Lung cancer is often diagnosed at a late stage with high associated mortality. Timely diagnosis depends on timely referral to a respiratory specialist; however, in Canada, little is known about how ...patients move through primary care to get to a respiratory specialist. Accordingly, we aimed to identify and describe lung cancer pre-diagnostic pathways in primary care from first presentation to referral.
In this retrospective cohort study, patients with primary lung cancer were recruited using consecutive sampling (
= 50) from a lung cancer center in Montréal, Québec. Data on healthcare service utilization in primary care were collected from chart reviews and structured patient interviews and analyzed using latent class analysis to identify groups of patients with similar pre-diagnostic pathways. Each group was described based on patient- and tumor-related characteristics and the sequence of utilization activities.
68% of the patients followed a pathway where family physician (FP) visits were dominant ("FP-centric") and 32% followed a pathway where walk-in clinic and emergency department (ED) visits were dominant ("ED-centric"). Time to referral in the FP group was double that of the ED group (45 days (IQR: 12-111) vs. 22 (IQR: 5-69)) with more advanced disease (65% vs. 50%). In the FP group, 29% of the patients saw their FP three times or more before being referred and 41% had an ED visit.
Our findings may reflect the challenge of diagnosing lung cancer in primary care, missed opportunities for earlier diagnosis, and a lack of integration between primary and specialist care.
Purpose
Antihypertensive drugs in general are beneficial for bone formation and remodeling, and are associated with lower risk of bone fractures. As osseointegration is influenced by bone metabolism, ...this study aimed to investigate the association between antihypertensive drugs and the survival rate of osseointegrated implants.
Materials and Methods
This retrospective cohort study included a total of 1,499 dental implants in 728 patients (327 implants in 142 antihypertensive‐drugs‐users and 1,172 in 586 nonusers). Multilevel mixed effects parametric survival analyses were used to test the association between antihypertensive drugs use and implant failure adjusting for potential confounders.
Results
Only 0.6% of the implants failed in patients using antihypertensive drugs while 4.1% failed in nonusers. A higher survival rate of dental implants was observed among users of antihypertensive drugs HR (95% CI): 0.12 (0.03–0.49) compared to nonusers.
Conclusions
Our findings suggest that treatment with antihypertensive drugs may be associated with an increased survival rate of osseointegrated implants. To our knowledge, this could be the first study showing that the systemic use of a medication could be associated with higher survival rate of dental implants.
Periodontitis is characterized by inflammation of the periodontium and leads to loss of teeth if untreated. Although a number of surgical and pharmacological options are available for the management ...of periodontitis, it still affects a large proportion of population. Recently, metformin (MF), an oral hypoglycemic, has been used to treat periodontitis. The aim of this review is to systematically evaluate the efficacy of MF in the treatment of periodontitis. An electronic search was carried out using the keywords ‘metformin’, ‘periodontal’ and ‘periodontitis’ via the PubMed/Medline, ISI Web of Science and Google Scholar databases for relevant articles published from 1949 to 2016. The addressed focused question was: ‘Is metformin effective in reducing bone loss in periodontitis? Critical review and meta-analysis were conducted of the results obtained in the selected studies. Following the removal of the duplicate results, the primary search resulted in 17 articles and seven articles were excluded based on title and abstract. Hence, 10 articles were read completely for eligibility. After exclusion of four irrelevant studies, six articles were included. The topical application of MF resulted in improved histological, clinical and radiographic outcomes. Additionally, results from the meta-analysis indicated that application of metformin improved the clinical and radiographic outcomes of scaling and root-planing, but at the same time heterogeneity was evident among the results. However, because of a lack of histological and bacterial studies, in addition to short follow-up periods and risk of bias, the long-term efficacy of MF in the treatment of bony defects is not yet ascertained. Further studies are needed to envisage the long-term efficacy of MF in the management of periodontitis.
Introduction
Acetylcholinesterase inhibitors (AChEIs) are commonly used to treat mild to moderate cases of Alzheimer disease (AD). To the best of our knowledge, there has been no study estimating the ...risk of bleeding and cardiovascular events in patients with non‐hypertensive AD. Therefore, this study aimed to estimate the association between AChEIs and the risk of bleeding and cardiovascular ischemic events in patients with non‐hypertensive AD.
Methods
A nested case‐control study was conducted to estimate the risk of bleeding and ischemic events (angina, myocardial infarction MI, and stroke) in patients with AD. This study was conducted using the UK Clinical Practice Research Datalink and Hospital Episode Statistics (HES) databases. The study cohort consisted of AD patients ≥65 years of age. The case groups included all AD subjects in the database who had a bleeding or ischemic event during the cohort follow‐up. Four controls were selected for each case. Patients were classified as current users or past users based on a 60‐day threshold of consuming the drug. Simple and multivariable conditional logistic regression analyses were used to calculate the adjusted odds ratio for bleeding events and cardiovascular events.
Results
We identified 507 cases and selected 2028 controls for the bleeding event cohort and 555 cases and 2220 controls for the ischemic event cohort. The adjusted odds ratio (OR) (95% confidence interval CI) for the association of AChEI use was 0.93 (0.75 to 1.16) for bleeding events, 2.58 (1.01 to 6.59) for angina, and 1.89 (1.07 to 3.33) for MI. Past users of AChEIs were also at increased risk of stroke (1.51 1.00 to 2.27).
