Population Studies and Surveillance

Toronto, Canada

Population Studies and Surveillance

Toronto, Canada
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Harris S.A.,Population Studies and Surveillance | Harris S.A.,University of Toronto | Harris S.A.,Occupational Cancer Research Center
American Journal of Infection Control | Year: 2010

Background: Little is known about compliance with universal precautions (CUP) or occupational exposures to blood and body fluids among Emergency Medical Services (EMS) providers. The objective of this study was to obtain estimates of CUP and knowledge of universal precautions (KUP), occupational exposures, and needle and lancet sticks in the prehospital environment. Methods: A convenience sample of workers (n=311, 51% response) from 17 agencies in Virginia that provided emergency ground transportation (volunteer, commercial, government rescue squads, and fire departments) completed a questionnaire on certification and training, KUP, CUP, exposures and needlesticks, risk perceptions, and demographic variables. Results: Nearly all EMS providers reported exposures and were concerned about risk of HIV and hepatitis. Providers reported inconsistent CUP when treating patients or using needles, including failure to wear gloves (17%) and to appropriately dispose of contaminated materials (79%), including needles (87%), at all times. Certification type (advanced and basic) was related to both KUP and CUP. Of those respondents reporting current sharps use, 40% recapped needles. A lancet stick was reported by 1.4% (n=5), and 4.5% reported a needlestick (n=14). Conclusion: EMS providers working in the prehospital environment experience significant exposures but are not consistently using universal precautions. © 2010 Association for Professionals in Infection Control and Epidemiology, Inc.


Gorey K.M.,University of Windsor | Fung K.Y.,University of Windsor | Luginaah I.N.,University of Western Ontario | Holowaty E.J.,Population Studies and Surveillance | Hamm C.,Clinical Trials and Research
Breast Journal | Year: 2010

Effects of socioeconomic status on the long-term survival of 808 women with node-negative breast cancer in Canada and the United States were observed. Ontario and California samples diagnosed between 1988 and 1990 were followed until 2006. Socioeconomic data were taken from population censuses. Compared with their California counterparts, residents of low-income urban areas in Ontario experienced a significant 15-year survival advantage (RR = 1.66 [95% CI: 1.00, 2.76]). In these and other vulnerable, lower-middle- to working-class neighborhoods, significantly more Ontario residents gained access to adjuvant radiation therapy (RR = 1.75 [1.21, 2.53]) which seemed associated with better long-term survival (RR = 1.36 [0.99, 1.86]). This stage-adjusted, historical cohort analysis suggests much greater cancer care equity in Canada than in the United States. © 2010 Wiley Periodicals.


Gorey K.M.,University of Windsor | Luginaah I.N.,University of Western Ontario | Hamm C.,Clinical Trials and Research | Fung K.Y.,University of Windsor | Holowaty E.J.,Population Studies and Surveillance
Health and Place | Year: 2010

This study examined the differential effect of extreme impoverishment on breast cancer care in urban Canada and the United States. Ontario and California registry-based samples diagnosed between 1998 and 2000 were followed until 2006. Extremely poor and affluent neighborhoods were compared. Poverty was associated with non-localized disease, surgical and radiation therapy (RT) waits, non-receipt of breast conserving surgery, RT and hormonal therapy, and shorter survival in California, but not in Ontario. Extremely poor Ontario women were consistently advantaged on care indices over their California counterparts. More inclusive health insurance coverage in Canada seems the most plausible explanation for such Canadian breast cancer care advantages. © 2009 Elsevier Ltd. All rights reserved.


