Cancer in Canada: Stage at diagnosis.

This article presents national data (excluding Quebec) on cancer incidence by stage at diagnosis for lung, colorectal, female breast and prostate cancers. Data from the Canadian Cancer Registry are combined for the diagnosis years 2011 to 2015. Half of all new lung cancers were diagnosed at stage IV, and of the two types of lung cancer, small cell was more often diagnosed at this stage than non-small cell. About half of colorectal cancers were diagnosed at stages III and IV, and stage-specific incidence rates were generally higher for males than females. More than 80% of female breast and almost three-quarters of prostate cancers were diagnosed at stages I and II. Later-stage diagnosis was more common in older age groups for both cancers.

Comparison of waist circumference using the World Health Organization and National Institutes of Health protocols.

BACKGROUND: This study compares waist circumference (WC) measured using the World Health Organization (WHO) and National Institutes of Health (NIH) protocols to determine if the results differ significantly, and whether equations can be developed to allow comparison between WC taken at the two different measurement sites. DATA AND METHODS: Valid WC measurements using the WHO and NIH protocols were obtained for 6,306 respondents aged 3 to 79 from Cycle 2 of the Canadian Health Measures Survey. Linear regression was used to identify factors associated with the difference between the NIH and WHO values. Separate prediction equations by sex were generated using WC NIH as the outcome and WC_WHO and age as independent variables. Sensitivity and specificity were calculated to examine whether health risk based on the WC_WHO and on WC_NIH predicted measurements agreed with estimates based on WC_NIH actual measured values. RESULTS: For adults and children, WC_NIH significantly exceeded WC_WHO (1.0 cm for boys, 2.1 cm for girls, 0.8 cm for men and 2.2 cm for women). Predicted NIH values were statistically similar to measured values. Sensitivity (86% to 98%) and specificity (70% to 100%) values for health risk category based on the NIH predicted values were very high, meaning that respondents would be appropriately classified when compared with actual measured values. INTERPRETATION: The prediction equations proposed in this study can be applied to historical datasets to compare estimates based on WC data measured using the WHO and NIH protocols.

Comparing United States and Canadian population exposures from National Biomonitoring Surveys: bisphenol A intake as a case study.

The Centers for Disease Control and Prevention provides biomonitoring data in the United States as part of the National Health and Nutrition Examination Survey (NHANES). Recently, Statistics Canada initiated a similar survey - the Canadian Health Measures Survey (CHMS). Comparison of US and Canadian biomonitoring data can generate hypotheses regarding human exposures from environmental media and consumer products. To ensure that such comparisons are scientifically meaningful, it is essential to first evaluate aspects of the surveys' methods that can impact comparability of data. We examined CHMS and NHANES methodologies, using bisphenol A (BPA) as a case study, to evaluate whether survey differences exist that would hinder our ability to compare chemical concentrations between countries. We explored methods associated with participant selection, urine sampling, and analytical methods. BPA intakes were also estimated to address body weight differences between countries. Differences in survey methods were identified but are unlikely to have substantial impacts on inter-survey comparisons of BPA intakes. BPA intakes for both countries are below health-based guidance values set by the US, Canada and the European Food Safety Authority. We recommend that before comparing biomonitoring data between surveys, a thorough review of methodologic aspects that might impact biomonitoring results be conducted.

The association between meeting physical activity guidelines and chronic diseases among Canadian adults.

BACKGROUND: Physical activity is associated with a reduced risk of chronic disease. This study describes the relationship between meeting the guidelines for physical activity described in Canada's Physical Activity Guide and heart disease, type 2 diabetes, hypertension, obesity, and low levels of general health. METHODS: Leisure-time energy expenditure (LTEE) was calculated from leisure-time physical activities reported by adults who participated in the 2007 Canadian Community Health Survey. Respondents were classified as meeting the guidelines for physical activity or not, and were stratified by sex into quartiles of LTEE. Logistic regression was used to determine the odds for all conditions associated with not meeting the guidelines and by quartile of LTEE, adjusting for covariates. RESULTS: The odds of type 2 diabetes, obesity, and fair/poor health were significantly higher among those not meeting the guidelines for both sexes and for high blood pressure among women. Significantly higher odds were seen between the lowest and highest quartiles of LTEE for type 2 diabetes and high blood pressure and across all quartiles for obesity and fair/poor health for both sexes. CONCLUSIONS: Canadian adults meeting the physical activity guidelines have lower odds of chronic diseases and fair/poor health than those not meeting the guidelines.

