Introduction: This study evaluated long-term outcomes of young survivors of colorectal cancer including survival, development of acute illnesses, and childbirth. Methods: Persons aged 20-44 diagnosed with colorectal cancer and surviving at least five years were identified using the Ontario Cancer Registry and compared to randomly selected controls. Outcomes included death, admission to hospital for acute illness, and childbirth in women, determined by linkage to provincial administrative data. Results: There were 917 cancer survivors in this study. Survivors were more likely to die (HR 8.2, 95%CI [5.8, 11.6]), and require admission to hospital for acute illness (rate ratio 3.4, 95%CI [2.9, 4.1]) than controls. There was no difference in admissions for childbirth in women (HR 0.6, 95%CI [0.3, 1.4]). Conclusions: Five-year survivors of colorectal cancer remain at high risk of long-term death and illness. Aggressive surveillance for recurrent malignant disease is necessary to mitigate risk of death.

Introduction: This study evaluated long-term outcomes of young survivors of colorectal cancer including survival, development of acute illnesses, and childbirth. Methods: Persons aged 20-44 diagnosed with colorectal cancer and surviving at least five years were identified using the Ontario Cancer Registry and compared to randomly selected controls. Outcomes included death, admission to hospital for acute illness, and childbirth in women, determined by linkage to provincial administrative data. Results: There were 917 cancer survivors in this study. Survivors were more likely to die (HR 8.2, 95%CI [5.8, 11.6]), and require admission to hospital for acute illness (rate ratio 3.4, 95%CI [2.9, 4.1]) than controls. There was no difference in admissions for childbirth in women (HR 0.6, 95%CI [0.3, 1.4]). Conclusions: Five-year survivors of colorectal cancer remain at high risk of long-term death and illness. Aggressive surveillance for recurrent malignant disease is necessary to mitigate risk of death.

Colorectal cancer is the third most diagnosed cancer and second leading cause of cancer related deaths in Canada. As Ontario has the largest population in Canada, it also has great disparities in colorectal cancer incidence. The region of Timiskaming has the highest incidence for colorectal cancer, while the region of Peel has the lowest incidence for colorectal cancer in Ontario. The purpose of this study is to identify the dominant non-nutritional modifiable environmental risk factors in the region of Timiskaming compared to the region of Peel that may be associated with diverging colorectal cancer incidence rates. The three objectives of the study included performing a systematic review on available published literature, creating an assessment questionnaire tool regarding environmental exposures, and utilizing the questionnaire assessment tool within a pilot study group while expanding it into the communities of interest. Findings indicate that there are dominant non-nutritional modifiable environmental risk factors in the regions of Timiskaming and Peel that may be associated with colorectal cancer. The dominant factors identified are tobacco/smoking, alcohol use, pesticides/organochlorines, and metal toxins. Following this study, it is imperative that recommendations are directed at a community level and relate to the assessment of potential non-nutritional modifiable environmental risk factors. Future research should accompany a larger sample size, multiple participant communities, and catering of the questionnaire tool towards the communities of interest. / UOIT

This study explored female international graduate students’ experiences in the Graduate Students’ Society (GSS) at the University of Victoria. The overall question that guided this study was: How does female international graduate students’ involvement with the Graduate Students’ Society shape their learning experiences? I used an arts-based methodology, and collected data through collage and photography and discussion in a series of three focus groups. Findings showed that GSS was in invaluable space of learning for women about culture, about organisations, about diversity and also, a place to acquire organisational skills. Learning, however, was almost all done ‘individually’ and there are challenges around exclusion, and sexism. Understanding the issues of sex and race needs to be addressed and collective learning environments needs to be created within the organization. / Graduate / 0745 / 0453

