Organizational Factors Associated With Quality Perinatal Care.

Perinatal care has been recognized as an integral part of ensuring quality health care in hospitals, and the focus on perinatal care quality is increasing. The previous hospital literature has focused much attention on measuring and improving quality of care generally, but recently there has been a call for a more comprehensive approach to measuring quality in the perinatal care setting. The perinatal literature is limited in addressing the association between organizational factors and perinatal quality. Using chart audit data for more than 10 000 maternity patients, we used multiple regression analysis to examine the association of organizational factors and perinatal quality of care. Findings show that ownership, setting (location), and hospital policy on infant feeding were statistically significant. Findings suggest that it is important that hospital boards and leaders develop and implement organizational policies to enhance perinatal quality of care.

Prostate cancer and occupational whole-body vibration exposure.

Prostate cancer is common and its etiology largely unknown; therefore, it is important to explore all potential risk factors that are biologically plausible. Recent literature suggests a relationship between whole-body vibration (WBV) and prostate cancer risk. The aim of this study was to determine whether occupational WBV was a risk factor for prostate cancer. Existing data, collected on 447 incident cases and 532 population controls (or their proxies), in Montreal, Canada, were used to evaluate this question. Personal interviews collected detailed job descriptions for every job held, the tasks involved, and type of equipment used. For each job, experts assessed the intensity and daily duration of WBV exposure. Inter-rater agreement for WBV ratings was examined using the kappa statistic, with values that ranged from 0.83 to 0.94. Logistic regression models explored the relationship between WBV exposure and prostate cancer, using various combinations of intensity, daily duration, and years of exposure. Potential confounders were also examined. Occupations with WBV exposure demonstrated an increased statistically non-significant risk [odds ratio (OR) = 1.44, 95% confidence interval (CI): 0.99-2.09]. The risk for transport equipment operation, a job with WBV exposure, was significantly elevated (OR = 1.90, 95% CI: 1.07-3.39). These results, together with those of an earlier study, suggest that workers in heavy equipment and transport equipment operation may have increased risk of prostate cancer. Further investigation is warranted.

What Solutions Exist for Developmental Delays Facing Indigenous Children Globally? A Co-Designed Systematic Review.

Early childhood is important for future cognitive and educational outcomes. Programs overcoming barriers to engagement in early education for Indigenous children must address family cultural needs and target developmental delays. This systematic review identifies culturally adapted programs to improve developmental delays among young children, in response to an identified priority of a remote Indigenous community. Five databases (the Cochrane Library, Embase, Medline, Scopus and CINAHL) were searched for English language papers in January 2018. Study quality was assessed, and findings were analysed thematically. Findings were presented to the community at an event with key stakeholders, to determine their inclusion and face validity. Seven relevant studies, published between 1997 and 2013, were identified by the researchers and each study was supported by the community for inclusion. Three studies included on Native American children and four studies included children from non-Indigenous disadvantaged backgrounds. Findings were reported narratively across four themes: storytelling to improve educational outcomes; family involvement improved development; culturally adapted cognitive behavioural therapy to reduce trauma; rewards-based teaching to improve child attention. Limited published research on culturally adapted and safe interventions for children with developmental delays exists but these four themes from seven studies identify useful components to guide the community and early childhood program development.

Dietary patterns and risk of incident gastric adenocarcinoma.

Few studies have assessed the relation between dietary patterns and gastric adenocarcinoma risk, yet this approach has advantages over single-nutrient analysis, including the ability to reflect eating patterns in populations and ease of implementing dietary recommendations. The authors evaluated associations between dietary patterns, a food index score, and incident gastric cancer risk in a Canadian study of 1,169 cases and 2,332 controls (1995-1997). Dietary patterns were assessed via factor analysis applied to a food frequency questionnaire. A food index score was derived based on risk factors for gastric cancer. A multivariable-adjusted prudent dietary pattern was associated with decreased risk of gastric cancer in women (odds ratio (OR) = 0.58, 95% confidence interval (CI): 0.37, 0.92); a Western dietary pattern was associated with increased risk in women (OR = 1.86, 95% CI: 1.20, 2.89) and men (OR = 1.44, 95% CI: 1.03, 2.02). The food index score was associated with decreased risk among women (OR = 0.40, 95% CI: 0.27, 0.59) and men (OR = 0.63, 95% CI: 0.45, 0.88). Dietary patterns especially characterized by Western features (soft drinks, processed meats, refined grains, and sugars) were associated with increased risk of gastric adenocarcinoma, whereas dietary patterns characterized by increased consumption of fruits, vegetables, and fish were associated with lessened risk.

