Carbohydrate intake in children - associations with dietary intakes, growth, serum lipids,and dental health. The STRIP Project

This study is part of the STRIP study, which is a long-term, randomized controlled trial, designed to decrease the exposure of children in the intervention group (n=540) to known risk factors of atherosclerosis. The main focus of the intervention was the quality of dietary fat. The control group (n=522) did not receive any individualized counselling. Food consumption was evaluated with food records, and blood samples were drawn and growth was measured regularly for all participating children from 13 months to 9 years. A subsample of 66 children participated in a dental health survey. The number of studies on children’s carbohydrate intake, especially fibre intake, is insufficient. The current international recommendations for fibre intake in children are based on average assumptions and data extrapolated from intakes in adults and intake recommendations for adults. Finnish nutrition recommendations lack strict recommendations for dietary fibre in children. Due to fibre’s high bulk volume, excessive dietary fibre is considered to decrease energy density and hence it may have an adverse effect on growth. If fats are reduced from the diet, the low-fat diet may become high in sucrose. Therefore, especially in the STRIP study, it is important to determine the use of fibre and sucrose in children and possible associations with growth and nutrition as well as dental health. The results of the present study indicate that a high fibre intake does not displace energy or disturb growth in children and that children with high fibre intake have better quality of diet than those with low fibre intake. Additionally, dietary fibre intake associated inversely with serum cholesterol concentration. Other carbohydrates also affected serum lipid levels as well, since total carbohydrates, sucrose, and fructose increased serum triglyceride concentration. Total carbohydrate intake reduced HDL cholesterol concentration only in children with apoE3 or apoE4 phenotype. Over the period from the 1970s to the 1990s the dental health of children in Finland has substantially improved despite an increase in sucrose intake. The improvement was thought to be due to improved dental hygiene and the use of fluorine. However, during the past twenty years improvement in dental health has stopped. The present study showed that high long-term sugar intake increases risk of caries in children. High intake of sugar had also negative effects on the diet of children, because it worsens dietary quality by displacing essential nutrients. Furthermore, the quality of dietary fat was worse in children with high sucrose intake. In this study the children’s high sucrose intake was not associated with overweight, but interestingly, it associated inversely with growth.

Relationship between the quality of life and the severity of obstructive sleep apnea syndrome

The effects of sleep disorders on the quality of life (QOL) have been documented in the literature. Excessive sleepiness and altered circadian rhythms may negatively affect ability to learn, employment, and interpersonal relations, and directly degrade QOL. The objective of the present study was to evaluate the impact of obstructive sleep apnea syndrome of varying severity on QOL. The study was conducted on 1892 patients aged 18 years or older referred by a physician to the Sleep Institute, São Paulo, with complaints related to apnea (snoring, excessive daytime sleepiness, hyperarousal, and fatigue). They were submitted to overnight polysomnography for the diagnosis of sleep disorders from August 2005 through April 2006. The patients completed the Epworth Sleepiness Scale and QOL SF-36 sleep questionnaires. They were classified as non-physically active and physically active and not-sleepy and sleepy and the results of polysomnography were analyzed on the basis of the apnea hypopnea index (AHI). The apneic subjects showed a reduction in QOL which was proportional to severity. There was a significant decrease in all domains (physical functioning, role physical problems, bodily pain, general health perceptions, vitality, social functioning, emotional problems, general mental health) for apneics with AHI >30, who generally were sleepy and did not participate in physical activities (P < 0.05). The present study provides evidence that the impact of sleep disorders on QOL in apneics is not limited to excessive daytime sleepiness and that physical activity can contribute to reducing the symptoms. Thus, exercise should be considered as an adjunct interventional strategy in the management of obstructive sleep apnea syndrome.

