The Association between Early-Onset Diagnosis and Clinical Outcomes in Triple-Negative Breast Cancer: A Systematic Review and Meta-Analysis.

Early-onset diagnosis, defined by age <40 years, has historically been associated with inferior outcomes in breast cancer. Recent evidence suggests that this association is modified by molecular subtype. We performed a systematic review and meta-analysis of the literature to synthesize evidence on the association between early-onset diagnosis and clinical outcomes in triple-negative breast cancer (TNBC). Studies comparing the risk of clinical outcomes in non-metastatic TNBC between early-onset patients and later-onset patients (≥40 years) were queried in Medline and EMBASE from inception to February 2023. Separate meta-analyses were performed for breast cancer specific survival (BCSS), overall survival (OS), and disease-free survival (DFS), locoregional recurrence-free survival (LRRFS), distant recurrence-free survival (DRFS), and pathological complete response (pCR). In total, 7581 unique records were identified, and 36 studies satisfied inclusion criteria. The pooled risk of any recurrence was significantly greater in early-onset patients compared to later-onset patients. Better BCSS and OS were observed in early-onset patients relative to later-onset patients aged >60 years. The pooled odds of achieving pCR were significantly higher in early-onset patients. Future studies should evaluate the role of locoregional management of TNBC and the implementation of novel therapies such as PARP inhibitors in real-world settings, and whether they improve outcomes.

Impairment in Health-Related Quality of Life among Community-Dwelling Stroke Survivors.

INTRODUCTION: Health utility instruments are increasingly being used to measure impairment in health-related quality of life (HRQoL) after stroke. Population-based studies of HRQoL after stroke and assessment of differences by age and functional domain are needed. METHODS: We used the Canadian Community Health Survey linked with administrative databases to determine HRQoL using the Health Utilities Index Mark 3 (HUI3) among those with prior hospitalization or emergency department visit for stroke and compared to controls without stroke. We used multivariable linear regression to determine the difference in HUI3 between those with stroke and controls for the global index and individual attributes, with assessment for modification by age (<60, 60-74, and 75+ years) and sex, and we combined estimates across survey years using random effects meta-analysis. RESULTS: Our cohort contained 1240 stroke survivors and 123,765 controls and was weighted to be representative of the Canadian household population. Mean health utility was 0.63 (95% confidence interval [CI] 0.58, 0.68) for those with stroke and 0.83 (95% CI 0.82, 0.84) for controls. There was significant modification by age, but not sex, with the greatest adjusted reduction in HUI3 among stroke respondents aged 60-74 years. Individual HUI3 attributes with the largest reductions in utility among stroke survivors compared to controls were mobility, cognition, emotion, and pain. CONCLUSIONS: In this population-based study, the reduction in HUI3 among stroke survivors compared to controls was greatest among respondents aged 60-74, and in attributes of mobility, cognition, emotion, and pain. These results highlight the persistent impairment of HRQoL in the chronic phase of stroke and potential targets for community support.

Association Between Physical Activity and Mortality Among Community-Dwelling Stroke Survivors.

OBJECTIVE: To determine the relationship between physical activity and mortality in community-dwelling stroke survivors. METHODS: The Canadian Community Health Survey was used to obtain self-reported physical activity (PA) across four survey cycles and was linked to administrative databases to obtain prior diagnosis of stroke and subsequent all-cause mortality. PA was measured as metabolic equivalents (METs) per week and meeting minimal PA guidelines was defined as 10 MET-hours/week. Cox proportional hazard regression models and restricted cubic splines were used to determine the relationship between PA and all-cause mortality in respondents with prior stroke and controls, adjusting for sociodemographic factors, co-morbidities, and functional health limitations. RESULTS: The cohort included 895 respondents with prior stroke and 97805 controls. Adhering to PA guidelines was associated with lower hazard of death for those with prior stroke (adjusted hazard ratio [aHR] 0.46, 95% CI 0.29-0.73) and controls (aHR 0.69, 95% CI 0.62-0.76). There was a strong dose-response relationship in both groups, with a steep early slope and the vast majority of associated risk reduction occurring between 0 and 20 MET-hours/week. In the group of stroke respondents, PA was associated with greater risk reduction in those <75 years of age (aHR 0.21, 95% CI 0.10-0.43) compared to those >75 years of age (aHR 0.68, 95% CI 0.42-1.12). CONCLUSIONS: PA was associated with lower all-cause mortality in an apparent dose-dependent manner among those with prior stroke, particularly in younger stroke survivors. Our findings support efforts towards reducing barriers to PA and implementation of PA programs for stroke survivors in the community. CLASSIFICATION OF EVIDENCE: This study provides Class IV evidence that in community-dwelling survivors of stroke, adhering to physical activity guidelines was associated with lower hazard of death.