Salivary gland cancer: an exploratory analysis of dietary factors.

This study was an exploratory analysis of dietary and other risk factors for primary salivary gland cancer in a population-based case-control study in Ontario, Canada. Cases were men and women diagnosed between 1995 and 1996 with a first primary cancer of the salivary gland, identified through the Ontario Cancer Registry. Controls were an age-matched random sample of the population of Ontario, identified through property assessment files. Cases (n = 91) and controls (n = 1897) completed a self-administered questionnaire with information on diet, smoking, height and weight, and other lifestyle and socio-demographic factors. Multivariate logistic regression was used to estimate odds ratios (ORs) and corresponding 95% confidence intervals (CIs). Among dietary variables, high relative to low intakes of alcohol (OR: 1.26; 95% CI: 0.68-2.35), fruits (OR: 1.26; 95% CI: 0.68-2.33), sweets (OR: 1.66; 95% CI: 0.85-3.25), dairy (OR: 1.41; 95% CI: 0.77-2.58), and starchy foods (OR: 1.78; 95% CI: 0.96-3.3) were associated with non-statistically significant increased risk of salivary gland cancer; whereas vegetables and meats were linked with non-statistically significant decreased risks of the disease. Among non-diet factors, male sex, obese BMI, exposure to occupational radiation, family history of cancer, and household income were suggestive of increased disease risk. Future work with larger numbers of cases are needed to further explore these associations.

Influence of physician and patient characteristics on adherence to breast cancer screening recommendations.

Identifying physician and patient characteristics is important in implementing effective, targeted strategies to improve breast cancer detection rates through increased screening recommendations and uptake. The purpose of this study was to determine whether Ontario physicians recommend breast screening using mammography every 2 years for women aged 50-69 as encouraged by the Ontario Breast Screening Program. This study also aimed to identify physician and patient characteristics that may influence adherence to these recommendations. The study design was a cross-sectional study. Using the Canadian Medical Directory-Ontario database, 3063 questionnaires were mailed to all active general and family practitioners. A response rate of 38% (N = 939) was achieved. Adherence to screening was defined as recommending screening to women aged 50-69 only, every 2 years as outlined by the Ontario Breast Screening Program. Bivariate analyses and unconditional logistic regression were used to assess physician adherence to screening guidelines. Only 38.9% of physicians followed recommended breast screening guidelines. After adjusting for physician sex and age, predictors of screening adherence include physicians working in academic or research centers (odds ratio 8.3, 95% confidence interval 1.7-39.7) and those reporting that over 31% of their patients to be of low-income (odds ratio 1.6, 95% confidence interval 1.1-2.4). Compared with physicians working in a rural/town setting (<10 000 people), those located in a large city (>100 000 people) were less likely to adhere to screening guidelines (odds ratio 0.5, 95% confidence interval 0.3-0.7). A low proportion of Ontario physicians adhere to recommended breast screening guidelines. Future research into effective strategies to increase adherence should take into account practice location, setting and patient characteristics.

Physical activity and stomach cancer risk: the influence of intensity and timing during the lifetime.

Physical inactivity is linked to risk for cancers of the colon, breast, lung and endometrium, but few data exist on this association with stomach cancer. We evaluated the association between recreational physical activity and incident stomach cancer in a case-control study. The data yielded odds ratios suggestive of approximately 20-40% reduced risk of stomach cancer when comparing more frequent (3+ times/week) to less frequent (<1/month) strenuous activities. The magnitudes of the associations for strenuous physical activities were consistent across the teens, early 30s, and early 50s. Compared to the least active quartile, the second, third, and fourth quartiles of average lifetime strenuous physical activity yielded odds ratios of 0.82, 0.69, and 0.58 (95% CI, 0.41-0.83), respectively. Odds ratios for moderate activity generally suggested a modest, but not statistically significant, inverse association. Increased strenuous physical activity, throughout the lifespan, was associated with decreased risk of incident stomach cancer.

Utility of proxy versus index respondent information in a population-based case-control study of rapidly fatal cancers.

