Dietary fat in relation to prognostic indicators in breast cancer.

The relation of diet, especially fat intake, to recognized prognostic indicators for breast cancer was investigated in 666 women with a newly diagnosed infiltrating breast carcinoma. Diet during the year preceding diagnosis was assessed by interview using a food frequency questionnaire covering the intake of 114 food items. Prognostic indicators included axillary node involvement at diagnosis, estrogen receptor status, and selected histologic features of the primary tumor such as nuclear grade, histologic grade, tubule formation, mitotic activity, and nuclear size of tumor cells. After adjustment for total energy intake, age, body weight, and tumor size at diagnosis, an increase in saturated fat intake was related to an increased frequency of node involvement at diagnosis among postmenopausal patients. In contrast, an elevation in polyunsaturated fat intake was related to a reduction of the percentage of patients with positive nodes at diagnosis. This relation was observed among both premenopausal and postmenopausal patients. Dietary fat was not related to the estrogen receptor status of tumors. No association was found between dietary habits and histologic features of the primary tumor. These data suggest that dietary fat may have an effect on the growth or spread of breast cancer during the preclinical phase of the disease and that this effect may vary according to the type of fat considered.

Physical activity and risk of cognitive impairment and dementia in elderly persons.

CONTEXT: Dementia is common, costly, and highly age related. Little attention has been paid to the identification of modifiable lifestyle habits for its prevention. OBJECTIVE: To explore the association between physical activity and the risk of cognitive impairment and dementia. DESIGN, SETTING, AND SUBJECTS: Data come from a community sample of 9008 randomly selected men and women 65 years or older, who were evaluated in the 1991-1992 Canadian Study of Health and Aging, a prospective cohort study of dementia. Of the 6434 eligible subjects who were cognitively normal at baseline, 4615 completed a 5-year follow-up. Screening and clinical evaluations were done at both waves of the study. In 1996-1997, 3894 remained without cognitive impairment, 436 were diagnosed as having cognitive impairment-no dementia, and 285 were diagnosed as having dementia. MAIN OUTCOME MEASURE: Incident cognitive impairment and dementia by levels of physical activity at baseline. RESULTS: Compared with no exercise, physical activity was associated with lower risks of cognitive impairment, Alzheimer disease, and dementia of any type. Significant trends for increased protection with greater physical activity were observed. High levels of physical activity were associated with reduced risks of cognitive impairment (age-, sex-, and education-adjusted odds ratio, 0.58; 95% confidence interval, 0.41-0.83), Alzheimer disease (odds ratio, 0.50; 95% confidence interval, 0.28-0.90), and dementia of any type (odds ratio, 0.63; 95% confidence interval, 0.40-0.98). CONCLUSION: Regular physical activity could represent an important and potent protective factor for cognitive decline and dementia in elderly persons.

Progression of impairment in patients with vascular cognitive impairment without dementia.

Little is known about progression, short of dementia, in vascular cognitive impairment. In the Canadian Study of Health and Aging, 149 participants (79.3 +/- 6.7 years; 61% women) were found to have vascular cognitive impairment, no dementia (CIND). After 5 years, 77 participants (52%) had died and 58 (46%) had developed dementia. Women were at greater risk of dementia (OR 2.1, 1.0 to 4.5). Of 32 participants alive without dementia, cognition had deteriorated in seven and improved in four. Half of those with vascular CIND developed dementia within 5 years, suggesting a target for preventive interventions.

A comparison of observed and reported restraint use by children and adults.

The reliability of estimates of automobile restraint use reported by interview is questionable. It is reasonable to assume that some respondents will give a socially desirable response, i.e. a false report about restraint use. To verify this assumption this study compares verbal reports about automobile restraint use with what was actually observed, both for the respondents and and their children. For the children the rate of parental over-reporting was 38% while for adults it was 24%. Additional analyses suggest that the discrepancy between reported and observed use is related to parents' educational level, father's occupation, child's sex and whether the mother works outside the home. However, these relationships differ between parents and their children.

[Environmental hazards for falls in elders in low income housing]. / Dangers environnementaux de chute dans des habitations à loyer modique pour personnes âgées.