Resting blood pressure and heart rate measurement in the Canadian Health Measures Survey, cycle 1.

BACKGROUND: Directly measured blood pressure (BP) data have not been collected in Canada since the Canadian Heart Health Surveys, conducted between 1985 and 1992. Because hypertension is often asymptomatic, a large proportion of those with the condition are unaware of it. DATA AND METHODS: These analyses use BP and heart rate (HR) data from cycle 1 of the 2007-2009 Canadian Health Measures Survey (CHMS) for respondents aged 6 to 79 years. Methods and quality assurance and control procedures are explained. Logistical and feasibility issues that arose during data collection are discussed. The reasons for repeating a series of measures are given. Between- and within- series variations and inter-tester variability are assessed. RESULTS: The BP and HR of almost all respondents who attended the examination centre were measured. Only one series of measurements was taken for 88% of respondents. The series was repeated for around 5% with variability in their BP or HR measurements. About 3% had HR or BP values above the screening cut-offs for the fitness tests. Almost 35% of respondents with HR or BP values above the screening cut-offs after their first series had values below the cut-points after the second series; a further 3% had values below after the third series. Within a series of six measurements, BP decreased until about the fourth measure, after which it remained stable. Mean BP and HR values indicated no inter-tester variability. INTERPRETATION: The protocol for measuring BP and HR by oscillometry in the CHMS appears to have produced reliable estimates. No benefit to repeating the series of six measurements a third time for screening purposes is evident. Four measurements may be sufficient to provide reliable BP and HR data. Oscillometry appears to eliminate inter-tester variability.

Patterns and trends in walking behaviour among Canadian adults.

OBJECTIVES: Regular walking is associated with many health benefits and is of particular interest for the promotion of daily physical activity. The purpose of this study is to describe the epidemiology of walking for exercise among Canadian adults aged 18-55 years. METHODS: Nationally representative cross-sectional data from the National Population Health Survey and Canadian Community Health Survey from 1994/95 to 2007 were used for this study. The weighted and age-standardized prevalence of walking for exercise, walking duration, regular walking (at least 4 times a week) and deriving 100% of the total leisure-time physical activity energy expenditure (LTPAEE) from walking were calculated. RESULTS: Overall, 70% of Canadian adults walked for exercise at least once during the previous three months; however, only 30% of the population reported walking regularly, a figure that has remained relatively stable since 2001. Women, older adults, those with lower body mass index (BMI) and those with lower total household income reported regular walking more often than their counterparts. Women, older adults and lower-income Canadians also tended to derive 100% of their total LTPAEE from walking more often than men, young adults and those in higher-income groups. CONCLUSION: Walking is a popular physical activity for Canadian adults, regardless of age, sex, BMI or income group, however, the prevalence of regular walking varies between demographic subgroups. Public health strategies that focus on promoting walking for exercise should consider these results when defining target audiences and designing interventions.

Estimating leisure-time physical activity energy expenditure in the Canadian population: a comparison of 2 methods.

The purpose of this study was to determine the impact of 2 different calculation methods for total leisure-time physical activity energy expenditure (LTPAEE) and LTPAEE from different intensity activities on the classification of level of physical activity in the population. Nationally representative cross-sectional data from the Canadian Community Health Survey Cycle 4.1 (2007) were used for this study (N = 64, 397). LTPAEE was calculated using a metabolic equivalent (MET) value of 4.0 for all activities in the "other activity" category for method 1 (currently employed by Statistics Canada) and using activity-specific MET values for method 2. The weighted prevalence and 95% confidence intervals of active (> or =3 kcal.kg-1.day-1 (kkd)), moderately active (1.5-2.9 kkd), and inactive (<1.5 kkd) were determined for each method by demographic characteristics. The agreement between the 2 methods was assessed overall, and for light, moderate, and vigorous activities. There was no difference between methods in the proportion classified as active, moderately active, or inactive for any of the subgroups studied and there was no difference in the distribution or mean LTPAEE between methods. However, assessment of the agreement showed a large number of outliers and a tendency to underestimate LTPAEE from light and vigorous activities while overestimating LTPAEE from moderate activities at the individual level. The results of this study should be considered when performing inferential statistics on the relationship between physical activity and health outcomes.