Brouwers M.C.,Program in Evidence based Care | Brouwers M.C.,McMaster University | De Vito C.,Program in Evidence based Care | De Vito C.,McMaster University | And 13 more authors.
Implementation Science | Year: 2011

Background: Appropriate screening may reduce the mortality and morbidity of colorectal, breast, and cervical cancers. However, effective implementation strategies are warranted if the full benefits of screening are to be realized. As part of a larger agenda to create an implementation guideline, we conducted a systematic review to evaluate interventions designed to increase the rate of breast, cervical, and colorectal cancer (CRC) screening. The interventions considered were: client reminders, client incentives, mass media, small media, group education, one-on-one education, reduction in structural barriers, reduction in out-of-pocket costs, provider assessment and feedback interventions, and provider incentives. Our primary outcome, screening completion, was calculated as the overall median post-intervention absolute percentage point (PP) change in completed screening tests.Methods: Our first step was to conduct an iterative scoping review in the research area. This yielded three relevant high-quality systematic reviews. Serving as our evidentiary foundation, we conducted a formal update. Randomized controlled trials and cluster randomized controlled trials, published between 2004 and 2010, were searched in MEDLINE, EMBASE and PSYCHinfo.Results: The update yielded 66 studies new eligible studies with 74 comparisons. The new studies ranged considerably in quality. Client reminders, small media, and provider audit and feedback appear to be effective interventions to increase the uptake of screening for three cancers. One-on-one education and reduction of structural barriers also appears effective, but their roles with CRC and cervical screening, respectively, are less established. More study is required to assess client incentives, mass media, group education, reduction of out-of-pocket costs, and provider incentive interventions.Conclusion: The new evidence generally aligns with the evidence and conclusions from the original systematic reviews. This review served as the evidentiary foundation for an implementation guideline. Poor reporting, lack of precision and consistency in defining operational elements, and insufficient consideration of context and differences among populations are areas for additional research. © 2011 Brouwers et al; licensee BioMed Central Ltd.


Weir H.K.,Centers for Disease Control and Prevention | Marrett L.D.,Population Studies and Surveillance | Cokkinides V.,American Cancer Society | Barnholtz-Sloan J.,Case Western Reserve University | And 6 more authors.
Journal of the American Academy of Dermatology | Year: 2011

Background: Invasive melanoma of the skin is the third most common cancer diagnosed among adolescents and young adults (aged 15-39 years) in the United States. Understanding the burden of melanoma in this age group is important to identifying areas for etiologic research and in developing effective prevention approaches aimed at reducing melanoma risk. Methods: Melanoma incidence data reported from 38 National Program of Cancer Registries and/or Surveillance Epidemiology and End Results statewide cancer registries covering nearly 67.2% of the US population were used to estimate age-adjusted incidence rates for persons 15-39 years of age. Incidence rate ratios were calculated to compare rates between demographic groups. Results: Melanoma incidence was higher among females (age-adjusted incidence rates = 9.74; 95% confidence interval 9.62-9.86) compared with males (age-adjusted incidence rates = 5.77; 95% confidence interval 5.68-5.86), increased with age, and was higher in non-Hispanic white compared with Hispanic white and black, American Indians/Alaskan Natives, and Asian and Pacific Islanders populations. Melanoma incidence rates increased with year of diagnosis in females but not males. The majority of melanomas were diagnosed on the trunk in all racial and ethnic groups among males but only in non-Hispanic whites among females. Most melanomas were diagnosed at localized stage, and among those melanomas with known histology, the majority were superficial spreading. Limitations: Accuracy of melanoma cases reporting was limited because of some incompleteness (delayed reporting) or nonspecific reporting including large proportion of unspecified histology. Conclusions: Differences in incidence rates by anatomic site, histology, and stage among adolescents and young adults by race, ethnicity, and sex suggest that both host characteristics and behaviors influence risk. These data suggest areas for etiologic research around gene-environment interactions and the need for targeted cancer control activities specific to adolescents and young adult populations. © 2011 by the American Academy of Dermatology, Inc.


