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Biomedical subjects

S J Bondy

Publications and source records attributed to S J Bondy.

17 recordsLinked to original sources
PubMed2002

Outcomes in surgery for ovarian cancer.

OBJECTIVE: Theobjective was to determine the relationship among hospital volume of ovarian cancer surgery,academic status of institution, surgical specialty, and outcomes of care (30-day postoperative mortality, reoperation rate, and overall survival). METHODS: This population-based cohort study included all newly diagnosed ovarian cancer patients treated from 1992 to 1998 in Ontario, Canada. Hospitalization and surgical billing databases were used. Logistic regression was used to evaluate the importance of hospital type, hospital volume, surgical specialty, and surgeon volume of ovarian cancer operations on postoperative mortality, reoperation rates, and survival. RESULTS: Ovarian cancer surgery was performed on 3815 women between April 1992 and March 1998. When adjusted for age, comorbidity, acuity of the operation, and metastatic disease, no factors influenced postoperative mortality. The adjusted relative risk for reoperation within 3 months of the initial surgery showed that patients were less likely to have a repeat operation if the initial operation was done in a high- or intermediate-volume hospital (RR 0.24 95% CI 0.12-0.48, RR 0.29 95% CI 0.20-0.42, respectively), a hospital with a gynecologic oncologist (RR 0.29 95% CI 0.15-0.56), by a gynecologic oncologist (RR 0.04 95% CI 0.01-0.12) or gynecologist (RR 0.37 95% CI 0.21-0.66), or by a high-volume surgeon (RR 0.09 95% CI 0.03-0.23). The adjusted survival was improved if the initial surgery was done by a gynecologic oncologist (HR 0.70 95% CI 0.57-0.85) or gynecologist (HR 0.65 95% CI 0.53-0.79). CONCLUSIONS: There is a relationship between hospital volume and reoperation rate. Institution type only influenced reoperation rate. Statistically significant associations were found between surgical specialty and all three outcome variables. The volume of surgery performed by an individual surgeon only influenced reoperation rate. Our results are preliminary but support the need for further studies examining factors such as stage.

Aged↗
PubMed2001

Trends in hormonal management of prostate cancer: a population-based study in Ontario.

OBJECTIVE: To provide a population-based description of current practice in the use of hormonal management of prostate cancer. DESIGN,SETTING & PARTICIPANTS: All men in Ontario, Canada, age 65 and older, with confirmed prostate cancer starting maintained hormonal therapy, from July 1992 through December 1998 (11,435 patients). Data sources included the provincial drug benefit plan, hospital services data, and Ontario Cancer Registry. OUTCOME MEASURES: Rates and trends in the use of: surgical or medical castration; total androgen blockade (TAB); and monotherapies based on steroidal or nonsteroidal antiandrogens. RESULTS: In 5.5 years, use of 'standard' therapy based on surgical or medical castration alone dropped from 36% to 26% of patients, while the use of TAB doubled from 22% to 41%. Approximately 15% of patients received nonsteroidal antiandrogens without evidence of therapy aimed at central androgen blockade. Marked regional differences were observed and not explained by patient age or practitioner specialty. CONCLUSIONS: New hormonal therapies for prostate cancer have implications in terms of disease control, patient survival, side effects, and costs. Rapid growth in prescribing of antiandrogens may represent an unnecessary expense for public or private payers, and observed regional differences likely reflect lack of consensus on the relative merit of TAB. Patients and practitioners must have current information on the advantages and disadvantages of different therapeutic options, and quality-of life, particularly with respect to emerging drug therapies.

Aged↗
PubMed2001

Chiropractic manipulation and stroke: a population-based case-control study.

BACKGROUND AND PURPOSE: Several reports have linked chiropractic manipulation of the neck to dissection or occlusion of the vertebral artery. However, previous studies linking such strokes to neck manipulation consist primarily of uncontrolled case series. We designed a population-based nested case-control study to test the association. METHODS: Hospitalization records were used to identify vertebrobasilar accidents (VBAs) in Ontario, Canada, during 1993-1998. Each of 582 cases was age and sex matched to 4 controls from the Ontario population with no history of stroke at the event date. Public health insurance billing records were used to document use of chiropractic services before the event date. RESULTS: Results for those aged <45 years showed VBA cases to be 5 times more likely than controls to have visited a chiropractor within 1 week of the VBA (95% CI from bootstrapping, 1.32 to 43.87). Additionally, in the younger age group, cases were 5 times as likely to have had >/=3 visits with a cervical diagnosis in the month before the case's VBA date (95% CI from bootstrapping, 1.34 to 18.57). No significant associations were found for those aged >/=45 years. CONCLUSIONS: While our analysis is consistent with a positive association in young adults, potential sources of bias are also discussed. The rarity of VBAs makes this association difficult to study despite high volumes of chiropractic treatment. Because of the popularity of spinal manipulation, high-quality research on both its risks and benefits is recommended.