BACKGROUND: About 35% of elders living at home fall each year. The objectives of this study were to evaluate the environmental hazards associated with falls in 58 low income housings for elders and to determine the contribution of environmental factors to these falls. METHODS: Participants were interviewed to document their health problems, their knowledge concerning the Issue of falls, and their history of falls during the last year. Environmental hazards were identified and evaluated with a standardised checklist. The levels of hazards (percentage of factors identified which represent a hazard) were measured for the different sectors and for the entire dwelling and communal spaces. The hazards were also evaluated according to four main variables (structure of the building, characteristics of the floor surface, environmental obstacles, risk-taking behaviour). RESULTS: A total of 172 participants were recruited for the study. For dwellings and communal spaces, the hazards were respectively higher in bathrooms (mean=27.0%; p<0.05) and interior stairs (mean=22.5%; p<0.05). For the communal spaces of buildings of less than 20 Years, the global hazard was higher in the smaller buildings (three stories, mean=12.6%; p<0.001). For dwellings of the larger buildings, the global hazard was higher for younger buildings (<20 years, mean=16.6%; >or=20 years, mean=13.5%; p<0.001). Among the variables documented, risk-taking behaviour was the more frequent factor for the dwellings (mean=32.0%; p<0.05) as for the communal spaces (mean=42.5%; p<0.05). Finally, only 34% of the participants mentioned receiving information concerning the falls among elders. Among the 27 falls documented, an environmental factor was identified in 55% of the cases. CONCLUSION: The study helped to document the presence of environmental factors which could be a hazard for falls in elders' housing and to suggest preventive and remedial actions.

Symptoms of psychological distress among older adults in Canadian long-term care centres.

Psychological distress can lead to negative consequences affecting the quality of life of older adults living in long-term care centres. The goal of this study was to determine the prevalence of symptoms of psychological distress and their associated factors among these residents. A cross-sectional descriptive study was conducted among 1999 long-term care residents aged 65 and over. Nine hundred and eleven persons (45.6%) displayed at least one symptom of psychological distress either at one time or more in the week preceding data collection, and 22.4% were identified as psychologically distressed. Multivariate analysis indicated that psychological distress was associated with disruptive behaviours and benzodiazepine use among women residents, and with insomnia in men residents. In conclusion, when clinicians screen for mental health disorders, they should take into consideration that symptoms of insomnia or disruptive behaviours may mask psychological distress.

The use of mass media in mental health.

This paper summarizes the theoretical aspects and the experimental studies on the efficacy of mass media in mental health information campaigns. In theory, most authors agree to give mental health information to the lay public but they caution against the overestimation of the power of mass media. Regarding research on the use of mass media in mental health very few experimental studies have been published and they refer mainly to primary prevention with children. The authors discuss reasons which may explain the mental health professionals' lack of interest in this area of research, suggest new approaches for the elaboration of educational programs for the population and emphasize the importance of secondary and tertiary prevention.

Marital adjustment and depression.

Twenty patients diagnosed major depression and 20 matched normal control subjects were compared in terms of marital adjustment and other related features. Marital adjustment reported by the depressed group was significantly worse than that of the normal group. Both groups, however, had adjustment scores above the cut-off point for maladjustment. These results question the causal role ascribed to marital maladjustment in the genesis of depression.

[Dietary treatment of mild to moderate hypercholesterolemia. Effectiveness of different interventions]. / Traitement diététique de l'hypercholestérolémie légère à modérée. Efficacité de différentes interventions.