Ghosh S.,Alberta Health Services Cancer Care | McLaughlin J.R.,Population Studies and Surveillance | McLaughlin J.R.,University of Toronto | McLaughlin J.R.,Samuel Lunenfeld Research Institute | And 5 more authors.
Journal of Occupational and Environmental Medicine | Year: 2011

OBJECTIVE: The present study aims to identify occupational exposures associated with incidence of multiple myeloma (MM). METHODS: A population-based case-control study of MM (ICD-9 203) was conducted among Canadian males, with a total of 342 cases and 1506 controls contributing to the final analyses. Conditional logistic regression was used to estimate odds ratios (OR) and confidence intervals (CI), stratifying by age groups and province of residence. RESULTS: Based on the most parsimonious multivariable model, the following variables were significantly associated with an increased incidence of MM: exposure to coal dust (OR 1.7, 95% CI 1.2-2.4), long-held occupations as a carpenter (OR 3.2, 95% CI 1.4-7.1) or a machinist (OR 2.4, 95% CI 1.0-5.8); and immediate family member having been previously diagnosed with certain cancers (OR 1.4, 95% CI 1.1-1.8). CONCLUSION: In this study of Canadian men, a higher risk of MM may be associated with exposure to coal dust, long-held occupations as a carpenter or machinist, and a positive family history of cancer. ©2011The American College of Occupational and Environmental Medicine.


Xie L.,Public Health Agency of Canada | Brisson J.,Laval University | Holowaty E.J.,Population Studies and Surveillance | Holowaty E.J.,University of Toronto | And 2 more authors.
International Journal of Cancer | Year: 2010

This study aimed to determine whether cosmetic breast implants impair the early detection of breast cancer, and adversely influence survival. This analysis derives from a cohort of 24,558 women who received bilateral cosmetic breast implants, and 15,893 women who underwent other plastic surgery procedures at the same practices in Ontario and Quebec, Canada, between 1974 and 1989. Incident cancers and vital status through 1997 were determined by record linkage to the Canadian Cancer Registry and Canadian Mortality Database. Analyses are based on a total of 182 and 202 incident cases of breast cancer identified among the implant and control groups, respectively. Contingency table analyses were performed to test for differences in the stage distribution of breast cancers between the 2 groups. Potential differences in survival were evaluated using the Kaplan-Meier estimates and Cox proportional hazards models. Women who received breast implants were more likely to have advanced stage breast carcinoma relative to the other plastic surgery patients (crude and adjusted ps < 0.01). No statistically significant differences in distributions between the implant and control patients were found for age at diagnosis, tumor size, histological type, period of diagnosis or length of follow-up. The delayed diagnosis in augmented women did not appear to influence the overall prognosis. Breast cancer-specific survival was similar in both groups (hazard ratio 5 1.06; 95% confidence interval 5 0.65-1.74). In conclusion, this study suggests that breast implants delay the detection of breast cancer, but there was no statistically significant difference in survival between the breast implant and other plastic surgery groups. © 2009 UICC.


Agalliu I.,Yeshiva University | Kirsh V.A.,Population Studies and Surveillance | Kirsh V.A.,University of Toronto | Kreiger N.,Population Studies and Surveillance | And 3 more authors.
Cancer Epidemiology | Year: 2011

Background: Prostate cancer is a disease with a complex etiology. Oxidative stress has been implicated in its pathogenesis; however, few prospective studies have investigated the association between an oxidative stress/balance score and risk of prostate cancer. Methods: We investigated associations between an oxidative balance score, calculated as the summation of individual scores obtained from five pro-oxidative and eight anti-oxidative exposures, as well as each individual constituent of the score and risks of prostate cancer overall, and by clinical characteristics, in a case-cohort study (661 cases and 1864 subcohort) nested within the Canadian Study of Diet, Lifestyle, and Health cohort. Men in the lowest quintiles of each pro-oxidant exposure received a score of four (the highest score), while those in the highest quintile received a score of zero (the lowest score). In contrast, scoring for all anti-oxidants was performed in the opposite way. Total oxidative balance score was calculated by summating all individual scores of pro- and anti-oxidative variables, with higher values indicating a higher antioxidant status. Results: The average oxidative balance score was similar between prostate cancer cases and men in the subcohort: 25.2 and 25.3, respectively. There was no association between oxidative balance score and overall risk of prostate cancer with hazard ratios (HRs) of 1.00, 1.02, 1.03, 0.97 and 1.01 for increasing quintiles of the score (p-trend = 0.71). There were also no associations for non-advanced or advanced disease, or when analysis was restricted to incident cases that arose after two years of follow-up (n = 508). In general constituents of the score were not associated with prostate cancer, except for red meat intake (HR = 1.44; 95%CI 1.06-1.95 comparing Q5 vs. Q1) and lycopene (HRs of 0.7-0.8 for increasing quintiles). Conclusion: Our findings do not support an association between oxidative balance score and risks of overall prostate cancer or advanced disease. © 2010 Elsevier Ltd.


