Palliative care that provides specialized attention to pain and symptom management is important for patients with cancer. Palliative care aims to reduce pain and other symptoms through an interdisciplinary approach involving physicians, nurses, social workers, and other members of the healthcare team. Families are included in care planning. Patients and families benefit from the availability of palliative care services early in the disease process, particularly when symptoms impact quality of life. One way to implement early palliative interventions is the establishment of an ambulatory care clinic dedicated to palliative care. This article describes the experience of an outpatient palliative care clinic at a large teaching hospital by using case studies to highlight the benefits of ambulatory palliative care and concluding with recommendations for research.
National health surveys are sometimes used to provide estimates on risk factors for policy and program development at the regional/local level. However, as regional/local needs may differ from national ones, an important question is how to also enhance capacity for risk factor surveillance regionally/locally. A Think Tank Forum was convened in Canada to discuss the needs, characteristics, coordination, tools and next steps to build capacity for regional/local risk factor surveillance. A series of follow up activities to review the relevant issues pertaining to needs, characteristics and capacity of risk factor surveillance were conducted. Results confirmed the need for a regional/local risk factor surveillance system that is flexible, timely, of good quality, having a communication plan, and responsive to local needs. It is important to conduct an environmental scan and a gap analysis, to develop a common vision, to build central and local coordination and leadership, to build on existing tools and resources, and to use innovation. Findings of the Think Tank Forum are important for building surveillance capacity at the local/county level, both in Canada and globally. This paper provides a follow-up review of the findings based on progress over the last 4 years.
First Nations (FN) women historically have low rates of preventive care, including breast cancer screening. We describe the frequency of breast cancer screening among FN women living in Manitoba and all other Manitoba (AOM) women after the introduction of a provincial, organized breast screening program and explore how age, area of residence, and time period influenced breast cancer screening participation.
The purpose of this paper is to examine the impact of a province-wide physical education (PE) policy on secondary school students' moderate to vigorous physical activity (MVPA).Policy: In fall 2008, Manitoba expanded a policy requiring a PE credit for students in grades 11 and 12 for the first time in Canada. The PE curriculum requires grades 11 and 12 students to complete a minimum of 55 h (50% of course hours) of MVPA (e.g., ≥30 min/day of MVPA on ≥5 days a week) during a 5-month semester to achieve the course credit.A natural experimental study was designed using two sub-studies: 1) quasi-experimental controlled pre-post analysis of self-reported MVPA data obtained from census data in intervention and comparison [Prince Edward Island (PEI)] provinces in 2008 (n = 33,619 in Manitoba and n = 2258 in PEI) and 2012 (n = 41,169 in Manitoba and n = 4942 in PEI); and, 2) annual objectively measured MVPA in cohorts of secondary students in intervention (n = 447) and comparison (Alberta; n = 224) provinces over 4 years (2008 to 2012).In Study 1, two logistic regressions were conducted to model the odds that students accumulated: i) ≥30 min/day of MVPA, and ii) met Canada's national recommendation of ≥60 min/day of MVPA, in Manitoba versus PEI after adjusting for grade, sex, and BMI. In Study 2, a mixed effects model was used to assess students' minutes of MVPA per day per semester in Manitoba and Alberta, adjusting for age, sex, BMI, school location and school SES.In Study 1, no significant differences were observed in students achieving ≥30 (OR:1.13, 95% CI:0.92, 1.39) or ≥60 min/day of MVPA (OR:0.92, 95% CI: 0.78, 1.07) from baseline to follow-up between Manitoba and PEI. In Study 2, no significant policy effect on students' MVPA trajectories from baseline to last follow-up were observed between Manitoba and Alberta overall (-1.52, 95% CI:-3.47, 0.42), or by covariates.The Manitoba policy mandating PE in grades 11 and 12 had no effect on student MVPA overall or by key student or school characteristics. However, the effect of the PE policy may be underestimated due to the use of a nonrandomized research design and lack of data assessing the extent of policy implementation across schools. Nevertheless, findings can provide evidence about policy features that may improve the PE policy in Manitoba and inform future PE policies in other jurisdictions.
The purpose of this study was to determine if participation in physical education (PE) was associated with increased moderate-to-vigorous physical activity (MVPA) levels in adolescents.This was a cross sectional study comparing MVPA levels in senior-years students-grade 11 and 12-enrolled in high school PE during the semester data were collected compared with those not enrolled in PE in that same semester. The primary outcome measure was daily MVPA measured by accelerometry. The primary exposure was participation in PE.Among the 508 adolescents (16.9 ± 0.8 yrs, 49% female, n = 338 exposed to PE) studied, no differences in MVPA (47.0 ± 25.8 vs. 43.9 ± 25.0 mins/day, P = .25) or sedentary time (540.2 ± 94.7 vs. 550.2 ± 79.4 mins/day, P = .79) were noted between students enrolled in PE compared with students not enrolled in PE. Participation in PE was associated with a greater odds of achieving >60 minutes of MVPA daily (OR: 1.69; 95% CI: 1.04-2.75). This association was stronger among boys (OR: 2.4; 95% CI: 1.2-4.8) than girls (OR: 1.17; 95% CI: 0.5-2.7).Enrollment in PE in grade 11 or 12 is associated with modestly higher levels of MVPA and an increased likelihood of meeting PA guidelines among students in grades 11 and 12, particularly among boys.