OBJECTIVE: To compare the efficacy of brief dietary intervention by family physicians in their daily practice and in group sessions to standard dietetic treatment in mild to moderate hypercholesterolemia. DESIGN: Randomised clinical trial. SETTING: Family practice clinic in a remote community. PARTICIPANTS: Between September 1, 1991 and September 30, 1992, 135 men and women between 20 and 60 years old with mild to moderate hypercholesterolemia were recruited and randomly assigned to three treatment groups to be taught the American Heart Association low fat diet. Each participant had an LDL-C reading higher than the desirable level set by the Canadian Consensus Conference on Cholesterol. INTERVENTIONS: The three treatment groups received different interventions: individual consultations with a family physician in his office (phase I); group sessions with a physician and a dietician (phase II); and individual consultations with a dietician (phase II). Participants were followed for 6 months with visits and blood tests every 2 months. MAIN OUTCOME MEASURES: Reduction in serum levels of total cholesterol, LDL-C, HDL-C, and triglycerides was measured after 2, 4, and 6 months of dietary treatment. Changes in risk factors (smoking, weight, level of physical activity) and patients' cholesterol/saturated fat index were also measured. RESULTS: Ninety-nine subjects completed the 6-month regimen. The mean reduction in serum LDL-C was 0.08 mmol/L (1.8%) in Group I, 0.07 mmol/L (1.6%) in Group II, and 0.28 mmol/L (6.3%) in Group III (P = 0.94). An LDL-C reduction of 10% or more relative to initial level was observed in 27% of participants in Group I and approximately 40% of subjects in the other two groups (P = 0.41). Counseling resulted in a decrease in body weight, smoking, and dietary fat consumption and an increase in physical activity. CONCLUSIONS: Treatment by a dietician achieved better results and should remain the standard. Physicians should focus on the detection and control of other heart disease risk factors.

Critical appraisal of medical literature: second update.

This skill-testing exercise was created for the purpose of updating the teaching package, Critical Appraisal Package: Therapy, published by the College of Family Physicians of Canada in 1986. This exercise follows the same format as the original package: presentation of a clinical scenario, an article, a worksheet, and methodology notes. The article being evaluated concerns the effectiveness of antihistamine decongestants in the prevention of acute otitis media in children with colds.

Behavioral approaches for reducing agitation in residents of long-term-care facilities: critical review and suggestions for future research.

Many residents in long-term-care facilities demonstrate agitated behaviors. Research on behavioral approaches for reducing agitation in nursing home residents has been conducted during the past 25 years. This research is critically reviewed in this article and suggestions for future research are offered. Empirical evidence suggests that behavioral approaches are effective. Antecedent control strategies have been shown to reduce physically nonaggressive behaviors. Both aggressive and verbally agitated behaviors have been successfully treated by manipulating reinforcing consequences of these behaviors. Future research in this area needs to test behavioral treatments using randomized group designs, compare behavioral interventions to other treatments used alone or in combination, specify criteria for clinically significant improvement, diversify and ascertain the validity of assessment methods, and verify the maintenance of treatment effects over relatively long follow-up periods.

Past exposure to vaccines and subsequent risk of Alzheimer's disease.

BACKGROUND: It has been suggested that changes to the immune system could be a factor in age-related conditions such as Alzheimer's disease. Our objective was to examine the association between past exposure to conventional vaccines and risk of Alzheimer's disease. METHODS: We analyzed data from a representative community sample of subjects 65 years of age or older participating in the Canadian Study of Health and Aging, a prospective cohort study of dementia. Screening and clinical evaluations were done at both baseline and follow-up. Past exposure to vaccines was assessed at baseline by means of a self-administered questionnaire. RESULTS: Of the 4392 eligible subjects who were cognitively unimpaired and for whom vaccine information was available at baseline (in 1991-1992) and who completed follow-up 5 years later (in 1996-1997), 527 were diagnosed as having cognitive impairment or dementia other than Alzheimer's disease and were excluded from these analyses. Of the remaining subjects, 3682 were cognitively unimpaired at follow-up and 183 were newly diagnosed as having Alzheimer's disease. After adjustment for age, sex and education, past exposure to vaccines against diphtheria or tetanus, poliomyelitis and influenza was associated with lower risk for Alzheimer's disease (odds ratio [OR] 0.41, 95% confidence interval [CI] 0.27-0.62; OR 0.60, 95% CI 0.37-0.99; and OR 0.75, 95% CI 0.54-1.04 respectively) than no exposure to these vaccines. INTERPRETATION: Past exposure to vaccines against diphtheria or tetanus, poliomyelitis and influenza may protect against subsequent development of Alzheimer's disease.

A case-control study of pedestrian and bicyclist injuries in childhood.