PURPOSE: This work provides an empirical assessment of the usefulness of obtaining exposure data from proxy respondents. METHODS: Two independent case groups were formed in data from a population-based case-control study. One case set was derived from proxy respondents. The second case series was derived from respondents who self-reported. The second case group was matched to the proxy case group for age, cancer site, and sex. These data were compared with a control group for completeness of information and identifying heterogeneity of risk estimates for a variety of variables. Index cases and controls were matched to the 829 available proxy respondents for sex, age (5-year groups), and cancer site. RESULTS: Proxy respondents provided levels of complete information similar to index cases and controls for height and weight; occupational physical activity; consumption of coffee, alcohol, and cigarettes; and family history of cancer. Proxies had more missing responses for variables concerning recreational physical activity, clinical depression, age at first menstruation, use of oral contraceptives, and occupational exposure to pesticides. Polytomous logistic regression models found only a few examples of meaningful heterogeneity among all variables, limited to models for coffee consumption and cigarette smoking. CONCLUSIONS: Our data suggest that proxy respondents, especially parents and spouses, provide adequately complete information for many, but not all, exposures common in epidemiologic studies.

Effect of Current Dietary Recommendations on Weight Loss and Cardiovascular Risk Factors.

BACKGROUND: Dietary recommendations emphasize increased consumption of fruit, vegetables, and whole grain cereals for prevention of chronic disease. OBJECTIVES: This study assessed the effect of dietary advice and/or food provision on body weight and cardiovascular disease risk factors. METHODS: Healthy overweight men (n = 209) and women (n = 710), mean age 44.7 years, body mass index [BMI] 32.4 kg/m2, were randomized between November 2005 and August 2009 to receive Health Canada's food guide (control, n = 486) or 1 of 3 interventions: dietary advice consistent with both Dietary Approaches to Stop Hypertension (DASH) and dietary portfolio principles (n = 145); weekly food provision reflecting this advice (n = 148); or food delivery plus advice (n = 140). Interventions lasted 6 months with 12-month follow-up. Semiquantitative food frequency questionnaires and fasting blood, anthropometric and blood pressure measurements were obtained at baseline, 6 months, and 18 months. RESULTS: Participant retention at 6 and 18 months was 91% and 81%, respectively, after food provision compared to 67% and 57% when no food was provided (p < 0.0001). Test and control treatments showed small reductions in body weight (-0.8 to -1.2 kg), waist circumference (-1.1 to -1.9 cm), and mean arterial pressure (0.0 to -1.1 mm Hg) at 6 months and Framingham coronary heart disease risk score at 18 months (-0.19 to -0.42%), which were significant overall. Outcomes did not differ among test and control groups. CONCLUSIONS: Provision of foods increased retention but only modestly increased intake of recommended foods. Current dietary recommendations showed small overall benefits in coronary heart disease risk factors. Additional dietary strategies to maximize these benefits are required. (Fruits, Vegetables, and Whole Grains: A Community-based Intervention; NCT00516620).

Benzodiazepines and risk for breast cancer.

PURPOSE: The study aim is to evaluate benzodiazepine use and risk for breast cancer in Ontario, Canada, by using a population-based case-control study design. METHODS: Cases were a random sample of women aged 25 to 74 years identified through the Ontario Cancer Registry and diagnosed with breast cancer between 1996 and 1998 (n = 3133). Controls were an age-matched random sample of women (n = 3062). Cases and controls completed a self-administered questionnaire that included questions about their past use of benzodiazepines (defined as daily use for at least 2 months) and potential confounders. Individual classes of benzodiazepines also were evaluated. Multivariate logistic regression analysis was conducted, and odds ratios (ORs) and 95% confidence intervals (CIs) were estimated. RESULTS: Compared with nonusers, ever use of benzodiazepines was not significantly associated with risk for breast cancer (OR, 1.06; 95% CI, 0.88-1.27). No apparent trends were observed for duration of use, time since first use, or time since last use. Estimates according to individual classes of benzodiazepines, including diazepam, lorazepam, and chlordiazepoxide, also were not statistically significant. CONCLUSION: Our data show no association between benzodiazepine use and breast cancer risk. Results confirm findings from previous studies that diazepam use does not increase the risk for breast cancer and also suggest no association with the use of other benzodiazepine compounds.

