Intra-individual changes in sperm parameters and total motile count with time among infertile men.

BACKGROUND: Paternal age association with sperm parameters has been previously studied, demonstrating a decrease in semen volume, sperm motility, and sperm morphology, but not in sperm concentration. However, scarce data exists on the individual intra-personal changes in semen parameters with time. STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To evaluate the changes in semen parameters and total motile count of infertile men over time. MATERIALS AND METHODS: In this retrospective cohort study, infertile men without known risk factors for sperm quality deterioration and at least two semen analyses done > 3 months apart, between 2005 and 2021, were evaluated. Allocation to groups was according to time between first and last semen analyses - 3-12 months, 1-3 years, 3-5 years, and > 5 years. Basic characteristics and first and last semen analyses were compared. The primary outcome was the change in sperm parameters and the secondary outcome was the occurrence of a total motile count < 5 million in men with an initial total motile count > 10 million. RESULTS: A total of 2018 men were included in the study. The median age at first semen analyses was 36.2 (interquartile range: 32.8-40.1) years and the median time between semen analyses was 323 days (range 90-5810 days). The overall trend demonstrated an increase in concentration in the 3-12 months and the 1-3 years groups, whereas volume, motility, and morphology remained similar in these time groups. Semen analyses done more than 5 years apart showed decreased volume (p < 0.05), motility (p < 0.05) morphology (p < 0.05), and steady sperm concentration. Significant declines in TMCs were found over time (p < 0.001), with 18% and 22% of infertile men with an initial total motile count > 10 million dropping to < 5 million after 3 and 5 years, respectively. The factors independently predictive of total motile count < 5 M in the last semen analyses in men with an initial total motile count of > 10 M in a multivariate logistic regression model were baseline volume (odds ratio 0.80, p = 0.03), baseline total motile count (odds ratio 0.98, p = 0.01) and time between semen analyses - 3-5 years (odds ratio 3.79, p < 0.001) and > 5 years (odds ratio 3.49, p = 0.04) DISCUSSION: Our study demonstrates, at the individual level, that while improvement in sperm concentration is observed in the first year and between 1 and 3 years, possibly due to fertility treatments, fertility-related counseling, and lifestyle changes, semen parameters decline with time over 3 years in individuals. Of significance, close to 22% of men with an initial total motile count > 10 million (a range where spontaneous pregnancy is attainable) declined to < 5 million (a range usually indicating a need for in-vitro fertilization/intracytoplasmic sperm injection) over 5 years. This data could contribute to individualized family planning for infertile men regarding the mode and timing of conception and the need for sperm banking, in order to minimize the need for future fertility treatments.

Building Healthy Babies: A Mixed-Methods Needs Assessment for a Pre-Conception Program in Ontario.

OBJECTIVES: The objective of this study was to gather Ontario clinicians' and public members' views on the design of a pre-conception patient education program. METHODS: In this mixed-methods study, online surveys comprised of rank order, multiple choice, and short answer questions were completed by clinicians and public members. Semi-structured focus groups consisting of 2-6 participants each were then held via videoconference. Demographic variables and survey responses were analyzed quantitatively using descriptive and summary statistics. Descriptive thematic qualitative analysis using the constant comparative method of grounded theory was completed on each transcript to generate themes. RESULTS: A total of 168 public members and 43 clinicians in Ontario completed surveys, while 11 clinicians and 11 public members participated in the focus groups. A pre-conception program in Ontario was felt to be important. An individual appointment with a primary care provider was the favoured program format per survey responses, whereas a virtual format with an interactive component was preferred among focus group participants. Important topics to include were pre-conception health (infertility, genetic screening, folic acid), prenatal and postpartum counselling (diet, activity, substance use, prenatal care, postpartum course), and medical optimization in pregnancy (high-risk medical conditions, medications, mental health). Both groups emphasized the need to consider accommodations for marginalized populations and various cultures and languages. CONCLUSION: A standardized pre-conception patient education program is felt to be of high value by Ontario clinicians and public members. A pre-conception program may help improve obstetrical outcomes and decrease rates of major congenital anomalies in Ontario.

The association between diabetes type, age of onset, and age at natural menopause: a retrospective cohort study using the Canadian Longitudinal Study on Aging.