Risk of Depression in Patients With Psoriatic Disease: A Systematic Review and Meta-Analysis.

BACKGROUND: Previous systematic reviews have assessed the prevalence and odds ratio (OR) of depression for patients with psoriatic disease. Due to probable bidirectional effects, prevalence and prevalence ORs are difficult to interpret. No prior reviews have quantified the relative risk (RR) of depression following a diagnosis of psoriatic disease. OBJECTIVE: To estimate the RR of depression in individuals with psoriasis and in psoriatic arthritis (PsA), clear-to-moderate psoriasis, and moderate-to-severe psoriasis subgroups. METHODS: Observational studies investigating the risk of depression in adults with psoriatic disease were systematically searched for in Medline, EMBASE, PsycINFO, and CINAHL databases; 4989 unique references were screened. Studies that reported measures of incident depression in psoriasis patients were included. Thirty-one studies were included into the systematic review, of which 17 were meta-analyzed. Random effects models were employed to synthesize relevant data. Sources of heterogeneity were explored with subgroup analysis and meta-regression. RESULTS: Seventeen studies were included in meta-analyses. The pooled RR of depression in psoriasis patients compared to nonpsoriasis controls was 1.48 (95% CI: 1.16-1.89). Heterogeneity was high (I2 = 99.8%). Subgroup analysis and meta-regression did not indicate that PsA status or psoriasis severity (clear-to-mild, moderate-to-severe) were sources of heterogeneity. No evidence of publication bias was found. CONCLUSIONS: This review demonstrates that the risk of depression is greater in patients with psoriasis and PsA. Future research should focus on developing strategies to address the mental health needs of this patient population for depression, including primary prevention, earlier detection, and treatment strategies.

Physical Activity and Mental Health: A Cross-sectional Study of Canadian Youth.

OBJECTIVE: Our objective was to examine the associations between recreational and non-recreational physical activity with mental health outcomes among Canadian youth aged 12-17. METHODS: Cross-sectional data from the 2015/2016 Canadian Community Health Survey was used for analysis. Physical activity was classified as either recreational or non-recreational. Both types of physical activity were categorized using the Canadian Physical Activity Guidelines. Mental health outcomes included the Patient Health Questionnaire-9 (PHQ-9) scale dichotomized with 5+ and 10+ cut-offs, self-perceived mental health, and self-reported professionally diagnosed mood and anxiety disorders. Descriptive statistics (proportions with 95% confidence intervals), and multivariable logistic regression were used in the analysis. RESULTS: It was found 21.20% of youth were not participating in recreational physical activity and 40.97% were engaging in below guideline recreational physical activity. No activity, or below guideline recreational physical activity was associated with negative mental health. Non-recreational physical activity models were generally non-significant. Additionally, it was determined that associations between recreational physical activity and PHQ-9 score were only evident in males. For the no activity and below guideline activity levels the odds ratios (ORs)=2.57 and 3.19 for males and OR=0.95 and 0.96 for females, respectively. CONCLUSIONS: Recreational physical activity is associated with youth mental health (particularly in males), but non-recreational physical activity is not consistently associated. While the data are cross-sectional and cannot support causal inference, these results highlight the potential importance of accessible recreational physical activity programs. Further, these results may inform guidelines about types of youth physical activity and their apparent mental health benefits.