Discussion
This is the first study assessing the risk of bleeding and cardiovascular events in patients with non‐hypertensive AD. Our findings could be of great interest for clinicians and researchers working on AD.
Objective
To describe the personal and professional behavior and assess the perceptions of protection and fear of contracting coronavirus disease 2019 (COVID‐19) among faculty, staff, and students ...from all 10 Canadian dental schools during the second year of the pandemic.
Method
Participants from a Pan‐Canadian prospective study answered monthly questionnaires about their activities between April 2021 and March 2022. In May 2022, additional questions were asked about their perception of protection, fear of infection, and instances of COVID‐19 testing.
Results
Six hundred participants were initially recruited. Over time, the participants spent less time at home and increased their participation in indoor social activities, a trend influenced by the fluctuations in COVID‐19 cases (β = ‒0.02). Over 90% of the participants were fully vaccinated, which decreased their fear of contracting the virus (χ24, 241‒243 = 196.07, p < 0.0001). Yet, their attitude toward protective measures did not change, and they followed them within school.
Conclusions
This work shows a paradoxical behavior among dental students, staff, and faculty members in Canadian dental schools. While factors such as the vaccine's limited efficacy and a desire to protect others may contribute to stringent protective behaviors within dental schools, the mandatory nature of these measures was likely the primary motivator for the compliance. Despite potential efforts to minimize exposure to the virus during risk periods and the frequent COVID‐19 testing, this paradoxical behavior raises questions about professional responsibilities extending beyond the workplace. Thus, dental schools should incorporate education about the rationale behind following different protocols and the potential consequences of outside school behaviors.
Some studies suggest that periodontal diseases increase the risk of oral cancer, but contradictory results also exist. Inadequate control of confounders, including life course exposures, may have ...influenced prior findings. We estimate the extent to which high levels of periodontal diseases, measured by gingival inflammation and recession, are associated with oral cancer risk using a comprehensive subset of potential confounders and applying a stringent adjustment approach. In a hospital‐based case‐control study, incident oral cancer cases (N = 350) were recruited from two major referral hospitals in Kerala, South India, from 2008 to 2012. Controls (N = 371), frequency‐matched by age and sex, were recruited from clinics at the same hospitals. Structured interviews collected information on several domains of exposure via a detailed life course questionnaire. Periodontal diseases, as measured by gingival inflammation and gingival recession, were evaluated visually by qualified dentists following a detailed protocol. The relationship between periodontal diseases and oral cancer risk was assessed by unconditional logistic regression using a stringent empirical selection of potential confounders corresponding to a 1% change‐in‐estimates. Generalized gingival recession was significantly associated with oral cancer risk (Odds Ratio = 1.83, 95% Confidence Interval: 1.10–3.04). No significant association was observed between gingival inflammation and oral cancer. Our findings support the hypothesis that high levels of periodontal diseases increase the risk of oral cancer.
What's new?
Can gum disease predict the onset of oral cancer? As with many such questions, there's data supporting both sides. A new report comes down on the side of yes—periodontal disease is associated with risk of oral cancer. It's a complex question, because both gum disease and oral cancer share certain established risk factors, such as smoking. These authors applied stringent criteria to correct for potential confounders. They evaluated periodontal disease by measuring inflammation and recession of the gums and determined that gingival recession—but not inflammation—did significantly associate with oral cancer risk.
Identifying life periods during which social conditions have the highest impact on risk of common cancers in a population may help to reveal their underlying shared social mechanisms. We used the ...life course framework to estimate the extent to which life course SEP is associated with risk of nine cancers. In addition, we tested whether these associations conform to a critical period or cumulative life course model. Data were from a population‐based case–control study of occupational exposures and cancer conducted in Montreal, Canada. Participants were males aged 35–70 years (n = 2,547) residing in the Montreal metropolitan area with primary, histologically confirmed cancers diagnosed between 1979 and 1985. Population controls (n = 512) were sampled from electoral lists. SEP was measured at three different periods of life based on respondent's report: during childhood, young adulthood and mid‐life. We used a structured modeling approach using a series of unconditional logistic regressions to test which models best fit the data. Life course SEP increased the risk of all cancers. SEP in childhood was identified as a critical period for prostate and all gastrointestinal tract cancers except for esophagus cancer. In addition, the accumulation model best explained the data for melanoma and lung squamous cell carcinoma. Our findings suggest that childhood social circumstances are a common risk factor for several cancers among men; our results provide insights into the mechanisms involved in the etiology of nine cancers.
What's new?
While evidence suggests that cancer is associated with life course socioeconomic position (SEP), little is known about which life periods and social circumstances have the greatest impact on cancer risk. Here, among men residing in Montreal, Canada, life course SEP was associated with increased risk of all cancers investigated. Disadvantageous SEP in childhood was a critical determinant, being associated with later increases in the risk of various gastrointestinal cancers and prostate cancer. Accumulation models further revealed associations between advantageous SEP and elevated melanoma risk and between disadvantageous SEP and increased risk of lung squamous cell carcinoma.
Highlights • Does-dependent risk for oral cancer associated with betel quid chewing is nonlinear. • Risk attenuates at high doses among ever users of paan. • Betel quid chewing increases risk of oral ...cancer by 3-fold, even at low doses.
Highlights • There is little information on human papillomaviruses and head and neck cancers among Canadians. • We conducted a large case-control study of head and neck cancers in Montreal, Canada. • ...HPV increased head and neck cancer risk, most strongly for the oropharynx subsite.
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