Are Canadians meeting the guidelines for moderate and vigorous leisure-time physical activity?

The purpose of this study was to determine the proportion of Canadian adults (aged 18-55 years) who met the guidelines for moderate and vigorous physical activity set out in Canada's Physical Activity Guide to Healthy Active Living. Leisure-time physical activity energy expenditure from moderate- and vigorous-intensity activities was calculated using data from the National Population Health Surveys (1994-1998) and the Canadian Community Health Surveys (2001-2007). The prevalence was estimated for no leisure-time physical activity, meeting only the moderate guideline, meeting both the moderate and vigorous guidelines, and meeting the guidelines through a combination of moderate and vigorous activities. Logistic regression was used to determine the odds of meeting the guidelines by various demographic characteristics. The prevalence of no activity did not change appreciably over time, ranging from 6.5% to 10%, depending on the survey year. Reporting of no activity was more prevalent among older adults, those in lower income groups, and those with a body mass index (BMI) > or =30 kg.m-2. Overall, 65% of adults met the guidelines for physical activity in 2007, which has increased from 54% in 1994-1995. Men, younger adults, those with a higher income, and those with a lower BMI more often met the guidelines. Among all subgroups, meeting the guidelines was most often accomplished through participation in moderate-intensity activities. These findings should be considered when designing and implementing public health interventions that promote participation in daily physical activity.

Validity of the Actical accelerometer step-count function.

PURPOSE: To assess the validity of the new Actical accelerometer step count function. METHODS: Actical step counts were compared according to two criterion standards. 1) Eight Acticals were assessed using a mechanical shaker table under six different testing conditions. 2) Thirty-eight volunteers (aged 9-59 yr) wore eight Acticals and eight Actigraphs during treadmill walking (50 and 83 m.min(-1)) and running (133 m.min(-1)) for 6 min at each speed. Steps were counted during the second and fourth minutes of each speed by a trained observer. RESULTS: The correlation between Actical step counts and the mechanical shaker step counts was excellent (r = 1.0). Compared with visually counted steps, both the Actical and Actigraph step counts were significantly different at 50 m.min(-1); however, no significant differences were evident at 83 and 133 m.min(-1). The criterion-related validity correlations (r) for the Actical and Actigraph, respectively, were 0.73 and 0.52 at the slow walk condition and 0.99 and 0.99 at the normal walk and run conditions. CONCLUSION: The new step count function of the Actical accelerometer provides valid estimates of step counts at 83 and 133 m.min(-1) on a range of healthy participants.

Canadian Health Measures Survey pre-test: design, methods, results.

The Canadian Health Measures Survey (CHMS) pre-test was conducted to provide information about the challenges and costs associated with administering a physical health measures survey in Canada. To achieve the specific objectives of the pre-test, protocols were developed and tested, and methods for household interviewing and clinic testing were designed and revised. The cost, logistics and suitability of using fixed sites for the CHMS were assessed. Although data collection, transfer and storage procedures are complex, the pre-test experience confirmed Statistics Canada's ability to conduct a direct health measures survey and the willingness of Canadians to participate in such a health survey. Many operational and logistical procedures worked well and, with minor modifications, are being employed in the main survey. Fixed sites were problematic, and survey costs were higher than expected.

Canadian Health Measures Survey: clinic operations and logistics.

The Canadian Health Measures Survey (CHMS) is conducted in two parts: a household interview and a visit to a mobile clinic. At 15 sites across Canada, the CHMS uses two trailers to collect physical measures on a sample of about 5,000 Canadians. The trailers contain clinic rooms outfitted with physical measures testing equipment; an administration area; and a fully functioning laboratory. The field team consists of 11 household interviewers and 20 clinic staff. At each site, about 350 respondents visit the clinic over a five- to six-week period. At the clinic, respondents participate in all tests for which they are eligible, including blood pressure, anthropometry, spirometry, a blood draw, a urine sample, tests of physical fitness, and an oral health examination. Respondents who are unable to visit the clinic may perform some of the tests in their home.