OBJECTIVES: With growing incidence of type 1 diabetes (T1D), type 2 diabetes (T2D), and gestational diabetes, more women are expected to spend a larger proportion of their reproductive years living with a diabetes diagnosis. It is important to understand the long-term implications of premenopausal diabetes type on women's reproductive health including their age at natural menopause (ANM). METHODS: Baseline data from the Comprehensive Cohort of Canadian Longitudinal Study on Aging were used. Females who reported premenopausal diagnosis of diabetes were considered exposed. Kaplan-Meier cumulative survivorship estimates and multivariable Cox regression models were used to assess the association between diabetes types and ANM. Sociodemographic, lifestyle, and premenopausal clinical factors were adjusted in the final model as covariates. RESULTS: The sample comprised 11,436 participants, weighted to represent 1,474,412Canadian females aged 45 to 85 years. The median ANM was 52 years. After adjusting for ethnicity, education, smoking, and premenopausal clinical factors, early age of diagnosis of both T1D (<30 years) and T2D (30-39 years) were associated with earlier menopause (T1D, <30: hazard ratio [HR], 1.55; 95% confidence interval [CI], 1.05-2.28; T2D, 30-39: HR, 1.82; 95% CI, 1.12-2.94), as compared with nondiabetics. In addition, later age of diagnosis of T2D (≥40 years) was associated with later ANM (T2D: HR, 0.63; 95% CI, 0.50-0.80). No significant association between gestational diabetes and ANM was noted. CONCLUSIONS: Our results point to early menopause among young women living with a diabetes diagnosis. These findings should allow for more focused research geared toward understanding the long-term health implications of diabetes on women's reproductive health and aging.

Cannabis use and patterns among middle and older aged Canadians prior to legalization: a sex-specific analysis of the Canadian Tobacco, Alcohol and Drugs Survey.

BACKGROUND: The recreational use of cannabis was legalized across Canada in October 2018. While many people use cannabis without harm, adverse outcomes have been noted in a few populations, including middle-aged and older adults. Given that the current literature has neglected to study cannabis use among this population and between sexes, the objective of our study was to identify the prevalence, characteristics, and patterns of cannabis use among middle and older aged males and females prior to legalization in Canada. METHODS: Secondary analysis was conducted on the Canadian Tobacco, Alcohol and Drugs Survey 2017, with the sample restricted to adults ages 40 and above. The main outcome was defined as past-year cannabis use and statistical analysis was conducted separately for males and females. Bivariate and multivariable logistic regression was performed to identify associations between the main outcome and various sociodemographic, health, and substance use variables. Explanatory supplementary variables were also explored. RESULTS: In 2017, 5.9% of females and 9.0% of males over the age of 40 reported past-year cannabis use. Almost 62% of males who used cannabis in the past-year reported a failed attempt at reducing or stopping their cannabis use. Over half (56%) of older females, self-reported using cannabis for medical purposes. Additionally, over one in five older adults reported using a vaporizer or e-cigarette as a delivery method for cannabis. Significant characteristics of male cannabis use included having no marital partner, cigarette smoking, and illegal drug use. Furthermore, significant predictors of past-year cannabis use in females included residing in an urban community, Eastern- Atlantic provinces or British Columbia, having fair/poor mental health, smoking cigarettes, use of other tobacco products, and illegal drugs. CONCLUSION: To our such knowledge, this is the first nationally representative study to outline the prevalence, characteristics, and patterns of past-year cannabis use prior to Canadian legalization, among middle and older aged Canadians. Results from this study are expected to be used to reliably to track changes in usage, behaviours, and related disorders in the years to come.

Prevalence and Factors Associated with Visiting the Dentist Only for Emergency Care Among Indigenous People in Ontario.

Ontario has the largest Indigenous population in Canada. This study aims to examine the prevalence and factors associated with poor dental care use amongst the Indigenous in Ontario. Data from the 2014 cycle of the Canadian Community Health Survey was used. The main outcome was defined as visiting the dentist only for emergency care. Stepwise multivariable logistic regression was performed to assess the association between socio-demographic, socio-economic, and the health related factors and emergency dental care use. 28% of the participants reported visiting the dentist only for emergencies. First Nations people were at increased odds of having poor dental care (OR 2.01, CI 1.12-3.95). Additionally, being male, a smoker, having fair/poor health and lacking dental insurance puts the Indigenous Ontarians at increased odds of having the outcome. Improvements to the current social benefit programs could help better cater to the needs of this population.

Systematic review of cardiac rehabilitation guidelines: Quality and scope.