The overall aim of this study was to investigate the association between family structure in childhood and mental health problems in young adulthood. A prospective cohort study was conducted with 481,777 individuals with complete follow-up information, which was obtained from national registers in Sweden. Individuals who were living with only one biological parent at age 17 were compared with those who grew up with two parents with regard to retrieval of prescribed psychotropic drugs at age 35. The association was examined by Cox regression analyses with equal survival time for all individuals included in the analyses. The results demonstrated a higher risk for retrieval of psychotropic medicines among the individuals who grew up with only one parent, with hazard ratio of 1,21 (95%CI: 1,19-1,23). The multivariate analyses showed that a part of the association was explained by familial and individual factors, namely parents’ country of origin, area of residence, parents’ and the individual’s educational attainment, receipt of social benefits and parents’ history of psychiatric disorder. The results indicated that the increased risk of mental health problems among individuals who grew up with only one parent might be accounted for by various psychological, social and economic factors associated to parental separation.

Stroke is a major cause of premature death and disability throughout the world and atrial fibrillation (AF) is one of the most common preventable causes of stroke. AF affects about 10% of individuals aged ≥80 years, but warfarin is substantially under-used in this age group despite being effective in preventing AF-related thromboembolic events. AF-related ischaemic strokes tend to be severe and incur high care costs, and non-cerebral systemic embolism secondary to AF is also a major clinical burden. Despite that, there are few population-based studies on AF-related ischaemic stroke, and no recent study of the burden of AF-related thromboembolism and the population impact of under-treatment. I have used data from the Oxford Vascular Study (OXVASC), a prospective, population-based incidence study of vascular disease in all territories, which was started in April 2002 and is on-going. The study population comprises of 92,728 individuals registered with 100 family physicians in nine general practices and uses multiple overlapping methods of “hot” and “cold” pursuit to achieve near-complete ascertainment of all patients with acute vascular events. There are several findings described by the research in this thesis which have important implications for public health and can be utilised to improve secondary prevention in stroke. First, I have shown that one-third of all incident embolic events were related to AF and 60% of AF-related embolic events occurred at ≥80 years. Second, I have shown that only 9% of patients aged ≥80 years with incident embolic event related to known prior AF were on premorbid warfarin, and consequently three quarters of those previously independent were dead or disabled six months post event. Third, I have shown that there has been no reduction in age-specific incidence of AF-related ischaemic stroke in Oxfordshire over the last 25 years. Fourth, I have shown that assuming age-specific incidence does not continue to rise, if prevention is not improved, the number of embolic events at age ≥80 years would be expected to treble by 2050 (72,975 AF-related embolic events), with 84% of events at all ages occurring at age ≥80. Fifth, I have shown through a meta-analysis that one in five incident strokes had a history of prior AF of which only 19% were on premorbid warfarin, and AF was related to one in three incident ischaemic strokes. Sixth, I have shown that 1 in 5 stroke patients with known prior AF subsequently became institutionalised and incurred high acute and long-term care costs. Seventh, I have shown that one in five patients with undetermined cerebral ischaemic event subsequently had AF-related late recurrent stroke. Eighth, I have shown that even though TIA or ischaemic stroke patients who subsequently turned out to have new AF at follow-up had significantly higher baseline NT-proBNP compared to non-AF group, its utility is limited by low sensitivity and specificity. Ninth, I have shown in another meta-analysis that the duration of cardiac monitoring after cerebral ischaemic events was the main determinant of the observed rate of pAF, and that 5-7 days of monitoring may be adequate in unselected patient populations. Finally, I have shown that using 5-day event loop recording in clinic patients with TIA and minor ischaemic stroke could detect 12% new AF and the delay in monitoring did not reduce the sensitivity of pAF detection.