Effect of aerobic training on EEG alpha asymmetry and depressive symptoms in the elderly: a 1-year follow-up study

The effect of physical exercise on the treatment of depressive elderly adults has not been investigated thus far in terms of changes in cortical hemispheric activity. The objective of the present study was to identify changes in depressive symptoms, quality of life, and cortical asymmetry produced by aerobic activity. Elderly subjects with a diagnosis of major depressive disorder (DSM-IV) were included. Twenty patients (70% females, 71 ± 3 years) were divided into an exercise group (pharmacological treatment plus aerobic training) and a control group (undergoing pharmacological treatment) in a quasi-experimental design. Pharmacological treatment was maintained stable throughout the study (antidepressants and anxiolytics). Subjects were evaluated by depression scales (Beck Depression Inventory, Hamilton Depression Rating Scale, Montgomery-Asberg Depression Rating Scale) and the Short Form Health Survey-36, and electroencephalographic measurements (frontal and parietal alpha asymmetry) before and after 1 year of treatment. After 1 year, the control group showed a decrease in cortical activity on the right hemisphere (increase of alpha power), which was not observed in the exercise group. The exercise group showed a significant decrease of depressive symptoms, which was not observed in the control group. This result was also accompanied by improved treatment response and remission rate after 1 year of aerobic exercise associated with treatment. This study provides support for the effect of aerobic training on alpha activity and on depressive symptoms in elderly patients. Exercise facilitates the treatment of depressive elderly adults, leading to clinical and physical improvement and protecting against a decrease in cortical activity.

Group cognitive behavior therapy for bipolar disorder can improve the quality of life

Bipolar disorder (BD) can have an impact on psychosocial functioning and quality of life (QoL). Several studies have shown that structured psychotherapy in conjunction with pharmacotherapy may modify the course of some disorders; however, few studies have investigated the results of group cognitive behavior therapy (G-CBT) for BD. Our objective was to evaluate the effectiveness of 14 sessions of G-CBT for BD patients, comparing this intervention plus pharmacotherapy to treatment as usual (TAU; only pharmacotherapy). Forty-one patients with BD I and II participated in this study and were randomly allocated to each group (G-CBT: N = 27; TAU: N = 14). Thirty-seven participants completed the treatment (women: N = 66.67%; mean age = 41.5 years). QoL and mood symptoms were assessed in all participants. Scores changed significantly by the end of treatment in favor of the G-CBT group. The G-CBT group presented significantly better QoL in seven of the eight sub-items assessed with the Medical Outcomes Survey SF-36 scale. At the end of treatment, the G-CBT group exhibited lower scores for mania (not statistically significant) and depression (statistically significant) as well as a reduction in the frequency and duration of mood episodes (P < 0.01). The group variable was significant for the reduction of depression scores over time. This clinical change may explain the improvement in six of the eight subscales of QoL (P < 0.05). The G-CBT group showed better QoL in absolute values in all aspects and significant improvements in nearly all subscales. These results were not observed in the TAU control group.

Negative emotions affect postoperative scores for evaluating functional knee recovery and quality of life after total knee replacement

This study aimed to determine whether psychological factors affect health-related quality of life (HRQL) and recovery of knee function in total knee replacement (TKR) patients. A total of 119 TKR patients (male: 38; female: 81) completed the Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), State Trait Anxiety Inventory (STAI), Eysenck Personality Questionnaire-revised (EPQR-S), Knee Society Score (KSS), and HRQL (SF-36). At 1 and 6 months after surgery, anxiety, depression, and KSS scores in TKR patients were significantly better compared with those preoperatively (P<0.05). SF-36 scores at the sixth month after surgery were significantly improved compared with preoperative scores (P<0.001). Preoperative Physical Component Summary Scale (PCS) and Mental Component Summary Scale (MCS) scores were negatively associated with extraversion (E score) (B=-0.986 and -0.967, respectively, both P<0.05). Postoperative PCS and State Anxiety Inventory (SAI) scores were negatively associated with neuroticism (N score; B=-0.137 and -0.991, respectively, both P<0.05). Postoperative MCS, SAI, Trait Anxiety Inventory (TAI), and BAI scores were also negatively associated with the N score (B=-0.367, -0.107, -0.281, and -0.851, respectively, all P<0.05). The KSS function score at the sixth month after surgery was negatively associated with TAI and N scores (B=-0.315 and -0.532, respectively, both P<0.05), but positively associated with the E score (B=0.215, P<0.05). The postoperative KSS joint score was positively associated with postoperative PCS (B=0.356, P<0.05). In conclusion, for TKR patients, the scores used for evaluating recovery of knee function and HRQL after 6 months are inversely associated with the presence of negative emotions.