Hormonal factors and the risk of breast cancer according to estrogen- and progesterone-receptor subgroup.

Evidence suggests hormonal factors may be more strongly associated with estrogen receptor+progesterone receptor+ (ER+PR+) than ER-PR- breast cancer risk. This study evaluated risk factors according to ERPR tumor status among pre- and postmenopausal women participating in two recent population-based case-control studies. Breast cancer cases, ages 25-74 years, and diagnosed 1995-1998 were sampled from the Ontario Cancer Registry. Controls were a random sample of women identified using the Ontario Ministry of Finance rolls and were frequency-matched to cases within 5-year age groups. Epidemiological data were collected from breast cancer cases and controls using two self-administered questionnaires. ERPR data were obtained for 87% of the breast cancer cases (3,276 of 3,748). Multivariate polytomous logistic regression was used to obtain odds ratios estimates and 95% confidence intervals. The following significant differences were observed in the risk factor profiles for ER+PR+ and ER-PR- breast cancer: among premenopausal women, late age at menarche was only associated with a reduction in ER+PR+ breast cancer risk; obesity was associated with an increased ER-PR- and decreased ER+PR+ cancer risk; and the association between alcohol intake and breast cancer risk was heterogeneous across ERPR subgroups, although the direction varied across the levels of alcohol intake. Among postmenopausal women, there were no statistically significant differences observed in the risk factor profiles for ER+PR+ and ER-PR- breast cancer. Some heterogeneity exists in the risk factor profiles of ER+PR+ and ER-PR- premenopausal breast cancer; however, risk factor profiles did not differ markedly for postmenopausal breast cancer.

Dietary factors and risk of non-Hodgkin lymphoma by histologic subtype: a case-control analysis.

There is speculation that etiologic heterogeneity exists among tumors classified as non-Hodgkin lymphoma (NHL), although it is not known whether diet-related associations vary between tumor subgroups. We analyzed data on 1,642 NHL cases and 5,039 controls aged 20 to 74 years from a population-based case-control study conducted in eight Canadian provinces to explore associations between dietary factors and NHL by histologic subtype. Dietary information was collected using a 69-item food frequency questionnaire. Tumors were categorized into histologic subtypes using the contents of pathology reports from the original histopathologic review of diagnostic material. Odds ratios (OR) relating consumption of dietary factors (divided into three categories) to each NHL subtype (diffuse, follicular, small lymphocytic, high grade, peripheral T cell, and unspecified lymphomas) were calculated using polytomous logistic regression. We found an increased risk of NHL with high (versus low) intake of processed meat (OR, 1.49), cheese (OR, 1.38), eggs (OR, 1.49), and dessert foods (OR, 1.24). Positive associations with NHL were also found for high consumption of total fat (OR, 1.28), saturated fat (OR, 1.29), and monounsaturated fat (OR, 1.27). Associations for consumption of some vegetables and fats were found to differ between lymphoma subtypes. Given the large number of diet/subtype comparisons done, however, the possibility that this heterogeneity arose by chance cannot be ruled out. In conclusion, these findings generally do not support the existence of etiologic heterogeneity between histologic subtypes of NHL in their associations with components of dietary intake.

Antidepressant medication use and breast cancer risk: a case-control study.

BACKGROUND: Animal and human studies have reported an association between antidepressant (AD) medication use and breast cancer risk. A population-based case-control study was designed specifically to examine this association among women in Ontario, Canada. METHODS: The Ontario Cancer Registry (OCR) identified women diagnosed with primary breast cancer. Controls, randomly sampled from the female population of Ontario, were frequency matched by 5-year age groups. A mailed self-administered questionnaire included questions about lifetime use of AD and potential confounders. Multivariate logistic regression yielded odds ratio estimates. RESULTS: 'Ever' use of AD was reported by 14% (441/3077) cases versus 12% (372/2994) controls. The age-adjusted odds ratio (AOR) for 'ever' use was 1.17, (95% CI: 1.01, 1.36). An increased risk was also observed for selective serotonin reuptake inhibitors = 1.33 (95% CI: 1.07, 1.66), Sertraline = 1.58 (95% CI: 1.03, 2.41), and Paroxetine = 1.55 (95% CI: 1.00, 2.40). None of the 30 variables assessed for confounding altered the risk estimate by more than 10%. Multivariate adjustment including all possible breast cancer risk factors yielded an unchanged, but not significant, point estimate (MVOR = 1.2, 95% CI: 0.96, 1.51). No relationship was observed for duration or timing of AD use. CONCLUSIONS: A modest association between 'ever' use of AD and breast cancer was found using the most parsimonious multivariate model. OR estimates did not change, but CI were widened and statistical significance lost, after adjustment for factors associated with breast cancer risk.

