The financial impact of cancer on Canadian young adults.

PURPOSE: To explore the financial impact of cancer in young adults (YAs) compared to matched non-cancer peers. METHODS: Five hundred seventy-five YAs from the Young Adults with Cancer in their Prime (YACPRIME) study reported on out-of-pocket cancer costs and missed work. YA cancer survivors were compared to matched peers without cancer on key financial indices based on current age (< 35 vs. 35 + years) and time since diagnosis (< 5 vs. 5 + years). Descriptive statistics, Chi-square tests, and prevalence ratios (PR) were used to compare groups on financial variables. RESULTS: Almost 60% of YA survivors spent at least $100/month on cancer-related expenses, and 49% missed at least one year of work. YA survivors were more likely to have outstanding credit card ((< 35 (PR = 1.37, p = 0.001); 35 + (PR = 1.33, p = 0.001)) and line of credit (< 35 (PR = 1.42, p = 0.008); 35 + (PR = 1.27, p = 0.016)) balances. Home ownership was higher among non-cancer peers ((< 35: PR = 1.42, p < 0.001); 35 + (PR = 1.69, p < 0.001); < 5 years (PR = 1.39, p < 0.001); 5 + years (PR = 1.41, p = 0.005)). YA survivors were more likely to not own assets ((< 5 years (PR = 2.25, p < 0.001); 5 + years (PR = 2.25, p = 0.004)). Those diagnosed within 5 years had higher rates of payday loans (PR = 3.91, p = 0.021). CONCLUSION: While exploratory, results suggest that YAs are disadvantaged compared to their peers in type and value of assets owned and debts carried. IMPLICATIONS FOR CANCER SURVIVORS: Survivorship care plans for YA survivors should include resources to manage the financial impacts of cancer.

Prognostic factors in major depressive disorder: comparing responders and non-responders to Repetitive Transcranial Magnetic Stimulation (rTMS), a naturalistic retrospective chart review.

AIM: Repetitive transcranial magnetic stimulation (rTMS) is widely utilized as an effective treatment for major depressive disorder (MDD) with varying response rates. Factors associated with better treatment outcome remain scarce. This naturalistic retrospective chart review hopes to shed light on easily obtainable and measurable predictive factors for patients referred to rTMS. METHODS: Protocol parameters, medication, rated scales, rTMS protocols, and treatment outcomes were reviewed for 196 patients with MDD who received rTMS at Saint Boniface Hospital between 2013 and 2019. Logistic regression and marginal effects were used to assess the different predictor variables for response (50% reduction or more on the Hamilton Depression Rating Scale (Ham-D)) and remission (Ham-D of ≤7 by the last session). RESULTS: HamD at 10 sessions was predictive of remission, and Sheehan Disability Scale (SDS) at 10 sessions was predictive of response to rTMS. Ham-D, SDS, and Beck Anxiety Inventory were predictive of remission and response by Beck Anxiety Inventory 20 sessions. High frequency rTMS had a similar response and remission rate to low frequency, but higher response rate to intermittent Theta Burst Stimulation with no difference in remission rate. Positive predictive factors of response were lower age and bupropion use. Negative predictive factors were antipsychotics, anticonvulsants, or benzodiazepine use. For remission, antipsychotics or anticonvulsants use were negative predictors; bupropion use and higher resting motor threshold were positive predictors. Severity of depression as measured by baseline HamD was not associated with different probabilities of treatment success.

Examining differences in diet quality between Canadian Indigenous and non-Indigenous adults: results from the 2004 and 2015 Canadian Community Health Survey Nutrition Surveys.

OBJECTIVES: The Truth and Reconciliation Commission includes a call to action to close gaps in health outcomes, including type 2 diabetes, of which diet quality must be considered an important mediator. The objectives of this study were to compare diet quality between off-reserve Indigenous and non-Indigenous adults in 2004 and 2015, and examine food security as a predictor of diet quality. METHODS: We employed a repeated cross-sectional design using the 2004 and 2015 Canadian Community Health Surveys-Nutrition. Both surveys include a representative sample of the Canadian population in the 10 provinces, excluding the northern territories and people living on-reserve. Healthy Eating Index (HEI) values were estimated, using 24-hour dietary recalls, for the Indigenous and non-Indigenous population in each time period. After matching, a generalized linear model was applied to test for differences in HEI between groups across time period, adjusting for household food security. RESULTS: Overall, HEI scores were not significantly different for Indigenous men and women in 2015 as compared with 2004, but continued to be lower compared with those of the non-Indigenous population. Indigenous adults reported significantly lower diet quality independent of food security status and other factors. Scores pertaining to percent energy from 'other' foods improved in 2015 compared with 2004. CONCLUSION: Dietary disparities persist between Indigenous and non-Indigenous populations. While addressing household food insecurity among Indigenous populations is necessary to improve diet quality, it is not sufficient. Results suggest that factors other than food insecurity and socio-economic status are impacting disparities in diet quality among Indigenous adults.