Physical activity and ethnicity: evidence from the Canadian Community Health Survey.

BACKGROUND: A large proportion of the Canadian population lives a sedentary lifestyle. Few data are available describing the physical activity behaviours among specific ethnic groups in Canada, so the purpose of this study is to examine the relationship between ethnicity and the level of self-reported physical activity. METHODS: Pooled data from cycles 1.1 (2000/01) and 2.1 (2003) of the cross-sectional Canadian Community Health Survey (ages 20-64 yrs; N = 171,513) were used for this study. Weighted prevalences of self-reported leisure-time moderate (> or = 1.5 kcal x kg(-1) day(-1) (kkd)); moderate to high (> or = 3 kkd) and high physical activity (> or = 6 kkd) were calculated, and multiple logistic regression models were used to quantify the odds of being physically active across ethnic groups, after adjustment for several covariates (White referent group). RESULTS: The rank order of prevalence of being moderately physically active by ethnicity was: White (49%), Other (48%), NA Aboriginal (47%), Latin American (40%), East/Southeast Asian (39%), Black (38%), West Asian/Arab (36%), South Asian (34%). Aboriginal men and women had the highest prevalences of being physically active at > or = 3 kkd (M = 32%, F = 22%) while East/Southeast Asian (19%) and East Asian/Arab men (19%), and South Asian women (12%) had the lowest prevalences. After accounting for covariates, Aboriginal men were at elevated odds of being physically active compared to Whites (> or = 3 kkd, OR=1.6, p < 0.05; > or = 6 kkd, OR = 2.7, p < 0.05). Only 7% and 3% of Canadian men and women, respectively, were active at > or = 6 kkd. CONCLUSION: These results suggest that the prevalence of physically active Canadian adults varies by ethnicity. Strategies to promote physical activity and prevent physical inactivity should consider these findings.

Physical activity and immigrant status: evidence from the Canadian Community Health Survey.

BACKGROUND: The immigrant population in Canada is diverse and growing, yet little is known about their physical activity behaviour and how it changes as they adapt to a Canadian lifestyle. This study extends the surveillance of physical activity in Canada to include the influence of time since immigration within and between ethnic groups. METHODS: Pooled data from cycles 1.1 (2000/01) and 2.1 (2003) of the cross-sectional Canadian Community Health Survey (ages 20-64 y; N = 171,513) were used for this study. Weighted prevalences of self-reported leisure-time physical activity (> or = 3 kcal x kg(-1) x day(-1) (kkd)) were calculated, and unadjusted and adjusted (age, income, education, BMI) multiple logistic regression models were used to quantify the odds of being physically active (PA) (> or = 3 kkd) by time since immigration (recent immigrant < or = 10 yrs, immigrant >10 yrs, non-immigrant) within and between ethnic groups (White referent group). RESULTS: The prevalence of recent immigrants (< or = 10 yrs) being PA (> or = 3 kkd) by ethnicity was: White (21%), Other (19%), Black (19%), Latin American (17%), West Asian/Arab (16%), East/Southeast Asian (14%), South Asian (11%). Recent immigrant Black men and White women had the highest prevalence of being PA (M = 27%, F = 18%) while South Asian men and women had the lowest prevalence (M = 14%, F = 9%). There is a gradient in the prevalence of being PA with recent immigrants (16%) < immigrants (20%) < non-immigrants (24%). Ethnic differences in the prevalence of being PA by time since immigration show similar patterns for men and women. Controlling for age, income, education and BMI had only small effects on the odds of being physical active across ethnicities and immigrant status. CONCLUSION: These results suggest that physical activity levels vary according to immigrant status and self-ascribed ethnicity in Canadian adults. Strategies to promote physical activity and prevent physical inactivity should consider both ethnicity and time since immigration.

In a retrospective study of chronic obstructive pulmonary disease inpatients, respiratory comorbidities were significantly associated with prognosis.