INTRODUÇÃO: os principais aspectos clínicos da esquistossomose mansônica (EM) são determinados pelas lesões vasculares e suas repercussões na hemodinâmica portal. O acesso não-invasivo a essas alterações tem importância fundamental na avaliação da morbidade da doença e na identificação de pacientes com maior risco de complicações. Este estudo de campo realizado em três áreas com níveis distintos de endemicidade, objetivou: a) verificar a viabilidade da USDoppler em estudos de campo; b) identificar os sinais de morbidade relacionados à EM e correlacioná-los com a endemicidade das áreas estudadas; c) determinar os valores dopplervelocimétricos do sistema vascular esplâncnico na EM; e d) determinar as alterações hemodinâmicas na EM. CASUÍSTICA E MÉTODOS: foram examinados por meio da US-Doppler, 554 pacientes esquistossomóticos, divididos em três grupos, de acordo com o local de realização do exame: área de baixa endemicidade (n=109); área de média endemicidade (n=255) e área de alta endemicidade (n=190). Avaliaram-se o fígado, o baço, a vesícula biliar, os vasos portais, as artérias hepática e esplênica, as veias hepáticas e os vasos colaterais. Para análise da morbidade da doença, foi utilizado o protocolo do Niamey Working Group (2000). O protocolo Doppler foi elaborado para fins específicos desta pesquisa. RESULTADOS: houve correlação estatisticamente significante entre as frequências de: espessamento periportal, esplenomegalia, espessamento da parede da vesícula biliar, aumento do calibre dos vasos portais, redução do lobo direito e o nível de endemicidade das áreas. Não houve relação significativa entre a hipertrofia do lobo esquerdo e a endemicidade das áreas. Considerando-se os achados ultrassonográficos de espessamento periportal e/ou esplenomegalia, os pacientes foram alocados em quatro grupos de acordo com a forma de apresentação da doença. As formas hepatointestinal e hepatoesplênica foram mais frequentes na área de alta endemicidade, demonstrando associação significativa entre o nível de endemicidade e a gravidade da doença. A velocidade máxima de fluxo da veia porta apresentou valores normais na maioria dos casos. O fluxo hepatofugal, a trombose portal e a circulação colateral foram pouco frequentes e identificados apenas na área de alta endemicidade. A veia gástrica esquerda foi a colateral prevalente. As veias hepáticas apresentaram padrão de fluxo alterado em 1/4 dos casos, alteração essa relacionada à presença e à intensidade de espessamento periportal. A artéria hepática não apresentou alterações significativas nos parâmetros avaliados. As alterações da artéria esplênica (aumento do calibre, da velocidade de pico sistólico e do índice de resistividade) foram mais frequentes na área de alta endemicidade e na forma hepatoesplênica, com diferença significativa entre os grupos. CONCLUSÃO: a US-Doppler mostrouse viável e adequada para avaliação das alterações hemodinâmicas da EM em estudos de campo. Os sinais de morbidade detectados ultrassonograficamente são parâmetros fidedignos do nivel de endemicidade da EM, e, as informações funcionais do sistema portal obtidas pela US-Doppler, contribuem para o diagnóstico mais preciso das formas clínicas da doença nas áreas endêmicas / INTRODUCTION: The main clinical aspects of schistosomiasis mansoni (SM) are determined by vascular lesions and their effects on the portal hemodynamic. The non-invasive access to these alterations has fundamental importance in assessing the morbidity of the disease and in identifying patients at higher risk of complications. This field study, carried out in three areas with different levels of endemicity, aimed to: a) assess the feasibility of Doppler ultrasound (US) in fieldbased studies; b) identify the signs of morbidity related to SM and correlate them with the endemicity of the studied areas; c) determine the dopplervelocimetric values of the splanchnic vascular system in SM; and d) determine the hemodynamic changes in SM. PATIENTS AND METHODS: Doppler US was performed in 554 patients with SM, divided into three groups according to the local of the examination: low endemicity area (n=109), medium endemicity area (n=255), and high endemicity area (n=190). The liver, the spleen, the gallbladder, the portal vessels, the hepatic and splenic arteries, the hepatic veins and collateral vessels were evaluated. The Niamey Working Group (2000) protocol was used for the disease morbidity analysis. The Doppler protocol was developed for the specific purposes of this study. RESULTS: There was a statistically significant correlation between the frequency of: periportal thickening, splenomegaly, gallbladder wall thickening, dilatation of the portal vessels, right lobe atrophy and the endemicity level of the areas. No significant correlation between the left lobe hypertrophy and the endemicity level was observed. Taking into account the US findings of periportal thickening and/or splenomegaly, the patients were allocated in four groups according to the form of the disease. The hepatointestinal and hepatosplenic forms were more frequent in the high endemicity area, showing a significant association between the endemicity level and the disease severity. The maximum flow velocity in portal vein showed normal values in most cases. The hepatofugal flow, portal vein thrombosis and collateral vessels were infrequent and identified only in the area of high endemicity. The left gastric vein was the prevalent collateral. The hepatic veins flow pattern was abnormal in 1/4 of the cases, with significant relation to the presence and intensity of periportal thickening. The hepatic artery had no significant alterations in the evaluated parameters. The splenic artery changes (increase of its diameter, peak systolic velocity and resistive index) were more frequent in the high endemicity area and in the hepatosplenic form, with significant difference between the analysed groups. CONCLUSION: Doppler US proved to be feasible and appropriate for the evaluation of the SM hemodynamic changes in field-based studies. The morbidity signs detected by ultrasound are reliable parameters of the endemicity level of SM, and the functional information of the portal system obtained by Doppler US, contributes to a more accurate diagnosis of clinical forms of the disease in endemic areas