Age of smoking initiation and risk of breast cancer in a sample of Ontario women.

OBJECTIVES: To examine the association between time of smoking initiation and both the independent and joint effects of active and passive tobacco smoke exposure and the risk of breast cancer in a sample of Ontario women. METHODS: Data from two large population-based case-control studies conducted among Ontario women aged 25-75 years were combined for analysis (n = 12,768). RESULTS: Women who had ever smoked and were exposed to passive smoke had a significant increased risk of breast cancer (OR 1.13, 95%CI 1.01-1.25). A significant increased risk was also observed among women who initiated smoking: at age 26 or older (OR 1.26, 95%CI 1.03-1.55); more than five years from menarche (OR 1.26, 95%CI 1.12-1.42); and, after their first live birth (OR 1.25, 95%CI 1.02-1.52). CONCLUSION: The results suggest that women who initiate smoking at an older age are at an increased risk of breast cancer.

Nonsteroidal antiinflammatory drug use and breast cancer risk: subgroup findings.

Nonsteroidal antiinflammatory drugs (NSAIDs) may play a role in breast cancer prevention; however, breast cancer subtypes and lifestyle/host factors may influence their impact. During 1996-1998 in Canada, the authors examined the association between regular NSAID use (defined as daily use for at least 2 months) and breast cancer risk by estrogen receptor (ER) and progesterone receptor (PR) status, cigarette smoking exposure, and history of arthritis. Breast cancer cases (n = 3,125, including 1,600 ER+PR+ and 591 ER-PR-) and an age-matched, random sample of controls (n = 3,062) completed a general risk factor questionnaire, including detailed questions on prescription and nonprescription NSAID use. NSAID use was associated with reduced risk of breast cancer (odds ratio = 0.76, 95% confidence interval: 0.66, 0.88). The association was not significantly different for ER+PR+ (odds ratio = 0.71, 95% confidence interval: 0.60, 0.84) and ER-PR- cancers (odds ratio = 0.80, 95% confidence interval: 0.62, 1.03) (p(heterogeneity) = 0.66). The magnitude of the NSAID inverse association was similar for women with and without arthritis and across smoking strata (risk estimates ranged from 0.74 to 0.84). Breast cancer risk tended to decrease with increasing duration of NSAID use and was generally lowest for >or=7 years of use, and both acetylsalicylic acid and non-acetylsalicylic acid use were associated with reduced risks.

Psychiatric disorders and use of mental health services by Ontario women.

OBJECTIVES: To describe the lifetime prevalence of selected psychiatric disorders in Ontario women and to compare these estimates with use of mental health resources. METHODS: We obtained data from a survey of 3062 Ontario women, aged 25 to 74 years, who participated in the Women's Health Study. A 5-item scale assessed lifetime prevalence of 5 psychiatric disorders (anxiety, depression, posttraumatic stress disorder [PTSD], obsessive-compulsive disorder [OCD], and anorexia [AN] or bulimia [BN]). We assessed use of mental health services by comorbidity. We employed stratified random sampling to select study subjects. Prevalence estimates were weighted and 95%CIs were obtained using Taylor linearization techniques (1). RESULTS: Nearly 30% of those surveyed reported at least 1 of the disorders studied. The most common were depression (27%) and anxiety (21%). Lifetime prevalence of PTSD, OCD, and AN or BN were 10.7%, 6.1%, and 3.9%, respectively. Successively younger birth cohorts displayed an increase in prevalence and a decrease in onset-age for all disorders. "Ever" use of mental health services was higher for women with 3 or more comorbid disorders (65%) than for those with no disorder (9.8%), or only 1 disorder (51.4%). CONCLUSIONS: The results of this study highlight the need to conduct more research into the reasons for the low rates of professional service use, especially for women with high comorbidity. They also highlight the need to understand the phenomenon underlying the possibly increasing rates of disorders in younger birth cohorts, so that outreach strategies can be modified to accommodate differences in younger women.