BACKGROUND AND OBJECTIVE: Comorbidities may be related to the prognosis for chronic obstructive pulmonary disease (COPD). We examined respiratory comorbidities associated with length of stay and in-hospital mortality among COPD patients. METHODS: We used the Hospital Person Oriented Information (HPOI) database of Statistics Canada for a 5-year period. Over 4 years (fiscal years 1994-1995 to 1998-1999), 143,135 records listed COPD as the most responsible diagnosis for men and 122,065 records for women aged 40 years or more, and 75,780 men and 69,539 women were admitted to hospital at least once. Logistic regression modeling was used to examine the relationships between respiratory comorbidities and hospital outcomes adjusting for covariates. RESULTS: Of the COPD patients, 10% had pneumonia-influenza and 3% had asthma as comorbid conditions. Women had a higher prevalence of asthma than men. The median length of stay at hospital was approximately 7 days, and 95% of patients were discharged alive. The odds ratio (95% confidence interval) for pneumonia-influenza in relation to in-hospital death was 3.56 (3.31, 3.83) for men and 3.29 (3.00, 3.61) for women. For comorbid asthma the corresponding odds ratios were 0.56 (0.36, 0.61) and 0.54 (0.35, 0.57), respectively. CONCLUSIONS: COPD inpatients with pneumonia-influenza had a worse prognosis and those with asthma had a better prognosis.

Obesity, overweight and ethnicity.

OBJECTIVES: This article describes the prevalence of self-reported overweight and obesity, based on body mass index (BMI), by ethnicity and examines the influence of time since immigration within and between ethnic groups. DATA SOURCES: Results are based on data from two cycles of Statistics Canada's Canadian Community Health Survey, conducted in 2000/01 and 2003. ANALYTICAL TECHNIQUES: Weighted prevalences of overweight (BMI > or =25) and obesity (BMI > or =30) were calculated by sex and ethnicity for the population aged 20 to 64. Multiple logistic regression models were used to examine associations between overweight/obesity and ethnicity, and within and between ethnic groups based on time since immigration, controlling for age, household income, education and physical activity. MAIN RESULTS: Aboriginal men and women had the highest prevalences of overweight and obesity; East/Southeast Asians, the lowest. Independent of age, household income, education and physical activity, Aboriginal people had elevated odds of overweight and obesity, compared with Whites; South Asians and East/Southeast Asians had significantly lower odds. Recent immigrants (10 years or less) had significantly lower prevalences of overweight, compared with non-immigrants, but this difference tended to disappear over time.

Changing age-pattern of hospitalisation risk of chronic obstructive pulmonary disease in men and women in Canada.

OBJECTIVE: To examine the changing pattern of age distributions of hospitalisation for chronic obstructive pulmonary disease (COPD) among Canadian men and women. DESIGN: Retrospective cohort study. PARTICIPANTS: 257,604 COPD inpatients aged 55-90 years with 463,089 hospital admissions during a 3-year study period (1994/95, 1995/96 and 1996/97) in Canada. MAIN OUTCOME MEASURES: COPD listed as one of the first five underlying diagnoses (broad definition, 463,089 hospitalisations) or as first diagnosis (narrow definition, 142,770 hospitalisations). RESULTS: Overall, men were more likely to have hospitalisations for COPD and had a higher proportion of death at hospital than did women. The 3-year cumulative incidence was 42.2/1,000 for the broadly defined COPD hospitalisation and 14.0/1,000 for the narrowly defined COPD hospitalisation, and steadily increased with increasing age. The relative risk for women versus men gradually increased with decreasing age, and was significantly greater than unity in the 55-59 year group for narrowly defined COPD hospitalisation. CONCLUSIONS: In terms of impact on secondary care COPD is a disease of the elderly and is becoming more common in women, particularly in younger age groups.