<p>Adverbial connectors join together sentences and units in a text to signal logical relations. Appropriately used, they can help the reader to make sense of the text. The usage of adverbial connectors can create problems for foreign language learners, and is often shown as under- , over- and misuse of connectors. In this study, a quantitative analysis of connector usage of advanced EFL learners’ and native speakers’ student writing is presented. For the current corpus-based study, three sub-corpora of the SUSEC (<em>Stockholm University Student English Corpus</em>) were chosen. The sample includes 164 linguistic essays from students at Stockholm University and 82 linguistic essays from students at King’s College in London. The analysis, where the learners’ connector usage is compared to that of native speakers, is based on 69 connectors. The results show that both the learners and the native speakers rely on a rather small set of these connectors in their writing. As a group, the advanced Swedish EFL learners underuse connectors in their written production. Additionally, the learners significantly overuse 12 and underuse 6 connectors. Similarities between the learners and the native speakers were found in the positioning of the connectors. Both groups prefer the most frequently used connectors in the medial position of a sentence, and prefer mostly the same set of connectors in the different positions of a sentence, although some differences in the positioning were also found. The findings create a basis for future research where a qualitative analysis of the connector usage could be carried out in order to increase knowledge of the interlanguage of the learners. The findings could also be used for pedagogical purposes.</p>

This thesis examined the factors correlated with rapid and benign progression of disease in a group of 1452 Parkinsons disease (PD) patients. The data were collected in a movement disorders clinic at the Royal University Hospital, University of Saskatchewan run by Dr. Alex Rajput and Dr. Ali Rajput. This data is a clinical dataset of PD patients collected from 1970 through to February, 2005. This was a retrospective cases-only study, with anticipated analytical follow-up if any correlations were detected between progression type of PD and the many independent variables available in the dataset. <p>Rapid progression was defined as those subjects who reached Hoehn and Yahr stage 3 within three years or H&Y stage 4 or 5 within five years. Subjects who remained in Hoehn and Yahr stage 1 or 2, ten years after onset of disease, were defined as having benign progression. The study analyzed demographic and clinical findings at first visit to this clinic associated with rapid and benign progression of PD. <p> Analysis revealed that, at first clinic visit, benign progression was positively associated with disease duration (OR=1.41; 95% CI 1.27, 1.57), male sex (OR=3.23; 95% CI 1.70, 6.16), and current smoking habit (OR=2.33; 95% CI 0.67, 8.11). Benign progression was negatively associated with older age of onset (OR=0.36; 95% CI 0.25, 0.50), past history of smoking (OR=0.46; 95% CI 0.24, 0.89), current or past use of levodopa (OR=0.45; 95% CI 0.21, 0.98), and mild to severe rigidity (OR=0.43; 95% CI 0.23, 0.80). <p>Analysis also revealed that, at first clinic visit, rapid progression was positively associated with older age of onset (OR=2.45; 95% CI 1.80, 3.33) and mild to severe rigidity (OR=1.73; 95% CI 1.02, 2.94). Rapid progression was negatively associated with disease duration (OR=0.52; 95% CI 0.44, 0.62), male sex (OR=0.58; CI 0.35, 0.95), and mild to severe resting tremor (OR=0.47; CI 0.28, 0.77). <p>The results of this study indicate that age of onset, disease duration, male sex, and rigidity are good potential predictors of disease progression in PD because they have opposite associations with rapid and benign progression. History of levodopa use was negatively associated with benign progression and as such may be good indicator of non-benign progression. Although previous studies found no predictive value for smoking history, the current study reported a unique association between smoking history and benign progression. Past smoking history was negatively associated with benign progression. While there was a positive association with current smoking history, the result was not statistically significant. Resting tremor was negatively associated with rapid progression and as such may be a good indicator of non-rapid progression. <p> Disease characteristics collected at first clinic visit are useful in predicting the course of progression of PD. With more rapid progression of PD closer and more frequent follow-up of patients may be necessary.