We identified children ages 0 to 14 years injured in traffic as pedestrians or bicyclists in Montreal, Canada. Two hundred children with injuries who received a score of 2 or more on the Maximum Abbreviated Injury Severity scale were considered as cases and compared with 400 uninjured children seen in the same hospitals for non-traumatic reasons. Systematic, blinded interviews and tests were conducted with parents to determine the role of a series of social, familial, personal, and behavioral characteristics. After adjustment for age, gender and socioeconomic area of residence, logistic regression analyses showed higher risks of injury to be related to fewer years of parents' education, a history of accident to a family member, an environment judged as unsafe, and poor parental supervision. Absence of physical health problems, fewer family preventive behaviors and reported lack of cautiousness were also related to a higher risk, whereas neither aggressivity nor behavioral disturbance, whether internalizing or externalizing, showed any such relation. These data suggest that the child's personality and behavior are weaker risk factors for pedestrian and bicyclist injuries than are family and neighborhood characteristics.

A case-control study of diet and invasive cervical cancer.

A population-based case-control study was conducted to assess the relation of diet, especially intake of vitamins A, C and E and of folic acid, to the risk of invasive cervical cancer. Cases were 189 women diagnosed with cervical carcinoma between 1979 and 1983 in 3 counties of the Seattle area. Controls (N = 227) were selected through random digit dialling. Diet during the year preceding diagnosis was assessed by interview, using a food frequency questionnaire covering the intake of 66 food items. After adjustment for known risk factors, frequent consumption of dark green or yellow vegetables and of fruit juices was related to a reduced risk of cervical cancer. Similarly, high dietary intake of carotene was associated with a lower risk of the disease, especially of the squamous-cell type. There was an inverse relationship between vitamin C intake and the risk of cervical carcinoma. The adjusted relative risk (RR) was 0.5 (95% confidence interval: 0.2-1.0) for the highest quartile of intake compared to a RR of 1.0 for the first quartile. High vitamin E intake was also related to a reduced risk, the risk for women in the highest quartile being only one-third of the risk for those in the first quartile. Intake of pre-formed vitamin A and of folic acid was not related to the risk of cervix cancer. Thus, our study suggests that the risk of invasive cervical carcinoma might be influenced by some aspects of diet.

Efficacy of eye patching for traumatic corneal abrasions: a controlled clinical trial.

STUDY OBJECTIVE: We sought to evaluate the efficacy of eye patching in the treatment of traumatic corneal abrasions in terms of time to healing and reduction in pain and discomfort. METHODS: One hundred sixty-three patients presenting at the emergency department of a large university-affiliated hospital with traumatic corneal abrasions were included in this single-blind prospective controlled trial. Eligible patients were assigned to 1 of 2 treatment regimens: topical antibiotic ointment and occlusive patch over the affected eye (n=82) or topical antibiotic ointment 4 times a day without an occlusive patch (n=81). Patients were reexamined every 24 hours until corneal healing occurred. Healing evaluation was performed by the emergency physician, using a slit lamp with fluorescein staining, without knowledge of the patient's assignment to a treatment group. The degree of discomfort was assessed at each visit by using a visual analog scale. RESULTS: Both treatment groups were similar regarding size of the corneal lesions, delay from trauma to first ED visit, presence of foreign body or siderosis, initial degree of discomfort, and presence of specific symptoms (irritation, foreign body sensation, photophobia, redness, and pain). In the patched group, cumulative incidences of healing were 51%, 78%, and 92% after 1, 2, and 3 days, respectively, compared with 60%, 83%, and 88% in the nonpatched group. In the patched group, symptoms of initial discomfort decreased by 4.8, 4.1, and 5.5 cm after 1, 2, and 3 days, respectively, compared with 3.3, 5.1, and 6.5 cm in the nonpatched group. CONCLUSION: Eye patching does not appear to be beneficial in the treatment of traumatic corneal abrasions compared with topical antibiotic ointment.

Body weight and prognostic indicators in breast cancer. Modifying effect of estrogen receptors.