There has been a rapid increase in screening for colorectal cancer (CRC) over the past several years in North America. This could paradoxically lead to worsening outcomes if the system is not adapted to deal with the increased demand. For example, this could create increased wait times for endoscopy and delayed time to CRC diagnosis, which could worsen clinical outcomes such as stage at diagnosis and⁄or survival. No previous Canadian study has evaluated the association between time to CRC diagnosis and clinical outcomes.The present historical cohort study used Manitoba's population-based cancer registry and Manitoba Health administrative databases. The effect of time to diagnosis on patient survival was evaluated using Cox regression analysis with adjustment for stage at diagnosis, grade of CRC, age, sex, socioeconomic status, comorbidity index score and year of CRC diagnosis. The association between time to diagnosis and CRC stage at diagnosis was evaluated using multivariate logistic regression analysis.The median time to CRC diagnosis increased significantly from 72 days (95% CI 61 days to 83 days) in 2004 to 105 days (95% CI 64 days to 129 days) in the first three months of 2009 (P=0.04). There was no significant association between time to diagnosis and survival. Individuals with the longest time to diagnosis were less likely to have stage III⁄IV CRC at diagnosis (quartile 4 versus quartile 1: OR 0.50 [95% CI 0.33 to 0.75).Time to CRC diagnosis is continuing to increase in Manitoba. Although the present study did not detect a significant negative clinical effect of increasing time to diagnosis, additional studies are required.
There is increasing interest in mathematical methods for the prediction of medical outcomes. Three methods have attracted particular attention: logistic regression, classification trees (such as ID3 and CART), and neural networks. To compare their relative performance, we used a large clinical database to develop and compare models using these methods.Each modeling method was used to generate predictive instruments for acute cardiac ischemia (which includes acute myocardial infarction and unstable angina pectoris), using prospectivel-collected clinical data on 5773 patients, who presented over a two year period to six hospitals' emergency departments with chest pain or symptoms suggesting acute ischemia. This data set was then split into training (n = 3453) and test (n = 2320) sets. Of 200 available variables, modeling was restricted to those available within the first 10 minutes of emergency department care (history, physical exam, and electrocardiogram).When the number of variables was limited to eight, representing a practical number for input in the real-time clinical setting, the logistic regression's receiver-operating characteristic (ROC) curve area, as a measure of diagnostic performance, was 0.887; the classification tree model's ROC curve area was 0.858, and the neural network's ROC curve area was 0.902. When the number of variables used by a model was not limited, the logistic regression's ROC area was 0.905, the classification tree model's 0.861, and the neural network's 0.923. Among these models the neural networks had noticeably poorer calibration. When the outputs from each of these unrestricted models were presented to each of the other methods as an additional independent variable, the ROC areas of the new "hybrid" models were not significantly better than the original unlimited models (ROC areas 0.858 to 0.920).Logistic regression, classification tree, and neural network models all can provide excellent predictive performance of medical outcomes for clinical decision aids and policy models. Their ultimate limitations seem due to the availability of the information in data (a "data barrier") rather than their respective intrinsic properties. Choices between these methods would seem to be most appropriately based on the needs of the specific application, rather than on the premise that any one of these methods is intrinsically more powerful.
Abstract In 2006, schools, communities and regional health authorities (RHAs) in Manitoba, Canada recognized the need for local risk factor surveillance data, and formed Partners in Planning for Healthy Living (PPHL) to pool in kind human resources, financial support and expertise in the pursuit of this common goal. PPHL was established as a network of partners involving collaboration with all Manitoba's RHAs, Manitoba Education, Manitoba Healthy Living (Healthy Schools program), Healthy Child Manitoba, Manitoba Health, NGOs, Manitoba Physical Education Supervisors' Association and the Public Health Agency of Canada Manitoba/Saskatchewan division. Between 2005 and 2008, PPHL implemented the Youth Health Survey (YHS) to explore the physical activity, healthy eating, BMI, tobacco use, substance use and school connectedness of Manitoba's youth. The survey was administered to students in grades 6-12 at more than 400 schools across Manitoba including First Nations, francophone and independent schools (n= 48,449). Local-level reports were provided to schools, school divisions and RHAs. The YHS data has been used extensively by schools, regional health authorities and other community health partners to help in planning and implementing healthy school policies and programs with support from Manitoba Healthy Living, RHAs and other community partners. The data has also provided a baseline for the evaluation of the recently implemented Grades 11 and 12 Active Healthy Lifestyles: Physical Education/Health Education curriculum. Secondary analysis of the data has recently begun to delve deeper into the relationships among the variables. One of the key areas of analysis is childhood obesity and its related factors. Obesity and its causes are major contributing factors to the development of certain cancers. Childhood obesity rates are rising at an alarming pace and as such, the development of programs aimed at curbing this rise is of primary importance to PPHL and its members. Recent research has provided information on the lifelong risks of childhood obesity which leads to healthy eating and adequate physical activity being top priorities in Manitoba. The purpose of our study is to identify factors related to and contributing to obesity levels of the children and youth who participated in the Manitoba YHS. A multilevel logistic regression approach with students nested within schools will be used to investigate both student- and school-level factors associated with (1) being underweight vs. a healthy weight and (2) being overweight vs. a healthy weight. Partners working and learning together has strengthened and developed relationships between health, education and communities. The partnerships have been critical to improving the health of our students in MB. The second cycle of the YHS will be implemented in all Manitoba schools this fall (2012). Citation Format: Jane Griffith, Tannis Erickson, Katherine Fradette, Oliver Bucher, Carly Leggett, Kate McGarry, Elizabeth Harland. Raising healthy youth: Using the Manitoba Youth Health Survey to identify predictive factors of childhood obesity. [abstract]. In: Proceedings of the Eleventh Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2012 Oct 16-19; Anaheim, CA. Philadelphia (PA): AACR; Cancer Prev Res 2012;5(11 Suppl):Abstract nr B74.