Associação entre trabalho, renda e qualidade de vida de receptores de transplante renal no município de Teresina, PI, Brasil

Introdução: Avaliar qualidade de vida de receptores de transplante renal tem sido uma maneira de determinar o impacto do transplante no cuidado de saúde e no tratamento subsequente de caráter crônico. Objetivo: Analisar a associação entre renda, trabalho e qualidade de vida de pessoas submetidas a transplante renal. Métodos: A amostra foi composta por 147 pessoas, com média de 74,3 meses de realização do transplante. Na coleta de dados, foram utilizados: instrumento de avaliação socioeconômica e o questionário Medical Outcome Study 36 - Item Short - Form Health Survey, validado no Brasil. Realizou-se análise bivariada por meio do teste U de Mann-Whitney. Resultados: A média da qualidade de vida relacionada à saúde para o componente físico foi 63,8 (DP = 29,4), e para o componente mental, 65,6 (DP = 29,2). A análise bivariada mostrou que o exercício da atividade laboral e renda familiar superior a três salários mínimos associaram-se significativamente com uma melhor qualidade de vida. Conclusão: A atividade laboral é significativa para os receptores de transplante renal, e atenção especial deve ser dada pela equipe multiprofissional na busca de estratégias que favoreçam e incentivem sua manutenção e reinserção no mercado de trabalho.

Exploring the relationship between ethnicity and hypertension in Canada

Background: Previous work examining differences in hypertension across ethnic groups employ race as the principal variable. While differences in hypertension have been identified across racial groups, there is great variation between ethnic groups amongst racial groupings that could mask differences in hypertension and cardiovascular disease (CVD) risk. In light of Canada's ethnic diversity, research aimed at identifying specific groups that are at a health disadvantage is essential for understanding the health of the overall population. In addition, this research would be beneficial for creating programs and policies aimed at reducing or eliminating these disparities. Since CVD is the leading cause of mortality in Canada and hypertension is one of the most significant and modifiable risk factors for CVD, it is important to move past crude classifications based on race and examine ethnic group differences. The purpose of this study is to examine the relationship between ethnicity and hypertension in Canada, while employing more narrow classifications for ethnicity than previous studies. In addition, because ethnicity has been shown to be representative of an individual's social experience, this study also aims to investigate whether this relationship can be explained by one or all of the following variable: socioeconomic status, physical activity, body mass index, smoking status, daily alcohol consumption or acculturation. Methods. This study used the 2004 Canadian Community Health Survey, cycle 2.1 to compare 29 different ethnic groups in Canada on whether they had high blood pressure that had been diagnosed by a health professional. Associations were examined using logistic regression. Subsequent logistic regression analyses included socioeconomic status, physical activity, body mass index, smoking status, daily alcohol consumption and acculturation to test for the effect of each of these variables on the relationship between ethnicity and hypertension. Results. Ukrainians, Chinese, Portuguese, South Asians, Aboriginals, Blacks, Filipinos and South East Asians were found to have significantly higher odds of having high blood pressure than Canadians (OR's = 1.50, 1.56, 2.72, 1.38, 1.36, 1.66, 2.21 & 2.24 respectively, p<.001). In addition, the only significant mediating effects were between SES and Aboriginals as well as obesity and Aboriginals. None of the other independent variables accounted for >10% of the risk experienced by the ethnic groups that were significantly associated with hypertension. Interpretation: The odds of having high blood pressure in Canada varies considerably across ethnic groups within racial groups indicating previous research is not specific enough to inform policy and program development. Because this study was not able to explain this relationship using the sociodemographic and lifestyle factors mentioned above, future research should be done to determine what places certain ethnic groups at a greater risk in order to tailor interventions aimed at reducing high blood pressure that are suited to the specific needs of each cultural group.

