Cancer incidence among Canadian Veterans: A matched cohort study.

INTRODUCTION: Occupational exposures related to military service may increase the risk of cancer for military Veterans, while high levels of fitness during service may decrease risk. However, few studies have compared this post-career cancer risk directly to the employed general population. METHODS: This retrospective cohort study used linked administrative data. Canadian Armed Forces and Royal Canadian Mounted Police Veterans in Ontario, Canada were matched 1:4 on age, sex, geography, and community-level income to a group of non-Veterans most likely to have been employed during a period similar to the Veterans' military service. Cancer diagnoses were identified using the Ontario Cancer Registry. RESULTS: During the study period, 642 of 30 576 included Veterans (2.1%) and 3408 of the 122 293 matched general population cohort (2.8%) experienced at least one cancer diagnosis. The crude rate of cancer was 153.5 per 100 000 person-years among Veterans vs. 205.9 per 100 000 person-years for the general population cohort. After adjusting for rurality and matching variables, Veterans had an 27% lower risk of developing any cancer than their matched comparators [hazard ratio = 0.73 (95% CI: 0.67-0.80)]. Among specific cancer types, the risk of lung and colorectal cancer was significantly lower for Veterans relative to the general population cohort; the risk of breast and prostate cancer was similar. DISCUSSION: This study adds to the growing international evidence suggesting that risk of many cancers among Veterans is lower or similar to the general population. Further understanding of the complex relationships among occupational exposures, environmental factors, and lifestyle factors is needed.

Two-month point prevalence of exposure to critical incidents in firefighters in a single fire service.

BACKGROUND: Firefighters have high rates of exposures to critical events that contribute to physical and mental stress, resulting in high rates of injury and work-injury compensation claims. OBJECTIVE: To determine the prevalence of critical incidents in firefighters from a single fire service, and whether the number of critical events varied based on age, gender, years of service and/or rank. METHODS: We recruited 300 full-time firefighters. Firefighters were asked to complete a self-report Critical Incident Inventory survey that included questions on exposure to critical events during firefighting duties, with a time reference point of the past two months. RESULTS: Among the 293 firefighters, 252 (85%) indicated exposure to some type of critical incident. More specifically, 187 (64%) reported a respond to incident involving one or two deaths, 155 (53%) indicated a direct exposure to blood and body fluids, and 98 (33%) reported a response to an incident involving multiple serious injuries. Age, gender, years of service and rank accounted for only 1% of the variance in the number of critical incidents among firefighters. CONCLUSIONS: In this study, 85% of firefighters had been exposed to some type of critical incident in the previous 2-months and this did not vary by age, gender, years of service and/or rank.

Applying the knowledge to action framework to plan a strategy for implementing breast cancer screening guidelines: an interprofessional perspective.

Integrated knowledge translation (IKT) interventions may be one solution to improving the uptake of clinical guidelines. IKT research initiatives are particularly relevant for breast cancer research and initiatives targeting the implementation of clinical guidelines and guideline implementation initiatives, where collaboration with an interdisciplinary team of practitioners, patients, caregivers, and policy makers is needed for producing optimum patient outcomes. The objective of this paper was to describe the process of developing an IKT strategy that could be used by guideline developers to improve the uptake of their new clinical practice guidelines on breast cancer screening. An interprofessional group of students as well as two faculty members met six times over three days at the KT Canada Summer Institute in 2011. The team used all of the phases of the action cycle in the Knowledge to Action Framework as an organizing framework. While the entire framework was used, the step involving assessing barriers to knowledge use was judged to be particularly relevant in anticipating implementation problems and being able to inform the specific KT interventions that would be appropriate to mitigate these challenges and to accomplish goals and outcomes. This activity also underscored the importance of group process and teamwork in IKT. We propose that an a priori assessment of barriers to knowledge use (i.e., level and corresponding barriers), along with the other phases of the Knowledge to Action Framework, is a strategic approach for KT strategy development, implementation, and evaluation planning and could be used in the future planning of KT strategies.