The purpose of the study was to examine the 7-year stability of systolic (SBP) and diastolic (DBP) blood pressures in the Canadian population.
The sample included 1,503 participants 7-69 years of age from the 1981 Canada Fitness Survey who were remeasured in Campbell's Survey of 1988. Both SBP and DBP were adjusted for the effects of body mass index (BMI) using regression procedures.
Interage correlations from baseline to follow-up ranged from -0.17 to 0.61 for SBP and from -0.22 to 0. 51 for DBP. With few exceptions, correlations were positive and significant, and were highest and most consistent in adulthood. Further, between 27 and 39% of participants in the upper or lower quintiles in 1981 remained there in 1988. There were few differences in adiposity between those who remained in the upper or lower quintiles and those who did not. One exception was that males who remained in the upper quintile of SBP had greater values for BMI, sum of skinfolds, and waist circumference at baseline. Among adults, the best predictor of future blood pressure was baseline blood pressure, which accounted for between 12 and 34% of the variance in follow-up blood pressure, followed by age, follow-up BMI, and, in females, baseline physical activity levels.
Blood pressure demonstrated low to moderate stability over 7 years in Canada, and baseline level of adiposity was related to the stability of SBP in males.
The perioperative and long-term risks for living kidney donors are of concern. We have studied donors at the University of Minnesota 20 years or more (mean 23.7) after donation by comparing renal function, blood pressure, and proteinuria in donors with siblings. In 57 donors (mean age 61 [SE 1]), mean serum creatinine is 1.1 (0.01) mg/dl, blood urea nitrogen 17 (0.5) mg/dl, creatinine clearance 82 (2) ml/min, and blood pressure 134 (2)/80 (1) mm Hg. 32% of the donors are taking antihypertensive drugs and 23% have proteinuria. The 65 siblings (mean age 58 [1.3]) do not significantly differ from the donors in any of these variables: 1.1 (0.03) mg/dl, 17 (1.2) mg/dl, 89 (3.3) ml/min, and 130 (3)/80 (1.5) mm Hg, respectively. 44% of the siblings are taking antihypertensives and 22% have proteinuria. To assess perioperative mortality, we surveyed all members of the American Society of Transplant Surgeons about donor mortality at their institutions. We documented 17 perioperative deaths in the USA and Canada after living donation, and estimate mortality to be 0.03%. We conclude that perioperative mortality in the USA and Canada after living-donor nephrectomy is low. In long-term follow-up of our living donors, we found no evidence of progressive renal deterioration or other serious disorders.
Comment In: Lancet. 1992 Nov 28;340(8831):1354-51360068
Aboriginal people living in Canada have a high prevalence of obesity, type 2 diabetes, and cardiovascular disease (CVD). To better understand the pre and postnatal influences on the development of adiposity and related cardio-metabolic factors in adult Aboriginal people, we will recruit and follow prospectively Aboriginal pregnant mothers and their children - the Aboriginal Birth Cohort (ABC) study.
We aim to recruit 300 Aboriginal pregnant mothers and their newborns from the Six Nations Reserve, and follow them prospectively to age 3 years. Key details of environment and health including maternal nutrition, glucose tolerance, physical activity, and weight gain will be collected. At birth, cord blood and placenta samples will be collected, as well as newborn anthropometric measurements. Mothers and offspring will be followed annually with serial measurements of diet and physical activity, growth trajectory, and adiposity.
There is an urgent need to understand maternal and child factors that underlie the early development of adiposity and type 2 diabetes in Aboriginal people. The information generated from this cohort will assist the Six Nations community in developing interventions to prevent early adiposity in Aboriginal children.
Centre for Behavioural Research and Program Evaluation, Lyle S Hallman Institute, Room 1717A, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, Canada, N2L 3G1. firstname.lastname@example.org
To conduct an exploratory, comparative study of the utilisation and effectiveness of tobacco cessation quitlines among aboriginal and non-aboriginal Canadian smokers.