The impact of the Canadian Standardized Test of Fitness and of health counselling on health attitudes and behaviour

The purpose of this research study was to determine whether or not the use of a single day of Personal Wellness Evaluations would be meaningful enough to change the attitudes of participants toward adopting a healthier lifestyle, or if it was necessary to include regular planned health counselling alon-g with the Personal Wellness Evaluations in order to'observe changes in beliefs, attitudes and behaviours toward active living and the adoption of a healthier lifestyle. Attitudes and behaviours toward physical fitness and healthy lifestyle choices were assessed through a questionnaire composed of the following instruments: Fishbein and Ajzen Attitude and Behaviour Questionnaire, Leisure Behaviour Questionnaire, Ten Centimeter Bipolar Health Continuum, Neugarten Life Satisfaction Assessment, Job Description Index, Selected questions from the Ontario Health Survey, and the Symptom Reporting Questionnaire. Physical fitness evaluation consisted of the Canadian Standardized Test of Fitness, measures of blood pressure, and total cholesterol. The participants were divided into three groups: Group 1- CSTF & health counselling, Group 2- CSTF only, and Group 3- a control group. All three groups received the questionnaire both at the beginning and at the end of the study. Group 1 and Group 2 also participated in fitness testing at these same times, with a three-month time interval between test times. Group 1 also received weekly one-hour health education sessions during the three months between fitness testing. While there were some differences found between the three groups in this study, the results of this study suggested that this three-month workplace wellness program had no impact on the participants' attitudes and behaviours toward health and physical activity. There were no significant differences in the physical fitness measures between Group 1 and Group 2 , nor in the participants' questionnaire responses. These results may be due to the participants' lack of compliance to this wellness program. Employees who 11 participate in a workplace weIlness program must be self-motivated to comply with the program in order to receive the full benefits the program has to offer. Some participants in this study did not have the internal motivation necessary to remain in the study for the three-month period. Future research may consider implementing a workplace wellness program for a longer duration as well as incorporating a specific physical fitness program for the participants to follow. An exercise program could improve the participants' physical fitness, while the health counselling would give the individuals the health education necessary to lead a healthy lifestyle.

“Weathering a Hidden Storm”: An Application of Andersen’s Behavioral Model of Health, and Health Services Use for Those with Diagnosable Anxiety Disorder

Abstract: Research has primarily focused on depression and mood disorders, but little research has been devoted to an examination of mental health services use amongst those with diagnosable anxiety disorder (Wittchen et al., 2002; Bergeron et al., 2005). This study examined the possible predicting factors for mental health services utilization amongst those with identifiable anxiety disorder in the Canadian population. The methods used for this study was the application of Andersen’s Behavioral Model of Health Services Use, where predisposing, need and enabling characteristics were regressed on the dependent variable of mental health services use. This study used the Canadian Community Health Survey (cycle 1.2: Mental Health and Well-Being) in a secondary data analysis. Several multiple logistics models predicted the likelihood to seek and use mental health services. Predisposing characteristics of gender and age, Enabling characteristics of education and geographical location, and those with co-occurring mood disorders were at the greatest increased likelihood to seek and use mental health services.

"Weathering a hidden storm" : an application of Andersen's behavioral model of health, and health services use for those with diagnosable anxiety disorder

"Weathering a Hidden Storm": An App~ication of Andersen's Behaviora~ Mode~ of Hea~th, and Hea~th Services Use for Those With Diagnosab~e Anxiety Disorder Research has primarily focused on depression and mood disorders, but little research has been devoted to an examination of mental health services use amongst those with diagnosable anxiety disorder (Wittchen et al., 2002; Bergeron et al., 2005). This study examined the possible predicting factors for mental health services utilization amongst those with identifiable anxiety disorder in the Canadian population. The methods used for this study was the application of Andersen's Behavioral Model of Health Services Use, where predisposing, need and enabling 111 characteristics were regressed on the dependent variable of mental health services use. This study used the Canadian Community Health Survey (cycle 1.2: Mental Health and Well- Being) in a secondary data analysis. Several multiple logistics models predicted the likelihood to seek and use mental health services. Predisposing characteristics of gender and age, Enabling characteristics of education and geographical location, and those with co-occurring mood disorders were at the greatest increased likelihood to seek and use mental health services.