State of the Art Compendium: Canadian Thoracic Society recommendations for the management of chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) is a common cause of disability and death in Canada. Moreover, morbidity and mortality from COPD continue to rise, and the economic burden is enormous. The main goal of the Canadian Thoracic Society's evidence-based guidelines is to optimize early diagnosis, prevention and management of COPD in Canada. The main message of the guidelines is that COPD is a preventable and treatable disease. Targeted spirometry is strongly recommended to expedite early diagnosis in smokers and former smokers who develop respiratory symptoms, and who are at risk for COPD. Smoking cessation remains the single most effective intervention to reduce the risk of COPD and to slow its progression. Education, especially self-management plans, are key interventions in COPD. Therapy should be escalated on an individual basis in accordance with the increasing severity of symptoms and disability. Long-acting anticholinergics and beta-2-agonist inhalers should be prescribed for patients who remain symptomatic despite short-acting bronchodilator therapy. Inhaled steroids should not be used as first line therapy in COPD, but have a role in preventing exacerbations in patients with more advanced disease who suffer recurrent exacerbations. Acute exacerbations of COPD cause significant morbidity and mortality and should be treated promptly with bronchodilators and a short course of oral steroids; antibiotics should be prescribed for purulent exacerbations. Patients with advanced COPD and respiratory failure require a comprehensive management plan that incorporates structured end-of-life care. Management strategies, consisting of combined modern pharmacotherapy and nonpharmacotherapeutic interventions (eg, pulmonary rehabilitation and exercise training) can effectively improve symptoms, activity levels and quality of life, even in patients with severe COPD.

Physical Activity and Obesity in Canadian Women.

HEALTH ISSUE: Overweight and obesity have been recognized as major public health concern in Canada and throughout the world. Lack of physical activity, through its impact on energy balance, has been identified as an important modifiable risk factor for obesity. Physical activity and obesity are also important risk factors for a variety of chronic diseases. This chapter provides an overview of the current state of physical activity and overweight/obesity among Canadian women. KEY FINDINGS: For all ages combined more women (57%) than men (50%) are physically inactive (energy expenditure <1.5 KKD). Physical activity increases as income adequacy and educational level decrease. Physical inactivity also varies by ethnicity. The prevalence of both overweight (BMI 25.0 - 29.9 kg/m2) and obese (BMI >/= 30 kg/m2) Canadian women has increased 7% since 1985. Obesity increases with age and is highest among women reporting low and lower middle incomes and lower levels of education. The prevalence of obesity is highest among Aboriginal women and men (28% and 22% respectively). DATA GAPS AND RECOMMENDATIONS: There is currently no surveillance system in Canada to monitor the level of physical activity among children, those performing activity at work, at school or in the home. There is a gap in the knowledge surrounding socio-cultural and ecological determinants of physical activity and obesity and the associations of these to chronic disease among women and minority populations. Multi-sectoral policy interventions that act to decrease the broad systemic barriers to physical activity and healthy weights among all women are needed.

Potentiation of shortening and velocity of shortening during repeated isotonic tetanic contractions in mammalian skeletal muscle.

The purpose of this study was to investigate the enhancement of shortening and of the velocity of shortening during repeated incompletely fused isotonic tetanic contractions. The medial gastrocnemius muscle of anesthetized rats was isolated in situ and the motor nerve stimulated with supramaximal pulses, 50 micros duration, at optimal length. Estimated maximal velocity of shortening (V(max)) was 210 +/- 6 mm x s(-1) (mean +/- SEM). Repeated incompletely fused tetanic contractions (three pulses at 80 Hz) resulted in initial shortening which was 1.5 +/- 0.1 mm, and this increased to 2.7 +/- 0.2 mm after 7 s of 4 s(-1) contractions. Peak velocity of shortening for intermittent 80 Hz stimulation increased from 60.5 +/- 4 mm x s(-1) to 91.8 +/- plus minus 6 mm x s(-1). The initial velocity of shortening for 80 Hz stimulation was substantially less than the velocity of shortening observed with 200 Hz stimulation, but increased to 72 +/- 3% of the load-specific value for 200 Hz stimulation. Myosin regulatory light chain phosphorylation increased from 11.1 +/- 1.5% at rest to 32.9 +/- 5.4% after 4 s of intermittent 80 Hz stimulation and 50.4 +/- 8.8% after 7 s ( P<0.01). The ascending limb of the length-force relationship was determined with tetanic contractions, 200 Hz for 100 ms. At the length corresponding to peak shortening after 7 s of repeated 80 Hz contractions, the maximal isometric force was five times greater than the isotonic load. The rate of phosphorylation was sustained from 4 to 7 s, but the rate of increase in shortening and velocity decreased. The slower rate of change in shortening and velocity may be due to approaching maximal velocity for this short duration of contraction, but is not due to slowing of the rate of phosphorylation of the myosin regulatory light chains.