Cardiac rehabilitation is a comprehensive model of secondary prevention proven to reduce mortality and morbidity. The World Health Organization is developing a Package of Rehabilitation Interventions for implementation by ministries of health as part of universal healthcare across the continuum. Through a systematic review, we sought to identify the best-quality cardiac rehabilitation guidelines, and extract their recommendations for implementation by member states. A systematic search was undertaken of academic databases and guideline repositories, among other sources, through to April 2019, for English-language cardiac rehabilitation guidelines from the last 10 years, free from conflicts, and with strength of recommendations. Two authors independently considered all citations. Potentially eligible guidelines were rated for quality using the Appraisal of Guidelines for Research and Evaluation tool, and for other characteristics such as being multi-professional, comprehensive and international in perspective; the latter criteria were used to inform selection of 3-5 guidelines meeting inclusion criteria. Equity considerations were also extracted. Altogether, 2076 unique citations were identified. Thirteen passed title and abstract screening, with six guidelines potentially eligible for inclusion in the Package of Rehabilitation Interventions and rated for quality; for two guidelines the Appraisal of Guidelines for Research and Evaluation tool ratings did not meet World Health Organization minimums. Of the four eligible guidelines, three were selected: the International Council of Cardiovascular Prevention and Rehabilitation (2016), National Institute for Health and Care Excellence (#172; 2013) and Scottish Intercollegiate Guideline Network (#150; 2017). Extracted recommendations were comprehensive, but psychosocial recommendations were contradictory and diet recommendations were inconsistent. A development group of the World Health Organization will review and refine the recommendations which will then undergo peer review, before open source dissemination for implementation.

The association between alcohol, marijuana, illegal drug use and current use of E-cigarette among youth and young adults in Canada: results from Canadian Tobacco, Alcohol and Drugs Survey 2017.

BACKGROUND: E-cigarettes have grown in popularity around the world since 2003. Although marketed as a smoking cessation tool, e-cigarettes can lead to tobacco cigarette smoking in youth. In Canada, among all age groups, youth and young adults have the highest prevalence of e-cigarette use. The objective of this study was to assess the factors associated with e-cigarette use among youth and young adults in Canada, and to specifically examine the association between alcohol, marijuana and illicit drug use. METHODS: Data from the 2017 Canadian Tobacco, Alcohol and Drugs Survey were used. The sample was restricted to those aged 15-24 years (n = 10,322), and main outcome defined as 'E-cigarette use in the past 30-days'. Multivariable logistic regression was performed to assess the association between the main outcome and substance use variables (illicit drug, marijuana and alcohol use), tobacco exposure variables, and demographic and health-related factors. RESULTS: 6.2% Canadians aged 15-24 reported using e-cigarettes in the past 30-days, while 23.9% reported having ever tried e-cigarettes. Twenty-three percent of the past 30-day users reported using e-cigarettes every day and 72.5% of the past 30-day users reported having nicotine in their last e-cigarette. Additionally, youth aged 15-17 were 4.95 times more likely to be e-cigarette users as compared to those aged 22-24 (OR: 4.95, 95% CI: 3.1-7.9). Moreover, e-cigarette use was significantly associated with marijuana use (OR:4.17, 95% CI: 2.6-6.7) and alcohol use (OR: 5.08, 95% CI: 2.9-9.0), and approached significance with illicit drug use (OR: 1.68, 95% CI: 1.0-2.9). Furthermore, being a current smoker (OR: 2.93, 95% CI: 1.8-4.7) and male (OR: 2.28, 95% CI: 1.5-3.4) was significantly associated with the outcome. CONCLUSION: This study is nationally representative and provides insight into e-cigarette use among youth and young adults aged 15-24 years. Given that e-cigarettes can be used as illicit drug delivery systems, more studies are needed to understand how Canadian youth and young adults are using e-cigarettes. Stricter restrictions on public e-cigarette smoking, and awareness campaigns informing youth of risks of e-cigarette smoking should be implemented.

Dental care use by immigrant Canadians in Ontario: a cross-sectional analysis of the 2014 Canadian Community Health Survey (CCHS).

BACKGROUND: Ontario is home to the largest number of immigrants in Canada. However, very little is known about their dental care utilization patterns. The purpose of this study is to determine the prevalence of poor dental health care use among the immigrant population of Ontario and how various socio-demographic, socio-economic and health-related factors are associated with it. METHODS: Analysis was performed on a total of 4208 Ontarian immigrants who participated in the dental care module of the 2014 cycle of the Canadian Community Health Survey. Poor dental care use was defined by the two variables: not visiting the dentist in the past year and/or visiting the dentist only for emergency purposes. Multivariable logistic regression was performed to assess the associations between the two outcomes and the socio-demographic, socio-economic and health-related factors. RESULTS: Thirty three percent of immigrants reported not visiting the dentist in the past year and 25% reported visiting only for emergencies. The leading components associated with poor dental care utilization were being a new immigrant, of male gender, having low educational attainment, low household income and lacking dental insurance. CONCLUSIONS: This study is the first to highlight oral health care use patterns amongst immigrants in Ontario. Given that a large proportion of the immigrant population in Ontario have poor dental care use, education and outreach programs informing incoming immigrants of preventative dental care may improve overall dental health.