This thesis examined the factors correlated with rapid and benign progression of disease in a group of 1452 Parkinsons disease (PD) patients. The data were collected in a movement disorders clinic at the Royal University Hospital, University of Saskatchewan run by Dr. Alex Rajput and Dr. Ali Rajput. This data is a clinical dataset of PD patients collected from 1970 through to February, 2005. This was a retrospective cases-only study, with anticipated analytical follow-up if any correlations were detected between progression type of PD and the many independent variables available in the dataset. <p>Rapid progression was defined as those subjects who reached Hoehn and Yahr stage 3 within three years or H&Y stage 4 or 5 within five years. Subjects who remained in Hoehn and Yahr stage 1 or 2, ten years after onset of disease, were defined as having benign progression. The study analyzed demographic and clinical findings at first visit to this clinic associated with rapid and benign progression of PD. <p> Analysis revealed that, at first clinic visit, benign progression was positively associated with disease duration (OR=1.41; 95% CI 1.27, 1.57), male sex (OR=3.23; 95% CI 1.70, 6.16), and current smoking habit (OR=2.33; 95% CI 0.67, 8.11). Benign progression was negatively associated with older age of onset (OR=0.36; 95% CI 0.25, 0.50), past history of smoking (OR=0.46; 95% CI 0.24, 0.89), current or past use of levodopa (OR=0.45; 95% CI 0.21, 0.98), and mild to severe rigidity (OR=0.43; 95% CI 0.23, 0.80). <p>Analysis also revealed that, at first clinic visit, rapid progression was positively associated with older age of onset (OR=2.45; 95% CI 1.80, 3.33) and mild to severe rigidity (OR=1.73; 95% CI 1.02, 2.94). Rapid progression was negatively associated with disease duration (OR=0.52; 95% CI 0.44, 0.62), male sex (OR=0.58; CI 0.35, 0.95), and mild to severe resting tremor (OR=0.47; CI 0.28, 0.77). <p>The results of this study indicate that age of onset, disease duration, male sex, and rigidity are good potential predictors of disease progression in PD because they have opposite associations with rapid and benign progression. History of levodopa use was negatively associated with benign progression and as such may be good indicator of non-benign progression. Although previous studies found no predictive value for smoking history, the current study reported a unique association between smoking history and benign progression. Past smoking history was negatively associated with benign progression. While there was a positive association with current smoking history, the result was not statistically significant. Resting tremor was negatively associated with rapid progression and as such may be a good indicator of non-rapid progression. <p> Disease characteristics collected at first clinic visit are useful in predicting the course of progression of PD. With more rapid progression of PD closer and more frequent follow-up of patients may be necessary.