Population based quitlines that provide free cessation information, advice and counselling to Canadian smokers.
First time quitline callers, age 18 years of age and over, who called the quitline between August 2001 and December 2005 and who completed the evaluation and provided data on their ethnic status (n = 7082).
Demographic characteristics and tobacco behaviours of participants at intake and follow-up; reasons for calling; actions taken toward quitting, and 6-month follow-up quit rates.
7% of evaluation participants in the time period reported aboriginal origins. Aboriginal participants were younger than non-aboriginals but had similar smoking status and level of addiction at intake. Concern about future health and current health problems were the most common reasons aboriginal participants called. Six months after intake aboriginals and non-aboriginals had taken similar actions with 57% making a 24-hour quit attempt. Quit rates were higher for aboriginals than non-aboriginals, particularly for men. The 6-month prolonged abstinence rate for aboriginal men was 16.7% compared with 7.2% for aboriginal women and 9.4% and 8.3% for non-aboriginal men and women, respectively.
This exploratory analysis showed that even without targeted promotion, aboriginal smokers do call Canadian quitlines, primarily for health related reasons. We also showed that the quitlines are effective at helping them to quit. As a population focused intervention, quitlines can reach a large proportion of smokers in a cost efficient manner. In aboriginal communities where smoking rates exceed 50% and multiple health risks and chronic diseases already exist, eliminating non-ceremonial tobacco use must be a priority. Our results, although exploratory, suggest quitlines can be an effective addition to aboriginal tobacco cessation strategies.
Cites: N Engl J Med. 2002 Oct 3;347(14):1087-9312362011
It has been a matter of controversy whether there is an increased risk of lung cancer among asbestos-exposed workers without radiographic asbestosis. A previous study of lung cancer risk among asbestos-cement workers has been updated with an additional 12 years of follow-up.
Subjects had received radiographic examination at 20 and 25 years from first exposure to asbestos. Radiographs were interpreted by a single National Institute of Safety and Health (NIOSH)-certified B-reader using the 1971 International Labor Office (ILO) Classification of the pneumoconioses as reference standard. Asbestosis was defined as an ILO coding of 1/0 or higher. Standardized Mortality Ratios (SMRs) were calculated using the general population of Ontario as reference.
Among asbestos-cement workers without radiographic asbestosis at 20 years latency the lung cancer SMR was 3.84 (2.24-6.14). Among workers without asbestosis when examined at 25 years latency the SMR was 3.69 (1.59-7.26).
Workers from an Ontario asbestos-cement factory who did not have radiographic asbestosis at 20 or 25 years from first exposure to asbestos continued to have an increased risk of death from lung cancer during an additional 12 years of follow-up.
Comment In: Am J Ind Med. 2011 Jun;54(6):495-6; author reply 497-821328422
Prevention in nephrology is only possible with the cooperation of patients and their families. The nurse plays a considerable role in working with patients and is a major player in the team, responsible for follow-up of the patient, where the earliest interventions can help delay and sometimes avoid dialysis. The hypertension clinic is the beginning of a continuum until dialysis. This paper describes three clinics that are managed in the renal service and indicates how they contribute to offering optimal care to a renal population.