The Effect of Functional Electrically Stimulated Ambulation Training on Locomotor Function and Quality of Life in Individuals With Incomplete Spinal Cord Injury

The purpose of this study was to investigate the effects of a 12-week FES-ambulation program on locomotor function and quality of life after incomplete spinal cord injury. Six individuals with incomplete SCI participated in the study. Over-ground walking endurance (6MWT), speed (10MWT), independence (WISCI II) and body-weight support were assessed. Quality of life was assessed via the SF-36, WHOQOL-BREF, Perceived Stress Scale, Center of Epidemiological Studies for Depression scale, and task self-efficacy. Participants experienced significant improvements in walking endurance (223.6±141.5m to 297.3±164.5m; p=0.03), body-weight support (55.3±12.6% to 14.7±23.2%; p= 0.005) and four of the six participants showed improvements on the WISCI II scale (1-4 points). In addition, there was a significant reduction in reported bodily pain (6.5±1.2 to 5.0±1.7; p=0.04). Therefore, FES-ambulation is an effective means for enhancing over-ground locomotor function in individuals with incomplete SCI. It may also be an effective method for reducing pain in individuals with SCI.

Quality of life in multiple sclerosis: translation in French Canadian of the MSQoL-54

Affiliation: Louise Lafortune: Faculté de médecine, Université de Montréal

La détresse psychologique et les problèmes cardiovasculaires chez les travailleurs: une étude transversale de la comorbidité

L’objectif principal de ce mémoire consiste à déterminer s’il existe une association entre la détresse psychologique et les problèmes cardiovasculaires chez les travailleurs, suite à l’influence de certains facteurs professionnels. Les données proviennent de l’Enquête sur la santé dans les communautés canadiennes (cycle 3.1 de l’ESCC), menée par Statistique Canada en 2005. Notre échantillon est composé de 15 394 canadiens et canadiennes en emploi de 15 ans et plus, représentatif sur le plan de l’âge, du genre et de la distribution géographique du lieu de résidence. Les analyses de régressions logistiques montrent que quatre facteurs professionnels présentent une association significative avec la détresse psychologique : les demandes psychologiques, la menace de perdre son emploi, le soutien social au travail, la satisfaction au travail. Puis, trois facteurs s’avèrent être reliés au développement de problèmes cardiovasculaires, soit l’utilisation des compétences, la satisfaction au travail ainsi que le nombre d’heures travaillées. Les analyses de variances multiples (MANOVA) révèlent que la détresse psychologique est associée aux problèmes cardiovasculaires et que ces deux problèmes de santé peuvent se retrouver en situation de comorbidité. Selon les résultats, on observe que cinq facteurs sont significativement corrélés à la présence de détresse psychologique en même qu’un problème cardiovasculaire : les demandes psychologiques, la menace de perdre son emploi, le soutien social au travail, la satisfaction au travail ainsi que le nombre d’heures travaillées. Par ailleurs, l’utilisation des compétences, l’autonomie décisionnelle et les exigences physiques de travail ne sont pas significativement associés à la détresse psychologique et à la présence de problèmes cardiovasculaires.

Facteurs environnementaux associés à un asthme mal maîtrisé chez les enfants montréalais