Martin L.J.,Ontario Cancer Institute | Melnichouk O.,Ontario Cancer Institute | Guo H.,Ontario Cancer Institute | Chiarelli A.M.,Population Studies and Surveillance | And 5 more authors.
Cancer Epidemiology Biomarkers and Prevention | Year: 2010

Purpose: Mammographic density is a strong and highly heritable risk factor for breast cancer. The purpose of this study was to examine the extent to which mammographic density explains the association of family history of breast cancer with risk of the disease. Subjects and Methods: We carried out three nested case-control studies in screening programs that included in total 2,322 subjects (1,164 cases and 1,158 controls).We estimated the independent and combined associations of family history and percent mammographic density at baseline with subsequent breast cancer risk. Results: After adjustment for age and other risk factors, compared with women with no affected first-degree relatives, percent mammographic density was 3.1% greater for women with one affected first-degree relative, and 7.0% greater for women with two or more affected relatives (P = 0.001 for linear trend across family history categories). The odds ratios for breast cancer risk were 1.37 [95% confidence interval (95% CI), 1.10-1.72] for having one affected relative, and 2.45 (95% CI, 1.30-4.62) for having two or more affected relatives (P for trend = 0.0002). Adjustment for percent mammographic density reduced these odds ratios by 16% and 14%, respectively. Percent mammographic density explained 14% (95% CI, 4-39%) of the association of family history (at least one affected first-degree relative) with breast cancer risk. Conclusions: Percent mammographic density has features of an intermediate marker for breast cancer, and some of the genes that explain variation in percent mammographic density might be associated with familial risk of breast cancer. ©2010 AACR.


Squires J.,Memorial University of Newfoundland | Roebothan B.,Memorial University of Newfoundland | Buehler S.,Memorial University of Newfoundland | Sun Z.,Memorial University of Newfoundland | And 7 more authors.
Cancer Causes and Control | Year: 2010

Objective: Although a large body of epidemiological research suggests that red meat intake increases the risk of colorectal cancer, little is known regarding how such an association varies across populations and types of red meat. The objective of this study was to assess whether an association exists between the intakes of total red meat and pickled red meat and the risk of colorectal cancer in study subjects residing in Newfoundland and Labrador. Methods: This case-control study of 1,204 residents of Newfoundland and Labrador was part of a larger study on colorectal cancer. Personal history food frequency questionnaires were used to collect retrospective data from 518 individuals diagnosed with colorectal cancer and 686 controls. Intakes were ranked and divided into tertiles. Logistic regression was used to examine the possible association between meat intakes and colorectal cancer diagnosis while controlling for possible confounding factors. Results: A positive, but non-statistically significant, association between total red meat intake and CRC was observed in this study. Pickled red meat consumption was found to be significantly associated with an increased risk of CRC (men, OR = 2.07, 95% CI 1.37-3.15; women, OR = 2.51, 95% CI 1.45-4.32), the odds ratios increasing with each tertile of consumption, suggesting a dose-response effect. Conclusion: Intake of pickled red meat appears to increase the risk of colorectal cancer in Newfoundland and Labrador. © 2010 Springer Science+Business Media B.V.

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