co-morbidity, diagnostic investigations, and management of CHF were recorded. Comparisons between male and female patients were conducted.ResultsOne hundred and forty five patients were reviewed. There were 80 male (M) and 65 female (F) patients of similar age [71.6 vs. 71.3 (M vs. F), p = NS]. Male patients were more likely to have had a previous myocardial infarction (66% vs. 35%, p < 0.01) and revascularization (41% vs. 20%, p < 0.05), and had worse left ventricular ejection fraction (LVEF) than women, [median LVEF 3 vs. 2 (M vs. F), p < 0.01]. Male patients were more likely to have a non-invasive assessment of left ventricular (LV) function [85% vs. 69%, (M vs. F), p < 0.05]. A logistic regression analysis suggests that amongst those without coronary disease, males were more likely to receive non-invasive testing. There were no differences in the use of prescribed medications, in this cohort.ConclusionsThis pilot study demonstrated that there seem to be important gender differences in the profile and management of patients with CHF. Importantly women were less likely to have an evaluation of LV function. As assessment of LV function has significant implications on patient management, this data justifies the need for larger studies to assess gender differences in CHF profile and treatment.

Ultrastructural observations on the body wall of the leech, Batracobdella picta

A series of closely spaced annulations surround the surface of the body of Batracobdella picta. The epidermis is covered by a thin cuticle which is composed of several layer of orthogonally arranged, fibrous bundles. Numerous fine projections carpet the surface of the cuticle and appear to be derived from microvillar processes which extend through the cuticle from subjacent epithelial cells. Septate junctions occur between adjacent epithelial cells, and hemidesmosomes with associated tonofilaments appear to anchor the epithelium to the overlying cuticle and to the basal connective tissue. The epithelial cells contain abundant organelles including granular endoplasmic reticulum, mitochondria and Golgi complexes. The cytology of the body wall of B. picta is compared with that of other annelids.

Sources of variation in oxygen consumption during a stepping task.

Factors that determine oxygen uptake during stepping exercise (modified Canadian Aerobic Fitness Test, CAFT) were examined in 66 women and 55 men. Subjects ranged in age from 15 to 67 yr, VO2max from 22.5 to 76.9, leg length from 75.0 to 101.0 cm, and body mass from 48.4 to 107.7 kg. In accordance with the modified CAFT protocol, subjects stepped at cadences determined by their age and heart rate response. The oxygen demand of stepping at each cadence was measured on two occasions. A paired t-test revealed no significant (P > 0.05) difference in oxygen demand between the repeats and the intraclass correlation coefficient was 0.51. The coefficient of variation of oxygen uptake (ml O2.kg-1.min-1) at a given stepping cadence averaged 10.4%. Regression analysis indicated that little variation in oxygen demand could be explained by simple descriptors of the subjects. Age was weakly related to oxygen demand at a given level (males r = 0.26, females r = 0.58). Stepwise multiple regression of the oxygen uptake at selected stepping cadences on possible independent variables confirmed that little of the variation could be explained by age, aerobic fitness, leg length, or adiposity (maximum R2 = 0.34). We conclude that variation in the oxygen demand of a stepping task can account for a large portion of the error in predicting VO2max from a submaximal stepping test. Our ability to predict the oxygen demand of stepping from subject characteristics is limited.

Work characteristics and social phobia in a nationally representative employed sample.

Objective: Social phobia is associated with long-term impairment and disability. Environmental and genetic influences may be important in etiology and persistence. This is the first study to examine the association of work characteristics with social phobia in a representative nationally employed population. Method: Self-reported work characteristics were linked to 12-month social phobia diagnosed by the World Mental Health Composite International Diagnostic Interview in 24 324 employed individuals from the Canadian Community Health Survey. Results: High job strain (OR = 1.62, 95%CI, 1.06 to 2.49) and job insecurity (OR = 2.47, 95%CI, 1.73 to 3.51) were associated with an increased risk of 12-month social phobia, adjusting for sociodemographic variables, prevalent depression, and other work characteristics. Conclusions: Work characteristics are associated with social phobia. Characteristics such as job insecurity may be a consequence of illness in employed populations, while high job strain may increase the risk of symptoms. More investigation is needed of the relation between work and social phobia to understand how to reduce occupational disability.