Problématique : Plusieurs expositions résidentielles ont été associées à la prévalence de l’asthme. Toutefois, peu d’études populationnelles ont examiné la relation entre ces facteurs et un asthme mal maîtrisé chez l’enfant. Objectif : Évaluer les facteurs environnementaux résidentiels associés à un asthme mal maîtrisé chez les enfants montréalais âgés de 6 mois à 12 ans. Méthodes : Les données sont tirées d’une enquête transversale menée en 2006 sur la santé respiratoire d’enfants montréalais âgés de 6 mois à 12 ans (n=7980). La maîtrise de l’asthme a été évaluée chez les enfants avec un asthme actif au cours de l’année précédent l’enquête (n=980) selon des critères recommandés par les lignes directrices canadiennes sur l’asthme. Les rapports de prévalence (RP) et les intervalles de confiance (IC) à 95 % caractérisant l’association entre les facteurs environnementaux, incluant la présence d’allergènes, d’irritants, d’humidité et de moisissures, et le risque d’un asthme mal maîtrisé ont été estimés à l’aide de modèles de régression log-binomiale. Les sujets avec une maîtrise acceptable de l’asthme ont été comparés à ceux dont la maladie était mal maîtrisée. Résultats : Des 980 enfants avec un asthme actif au cours de l’année précédant l’enquête, 36 % ont rencontré au moins un des critères des lignes directrices canadiennes suggérant un asthme mal maîtrisé. Les caractéristiques de la population associées à un asthme mal maîtrisé sont : un plus jeune âge, des antécédents d’atopie parentale, une faible scolarisation de la mère, une mère d’origine étrangère et le statut de locataire. Après ajustement pour l’âge de l’enfant, l’atopie parentale et l’exposition à la fumée de tabac au domicile, une intensité de trafic élevée à proximité du domicile (RP, 1,35; IC 95 %, 1,00-1,81) et la localisation au sous-sol de la chambre de l’enfant ou de sa résidence (RP 1,30; IC 95 %, 1,01-1,66) étaient associées à un risque accru d’asthme mal maîtrisé. Conclusions : Une maîtrise sous-optimale de l’asthme semble être associée à l’exposition au trafic routier et à des conditions d’humidité excessive et probablement de moisissures. Cette dernière exposition étant plus fréquente, elle a probablement un plus grand impact en matière de santé publique.

Lumbar-sacral pedicle screw insertion with preoperative CT-based navigation

Objectif: Nous avons effectué une étude chez 135 patients ayant subis une chirurgie lombo-sacrée avec vissage pédiculaire sous navigation par tomographie axiale. Nous avons évalué la précision des vis pédiculaires et les résultats cliniques. Méthodes: Cette étude comporte 44 hommes et 91 femmes (âge moyen=61, intervalle 24-90 ans). Les diamètres, longueurs et trajectoires des 836 vis ont été planifiés en préopératoire avec un système de navigation (SNN, Surgical Navigation Network, Mississauga). Les patients ont subi une fusion lombaire (55), lombo-sacrée (73) et thoraco-lombo-sacrée (7). La perforation pédiculaire, la longueur des vis et les spondylolisthesis sont évalués par tomographies axiales postopératoires. Le niveau de douleur est mesuré par autoévaluations, échelles visuelles analogues et questionnaires (Oswestry et SF-36). La fusion osseuse a été évaluée par l’examen des radiographies postopératoires. Résultats: Une perforation des pédicules est présente pour 49/836 (5.9%) des vis (2.4% latéral, 1.7% inférieur, 1.1% supérieur, 0.7% médial). Les erreurs ont été mineures (0.1-2mm, 46/49) ou intermédiaires (2.1 - 4mm, 3/49 en latéral). Il y a aucune erreur majeure (≥ 4.1mm). Certaines vis ont été jugées trop longues (66/836, 8%). Le temps moyen pour insérer une vis en navigation a été de 19.1 minutes de l΄application au retrait du cadre de référence. Un an postopératoire on note une amélioration de la douleur des jambes et lombaire de 72% et 48% en moyenne respectivement. L’amélioration reste stable après 2 ans. La dégénérescence radiologique au dessus et sous la fusion a été retrouvée chez 44 patients (33%) and 3 patients respectivement (2%). Elle est survenue en moyenne 22.2 ± 2.6 mois après la chirurgie. Les fusions se terminant à L2 ont été associées à plus de dégénération (14/25, 56%). Conclusion: La navigation spinale basée sur des images tomographiques préopératoires est une technique sécuritaire et précise. Elle donne de bons résultats à court terme justifiant l’investissement de temps chirurgical. La dégénérescence segmentaire peut avoir un impact négatif sur les résultats radiologique et cliniques.