OBJECTIVE: The aim of this study was to investigate associations of adiponectin, leptin, C-reactive protein (CRP), interleukin (IL)-6, and serum amyloid A (SAA), individually or in combinations, with risk of incident type 2 diabetes in a Aboriginal Canadian [corrected] population. RESEARCH DESIGN AND METHODS: Of the 606 Sandy Lake Health and Diabetes Project cohort subjects who were free of diabetes at baseline, 540 (89.1%) participated in 10-year follow-up assessments. Concentrations of fasting adiponectin, leptin, CRP, IL-6, SAA, and covariates were measured at baseline. Fasting glucose and a 75-g oral glucose tolerance test were obtained at baseline and follow-up to determine incident type 2 diabetes, defined as clinically diagnosed type 2 diabetes or as fasting plasma glucose > or =7.0 mmol/l or 2-h postload plasma glucose > or =11.1 mmol/l at follow-up. RESULTS: Low adiponectin, high leptin, and low adiponectin-to-leptin ratio at baseline were associated with increased risk of incident type 2 diabetes after adjustment for age, sex, triglycerides, HDL cholesterol, hypertension, and impaired glucose tolerance (odds ratio 0.63 [95% CI 0.48-0.83], 1.50 [1.02-2.21], and 0.54 [0.37-0.77], respectively). When the models were additionally adjusted for waist circumference or BMI, however, only low adiponectin remained significantly associated with increased incident diabetes (0.68 [0.51-0.90]). Combinations of leptin, CRP, IL-6, and/or SAA with adiponectin, assessed using either the ratio or joint effects, did not improve diabetes prediction. CONCLUSIONS: Low baseline adiponectin is associated with increased risk of incident type 2 diabetes independent of leptin, CRP, IL-6, SAA, and metabolic syndrome variables including obesity.
To compare mortality rates across indicators of adiposity and relative adipose tissue distribution in the Canadian population.
The sample included 10,323 adult participants 20-69 y of age from the Canada Fitness Survey who were monitored for all-cause mortality over 13 y.
BMI, waist circumference (WC) and the sum of five skinfolds (SF5) were indicators of adiposity, and the first principal component of skinfold residuals (PC1) represented subcutaneous adipose tissue distribution. Proportional hazards regression was used to estimate relative mortality risk from mortality rates across levels of adiposity and adipose tissue distribution, controlling for the confounding effects of age, smoking status and alcohol consumption.
:Significant curvilinear (J-shaped) relationships in men and linear relationships in women were observed between BMI, WC and SF5 and all-cause mortality rates. PC1 was not related to mortality rates in either men or women. In women, the inclusion of the other indicators of adiposity and adipose tissue distribution did not significantly add to the prediction of mortality rates beyond BMI; however, combinations of BMI and both WC and SF5 produced significant models in men.
The results support the hypothesis that overall level of adiposity is an important predictor of all-cause mortality, more so than the relative distribution of subcutaneous body fat, once overall level of body fatness has been accounted for.
Adjuvant chemotherapy (ACT) is known to improve survival in patients with early-stage non-small cell lung cancer. Herein, we describe chemotherapy regimens used, dose modifications, survival, and treatment-related toxicity in the general population.
All cases of non-small cell lung cancer diagnosed in Ontario in the period 2004-2006 who underwent surgical resection (n = 3354) were identified using the Ontario Cancer Registry in this population-based retrospective cohort study. We linked electronic records of treatment to the registry to identify all cases treated with ACT (n = 1032) and describe drugs, regimens, and dosages delivered. As a proxy measure of ACT-related toxicity, we evaluated deaths and hospitalizations within 16 weeks of starting ACT. Factors associated with dose modification were evaluated by logistic regression. The Cox proportional hazards model was used to describe associations between patient-, disease-, and treatment-related factors and survival.
ACT regimens were identified for 584 of 1032 ACT cases. Almost all cases included cisplatin- or carboplatin-based regimens (478/584, 82%, and 99/584, 17%, respectively). The most common regimen was a vinroelbine/cisplatin doublet (412/584, 71%); 64% of these cases had a dose reduction or omission. Dose modification was not associated with inferior survival on multivariate analysis. Twelve percent of all ACT cases were admitted to hospital within 16 weeks of starting ACT, and there was a 1.6% death rate potentially attributable to ACT. Survival of all ACT cases was comparable with outcomes reported in clinical trials.
ACT regimens used, toxicity, and survival outcomes in the general population are comparable with those reported in clinical trials. Dose modifications used in clinical practice are not associated with inferior survival.