The relations of body weight, height, and Quetelet index to axillary node involvement at diagnosis, estrogen receptor status, and histologic features of the primary tumor were examined in 656 patients with a newly diagnosed infiltrating breast carcinoma first treated in Québec City from July 1982 to December 1984. Node involvement increased with body weight and Quetelet index. This association was more regular and much stronger among patients with estrogen receptor-positive tumors than among those with estrogen receptor-negative breast cancers. Among patients with estrogen receptor-positive tumors, the percentage with involved nodes at diagnosis increased regularly from 32.9% among lean patients (Quetelet index less than 21 kg/m2) to 65.6% among obese women (Quetelet index greater than 27 kg/m2). This trend was seen even after adjustment for age and tumor size. In contrast, among patients with estrogen receptor-negative breast cancers, the association of weight and Quetelet index with node involvement were weak and irregular. The modifying effect of estrogen receptor status on the relation of obesity to node involvement was apparent in pre- and post-menopausal women. Body weight and Quetelet index were not related to estrogen receptor status or to any of the measured histologic features of breast tumors including nuclear grade, histologic grade, tubule formation, mitotic activity, and size of nucleus of cancer cells. These findings suggest that the observed deleterious effect of obesity on breast cancer prognosis is unlikely to be an artifact of delayed diagnosis in overweight patients. It may be due to hormonal changes associated with increases in body weight.

The epidemiology of road accidents in childhood.

We report the incidence of traffic injuries to children in Montreal: 33.4 per 10,000, 57 per cent pedestrians, 24.5 per cent passengers, and 18.4 per cent bicyclists. Nearly 20 per cent were hospitalized and 1.2 per cent died. One-third had MAIS scores of 2 or more with the highest rate of severe injuries found among pedestrians. Pedestrian and bicycle (but not passenger) injuries in low income areas were four to nine times greater than those in more affluent areas.

Diet, mammographic features of breast tissue, and breast cancer risk.

This case-control study was designed to reevaluate the association of the morphology of breast tissue seen on mammograms with breast cancer risk and to assess the relation of diet, especially intake of fat and vitamin A, to the high-risk mammographic images. The cases included 290 patients with newly diagnosed breast cancer who were first treated in Quebec in 1982-1984. The controls included 645 women who participated in the Canadian National Breast Screening Study. Risk of breast cancer was higher among women with the P2 or DY parenchymal pattern (relative risk (RR) = 3.7, 95% confidence interval (Cl) 2.0-7.0) than it was among those with the N1 pattern. Moreover, risk increased regularly with the extent of nodular and homogeneous densities on the mammogram. Relative risk was 5.5 (95% Cl 2.3-13.2) for women in whom 60% or more of the volume of the breast showed either nodular or homogeneous densities compared with women without such densities. Among controls, increase in energy-adjusted saturated fat intake was associated with an increase in extent of high-risk mammographic features. Energy-adjusted polyunsaturated fat or cholesterol intake did not, however, appear to influence the morphology of breast tissue seen on the mammogram. Increasing carotenoid and fiber intakes were associated with a reduction of the extent of densities on the mammogram, but retinol intake seemed to have little or no effect on mammographic features. These data suggest that elevation in saturated fat intake and reduction in carotenoid and fiber intakes may be related to an increase in breast cancer risk through effects of these nutrients on breast tissue morphology.

Use of automobile seat restraints by children in two Canadian cities.

A telephone survey was conducted in Montreal and Calgary to determine the extent to which parents use safety restraints for their children in cars, the types of restraints used and the factors associated with such use. Of the combined sample 39% reported that their child regularly used a restraint, and 47% of the children in Montreal and 55% of those in Calgary wore an age-appropriate safety device. Birth order and the child's and the respondent's ages were significantly related to the use of restraints. However, the respondent's use of seatbelts was the factor most likely to affect the rate of use of restraints for children. Although a large proportion of the parents with younger children owned a carseat, one in four did not use it regularly. Parents who did not use carseats believed they were useless or dangerous; many preferred to hold the child in their laps or arms. The seatbelt law in Quebec and the existence of a carseat rental program in Calgary appear to have had some influence on the rate of the use of restraints for children.