OBJECTIF: Notre objectif était d'examiner les associations entre l'activité physique récréative et non récréative et les résultats de santé mentale chez les adolescents canadiens de 12 à 17 ans. MÉTHODES: Les données transversales de l'Enquête sur la santé dans les collectivités canadiennes de 2015­2016 ont servi à l'analyse. L'activité physique était classée récréative ou non récréative. Les deux types d'activité physique ont été répartis en catégories selon les Lignes directrices canadiennes en matière d'activité physique. Les résultats de santé mentale comportaient le Questionnaire sur la santé du patient-9 (QSP-9), une échelle dichotomisée avec 5+ et 10+ seuils d'inclusion, la santé mentale auto-perçue, et les troubles de l'humeur et anxieux diagnostiqués professionnellement et auto-déclarés. Les statistiques descriptives (les proportions ayant des intervalles de confiance à 95 %) et la régression logistique multivariée ont été utilisées dans l'analyse. RÉSULTATS: Il a été constaté que 21,20 % des adolescents ne participaient pas à des activités physiques récréatives et que 40,97 % s'adonnaient à des activités physiques récréatives inférieures aux lignes directrices. Aucune activité ou des activités physiques récréatives inférieures aux lignes directrices étaient associées à une santé mentale négative. Les modèles d'activité physique non récréative étaient généralement non significatifs. En outre, il a été déterminé que les associations entre l'activité physique récréative et le score au QSP-9 n'étaient manifestes que chez les garçons. Pour l'absence d'activité et les niveaux d'activité inférieurs aux lignes directrices, les rapports de cotes (RC) = 2,57 et 3,19 pour les garçons et RC = 0,95 et 0,96 pour les filles, respectivement. CONCLUSIONS: L'activité physique récréative est associée à la santé mentale des adolescents (particulièrement chez les garçons), mais l'activité physique non récréative n'est pas associée constamment. Bien que les données soient transversales et qu'elles ne puissent soutenir une inférence causale, ces résultats soulignent l'importance potentielle de programmes accessibles d'activité physique récréative. De plus, ces résultats peuvent éclairer les lignes directrices au sujet des types d'activités physiques des adolescents et de leurs avantages apparents pour la santé mentale.

The Association of Active Living Environments and Mental Health: A Canadian Epidemiological Analysis.

Environments that promote use of active transport (walking, biking, and public transport use) are known as "active living environments" (ALE). Using a Canadian national sample, our aim was to determine if ALEs were associated with mental health outcomes, including depressive symptoms, and mood and anxiety disorders. Data from the Canadian Community Health Survey from 2015-2016 was used for demographic characteristics and mental health outcomes (n ≈ 110,000). This data was linked to datasets from the Canadian Urban Environmental Health Research Consortium, reporting ALE and social and material deprivation. Depressive symptoms were evaluated using standard dichotomized scores of 5+ (mild) and 10+ (moderate/severe) from the Patient Health Questionnaire-9. Self-reported diagnosed mood and anxiety disorders were also included. Logistic regression was used to determine the association of mental health outcomes with four classes of ALE. The analysis included adjustments for social and material deprivation, age, sex, chronic conditions, marital status, education, employment, income, BMI, and immigrant status. No association between any mental health outcome and ALE were observed. While the benefits of ALE to physical health are known, these results do not support the hypothesis that more favorable ALE and increased use of active transport is associated with better mental health outcomes.

Antidepressant Prescriptions, Including Tricyclics, Continue to Increase in Canadian Children.