RéSUMé: OBJECTIFS: L'un des appels à l'action lancé par la Commission de vérité et réconciliation vise à combler les écarts dans les résultats cliniques, notamment pour le diabète de type 2, dont la qualité du régime doit être considérée comme un médiateur important. Nous avons cherché à comparer la qualité du régime des adultes autochtones vivant hors réserve et des adultes non autochtones en 2004 et en 2015 et à examiner la sécurité alimentaire comme variable prédictive de la qualité du régime. MéTHODE: Nous avons employé un plan transversal répété en utilisant les Enquêtes sur la santé dans les collectivités canadiennes ­ Nutrition de 2004 et de 2015. Les deux enquêtes incluent un échantillon représentatif de la population canadienne dans les 10 provinces, sans les territoires nordiques ni les populations vivant dans les réserves. Les valeurs de l'Indice d'alimentation saine (IAS) ont été estimées, à l'aide de rappels alimentaires de 24 heures, pour la population autochtone et non autochtone durant chaque intervalle. Après appariement des données, nous avons appliqué un modèle linéaire généralisé pour découvrir les différentes valeurs de l'IAS entre les groupes au fil du temps, en apportant des ajustements pour tenir compte de la sécurité alimentaire des ménages. RéSULTATS: Dans l'ensemble, les valeurs de l'IAS n'étaient pas significativement différentes chez les hommes et les femmes autochtones en 2015 comparativement à 2004, mais elles restaient inférieures aux valeurs de l'IAS pour la population non autochtone. Les adultes autochtones ont déclaré une qualité du régime significativement inférieure, indépendamment de leur statut de sécurité alimentaire et d'autres facteurs. Les valeurs afférentes au pourcentage d'énergie provenant d' « autres ¼ aliments s'étaient améliorées en 2015 par rapport à 2004. CONCLUSION: Les disparités du régime alimentaire persistent entre les populations autochtones et non autochtones. Bien qu'il soit nécessaire d'aborder l'insécurité alimentaire des ménages dans les populations autochtones pour améliorer la qualité du régime, ce n'est pas suffisant. Nos résultats indiquent que d'autres facteurs que l'insécurité alimentaire et le statut socioéconomique accentuent les disparités dans la qualité du régime chez les adultes autochtones.

Cardiovascular disease and the risk of dementia: a survival analysis using administrative data from Manitoba.

OBJECTIVES: Recent research has shown that cardiovascular disease (CVD) raises the risk of dementia and other forms of cognitive decline. Generally, these studies are unable to model the time of diagnosis of CVD in their analyses and treat CVD as a time-fixed variable. Our objective was to assess the risk of being diagnosed with dementia for individuals diagnosed with CVD when CVD is time-dependent. METHODS: We performed a retrospective cohort study using administrative health datasets from the Manitoba Population Research Data Repository in Canada. We constructed a longitudinal dataset to track individuals enrolled in the Manitoba Health Insurance Registry between April 1, 1997 and March 31, 2015. The study population consisted of 496,192 individuals 30 years of age or older who were not diagnosed with CVD or dementia prior to April 1, 1997. Diagnoses of CVD and dementia were based on diagnosis codes from medical claims and hospitalizations and the use of prescription medications. Hazard ratios were then computed using adjusted Cox-proportional hazards analyses. RESULTS: Among the CVD subgroups considered, atrial fibrillation, ischemic heart disease, and stroke increased the risk of developing dementia, with stroke doubling one's risk of being diagnosed with the disease (hazard ratio: 1.95; 95% confidence interval: 1.9, 2.01). Age, lower socioeconomic status, and worsening comorbidities also increased the risk of being diagnosed with dementia. CONCLUSION: A diagnosis of CVD is associated with an increased risk of a future diagnosis of dementia. Promoting good cardiovascular health may serve as an effective measure for preventing dementia.

RéSUMé: OBJECTIFS: De récentes études montrent que la maladie cardiovasculaire (MCV) accroît le risque de démence et d'autres formes de déclin cognitif. De façon générale, ces études sont incapables de modéliser la date d'un diagnostic de MCV dans leurs analyses et traitent donc les MCV comme des variables fixes dans le temps. Nous avons cherché à évaluer le risque de recevoir un diagnostic de démence chez les personnes ayant un diagnostic de MCV quand la MCV est variable dans le temps. MéTHODE: Nous avons mené une étude de cohorte rétrospective à l'aide des fichiers de données administratives sur la santé du Dépôt de données de recherche en santé des populations du Manitoba, au Canada. Nous avons construit un fichier longitudinal pour suivre les personnes inscrites au registre d'assurance-maladie du Manitoba entre le 1er avril 1997 et le 31 mars 2015. La population étudiée comptait 496 192 personnes de 30 ans et plus n'ayant pas reçu de diagnostic de MCV ou de démence avant le 1er avril 1997. Les diagnostics de MCV et de démence étaient fondés sur les codes diagnostiques dans les demandes d'indemnisation de frais médicaux et les dossiers d'hospitalisation, et sur l'utilisation de médicaments sur ordonnance. Les indices de risque ont été calculés à l'aide du modèle à risques proportionnels de Cox. RéSULTATS: Dans les sous-groupes atteints de MCV que nous avons étudiés, la fibrillation atriale, la cardiopathie ischémique et l'AVC faisaient augmenter le risque de démence; l'AVC, en particulier, doublait le risque d'être diagnostiqué avec cette maladie (indice de risque : 1,95; intervalle de confiance de 95% : 1,9, 2,01). L'âge, le faible statut socioéconomique et l'évolution défavorable des comorbidités faisaient aussi augmenter le risque de recevoir un diagnostic de démence. CONCLUSION: Un diagnostic de MCV est associé à un risque accru de diagnostic de démence plus tard. La promotion d'une bonne santé cardiovasculaire pourrait donc être un moyen efficace de prévenir la démence.