Objective: Few studies have longitudinally followed trends in antidepressant prescribing for Canadian children following the Black Box warning issued in 2004. Using a national data source, we aim to describe trends in antidepressant recommendations for Canadian children ages 1-18 during 2012 to 2016. Methods: A database called the Canadian Disease and Therapeutic Index (CDTI), provided by IQVIA, was used to conduct analyses. The CDTI dataset collects a quarterly sample of pediatric antidepressant recommendations, projected using a weight procedure from a dynamic sample of 652 Canadian office-based physicians. The term "recommendations" is used because nonprescription drugs may be recommended and there is no confirmation in the database that the prescriptions were filled or medications taken. The data were collected from 2012 to 2016 and the sample population was projected by IQVIA to be representative of the entire Canadian pediatric population. Results: The total number of projected antidepressant recommendations for children increased from 2012 to 2016. Selective serotonin reuptake inhibitors were the most recommended class of antidepressants. Analysis indicated that fluoxetine was the most frequently recommended drug. Findings also suggest that recommendations for tricyclic antidepressants (TCAs) are increasing, but predominantly for reasons other than treatment of depression. Conclusions: Overall, antidepressant use in Canadian children increased over the study period. Unsurprisingly, fluoxetine was the most recommended antidepressant for Canadian children. However, the observed increase in TCA use for a pediatric population is unexpected. The data source is descriptive and lacks detailed measures supporting comprehensive explanation of the findings, therefore, further research is required.

Seasonal variation in specific depressive symptoms: A population based study.

INTRODUCTION: Depression varies with season in Canadian youth. However, the symptom profile of seasonal depression may differ from that of non-seasonal depression. Here we evaluate which specific symptoms vary by season. METHODS: Using data from the 2015/2016 Canadian Community Health Survey, cross-sectional analysis was conducted. The Patient Health Questionnaire-9 (PHQ-9) was administered to respondents in 8 provinces/territories (n ≈ 53,000), with interviews conducted throughout the year. Seasonal effects were assessed using quadratic terms in a logistic regression model. Guided by previous literature and analysis, analyses were stratified by age into youth (age 12-24) and adult (age 25+) groups. RESULTS: In the youth, 8 items of the PHQ-9 exhibited a significant season variation: lack of interest/pleasure, feeling depressed/down, hypersomnia/insomnia, lacking energy, poor appetite/overeating, feeling bad about yourself/ like a failure, being slow/fidgety, and trouble concentrating. In the adult group, only sleep and poor appetite/overeating exhibited a seasonal effect. Notably, symptoms of self-harm/suicide did not demonstrate seasonality in either group. LIMITATIONS: Due to use of cross-sectional data and a brief symptom rating scale, conventional criteria for Seasonal Affective Disorder or Major Depressive Disorder with seasonal variation could not be applied. Also, treatment status of respondents was not assessed in the survey, therefore possible confounding by this variable could not be assessed. CONCLUSIONS: A seasonal pattern was observed in most symptoms of depression in Canadian youth, whereas in adults, only symptoms related to sleep and appetite disturbance displayed seasonal variation.

Seasonal variation in symptoms of depression: A Canadian population based study.

BACKGROUND: There is no consensus as to whether depressive symptoms vary by season. Using data from the Canadian Community Health Survey (CCHS), the purpose of this study was to evaluate seasonal variation in depressive symptoms in the Canadian household population. METHODS: A cross-sectional analysis of data from the CCHS in 2015 and 2016 was used. Mean Patient Health Questionnaire-9 (PHQ-9) scores, and categories defined by 5+ or 10+ cut-points were used for analysis. Seasonal effects were assessed using quadratic terms in regression models, generalized linear models were used for this purpose. Models were stratified by youth ages 12-24 (rounded n ≈ 8000) and adults ages 25+ (rounded n ≈ 45,000). RESULTS: Significant seasonal variation was observed for youth (age 12-24) for mean PHQ-9 scores and proportion with scores of 5+. There was evidence of effect modification by age. The youth group had stronger seasonal effects compared to respondents age 25+. Seasonal effect was highly significant for mean PHQ-9 scores (p = 0.009) and 5+ (p = 0.001), but not for 10+ (p = 0.481). LIMITATIONS: Use of cross-sectional data limits the capacity to generalize results to the classic definition of Seasonal Affective Disorder. Data surrounding respondent's anti-depressant use was unavailable. CONCLUSIONS: Seasonal variation in depressive symptoms is evident in the Canadian population. Higher levels of symptoms were reported in winter months compared to summer months. The seasonal trend is most pronounced in youth specifically those who reported at least mild depressive symptoms, but not in respondents reporting moderate to severe symptoms.