Diet quality among Indigenous and non-Indigenous children and youth in Canada in 2004 and 2015: a repeated cross-sectional design.

OBJECTIVE: The objectives were to describe changes in diet quality between off-reserve Indigenous and non-Indigenous children and youth from 2004 to 2015 and examine the association between food security and diet quality. DESIGN: We utilised a repeated cross-sectional design using both the 2004 and 2015 nutrition-focused Canadian Community Health Surveys, including 24-h dietary recall. Diet quality was estimated according to the Healthy Eating Index (HEI). SETTING: The surveys were conducted off-reserve in Canada's ten provinces. PARTICIPANTS: Our analysis included children and youth 2-17 years old (n 18 189). Indigenous and non-Indigenous participants were matched, and using a general linear model, we tested time period and (non-)Indigenous identifiers, including their interaction effect, as predictors of HEI. RESULTS: Both Indigenous and non-Indigenous children and youth had significantly higher HEI scores in 2015 as compared to 2004. There was not a significant (non-)Indigenous and time period interaction effect, indicating the improvements in diet quality in 2015 were similar between both Indigenous and non-Indigenous populations. Improvements in diet quality are largely attributed to reductions in percentage energy from 'other' foods, though a disparity between Indigenous and non-Indigenous children and youth persisted in 2015. Overall, food security was lower among the Indigenous population and positively, and independently, associated with diet quality overall, though this relationship differed between boys and girls. CONCLUSIONS: School policies may have contributed to similar improvements in diet quality among Indigenous and non-Indigenous populations. However, an in-depth sex and gender-based analysis of the relationship between food security and diet quality is required.

Impact of Age, Menopause, and Obesity on Oxylipins Linked to Vascular Health.

OBJECTIVE: Cardiovascular disease, a major cause of mortality and morbidity, exhibits sexual dimorphism since the onset of cardiovascular disease occurs later in women than in men. The loss of cardioprotection in older women may be due to an increase in arterial stiffness after menopause. Free fatty acid metabolites of polyunsaturated fatty acids, called oxylipins, are known to impact vessel function and may be responsible for the vascular benefits of polyunsaturated fatty acids. The objectives of this study were to compare the plasma oxylipin profiles of young females (20-55 years), older females (55+), and older males (55+) and to identify associations between oxylipins and cardiovascular disease risk factors, such as obesity and arterial stiffness. Approach and Results: We quantified plasma oxylipins by high-performance liquid chromatography-tandem mass spectrometry in archived samples taken from completed clinical trials. We identified 3 major 12-lipoxygenase products, 12-hydroxy-eicosatetraenoic acid, 12-hydroxy-eicosapentaenoic acid, and 14-hydroxy-docosahexaenoic acid, that are present at high levels in young females compared with older females and males. These oxylipins also decreased with obesity and displayed robust negative associations with arterial stiffness as assessed by brachial-ankle pulse wave velocity. According to multiple linear regression modeling, these associations were maintained even after correcting for body mass index category combined with either age, menopausal status, or estradiol levels. Using linear discriminant analysis, the combination of these 3 oxylipins effectively distinguished participants according to both brachial-ankle pulse wave velocity risk group and age. CONCLUSIONS: Higher 12-lipoxygenase oxylipin plasma concentrations associated with lower arterial stiffness in premenopausal females may be an important contributing factor to sex differences in cardiovascular disease. Registration: URL: https://www.clinicaltrials.gov; Unique identifiers: NCT01661543, NCT01562171, NCT01890330, NCT02571114 and NCT02317588.

O brother how art thou: Propensity to report self-assessed unmet need.

Research investigating self-assessed unmet need (SUN) has taken the reports from surveys as given and subsequently attempted to discover patterns in inequality of access to healthcare. This requires the yet untested assumption that, given a certain level of care and demand, the likelihood of reporting unmet need does not vary across socioeconomic/demographic status (SEDS), be satisfied. Using an administrative dataset spanning 2001 to 2011 comprised of sufferers of a set of conditions that suggest unmet need (n = 3300) we evaluate the proposition that, given health status and care received, the propensity to report unmet need does not vary along SEDS. The results are further validated using the Canadian Community Health Surveys between 2001 and 2013 (n = 237,483). We find that the assumption of independence between reporting SUN and SEDS is not satisfied. Many of the groups found to have less access in previous studies may simply be more prone to interpret/answer the survey questions about unmet need in a certain way. The results of this research suggest that, in its present incarnation, survey data on self-assessed unmet need does not accurately measure what much of the academic literature has assumed it does.