Adult↗
PubMed2001

Impact of normative feedback on problem drinkers: a small-area population study.

OBJECTIVE: As many as one in four adults in North America experiences some problems due to alcohol consumption. Although most of these problem drinkers do not have concerns that are severe enough to merit formal treatment, such drinking has large economic costs and can place the drinker at risk for long-term negative health and social consequences. The present study evaluated a minimal intervention that used normative feedback about population drinking to motivate changes in alcohol use. METHOD: An intervention pamphlet was mailed to over 6,000 households in Toronto, randomized by block from a region containing almost 10,000 households. In the month after the mailing, a general population survey was conducted in the region to assess alcohol use. RESULTS: Respondents from households receiving normative feedback (n = 472) reported significantly lower alcohol use than controls (n = 225), but this effect occurred only among respondents who met an objective criterion for problem drinking and who perceived some risk associated with their drinking. CONCLUSIONS: Viewed from a public health perspective, normative feedback interventions have the potential for a significant payoff because they can be provided at low cost and to problem drinkers who might ordinarily never access any treatment services.

Adult↗
PubMed2000

Alcohol and breast cancer mortality in a cohort study.

Available epidemiological evidence indicates that alcohol intake is associated with a higher risk of developing breast cancer. Plausible biological pathways include its effect on levels of estrogens, cell membrane integrity and cell-to-cell communication, inhibition of DNA repair, and congener effect. The present study evaluated the impact of alcohol on mortality from breast cancer, an area with relatively few studies in the literature. The subjects were participants in a Canadian prospective cohort study, the National Breast Screening Study (NBSS). Women were enrolled in the cohort from 1980 to 1985 to evaluate the efficacy of mammographic screening. Information on usual diet and alcohol intake at enrolment and other epidemiological variables was collected by means of a mailed, self-administered questionnaire. Mortality from breast cancer during follow- up to 31 December, 1993 was ascertained by record linkage to the Canadian Mortality Data Base maintained by Statistics Canada. During the follow-up period of 1980-1993 (average 10.3 years), 223 deaths from breast cancer were identified for this analysis. The hazard ratios for the risk of death from breast cancer increased with intakes of total alcohol of 10-20 g/day (1.039, 1.009-1.071) and > 20 g/day ( 1.063, 1.029-1.098). This increase was contributed largely by the intake of wine, a 15% increase in risk at intakes higher than 10 g/day of alcohol from wine. Alcohol from spirits was associated with a small decrease in risk of death (hazard ratio at 10g/day, 0.945, 0.915-0.976). The effect of alcohol from beer was not significant in the two categories studied. Although our results were statistically significant, the magnitude of the change in risk was small.

Adult↗
PubMed2000

Measuring alcohol-related harm: test-retest reliability of a popular measure.

This study assessed the test-retest reliability of a measure of alcohol-related harm commonly used in cross-sectional surveys. Sixty-four respondents of a 1995 telephone survey participated in a second interview 3 to 5 months after the survey. Drinking status and average volume of alcohol consumed proved to be highly reliable. For the lifetime harm scale, correlation was satisfactory, and reliability fell just short of satisfactory agreement (kappa = 0.716). For a score of alcohol-related harm in the past year, poor reliability was shown (kappa = 0.484). Future research must place greater emphasis on objective indicators and on validation of the measures used.

Alcohol Drinking↗
PubMed1997

Alcohol consumption and coronary heart disease morbidity and mortality.

Alcohol consumption is associated with a reduced risk of coronary heart disease (CHD) but an increased risk of other causes of morbidity and mortality. It remains unclear whether there is an upper limit to a protective effect of alcohol intake on CHD risk. Whether there is a U- or an L-shaped relation between alcohol consumption and CHD incidence (hospitalization and mortality due to ischemic heart disease: International Classification of Diseases codes 410-414) is examined using the National Health and Nutrition Examination Survey I. Baseline data were collected in 1971-1975. Follow-up data through 1987 (14.6 years mean follow-up) were analyzed for 6,788 European-American males (n = 2,960) and females (n = 3,828) aged 40-75 years at baseline. Cox regression was used to assess the association between alcohol consumption and incidence of CHD. For females, an increased risk was found above 28 drinks per week relative to abstainers (relative risk = 2.6, 95% confidence interval 1.2-5.5), which was significant, but was based on small numbers. For males, no upturn in risk was found at higher intake. Mortality data supported these results. Sex differences should be explored further, since they are relevant to understanding causal mechanisms and public policy and prevention.

Adult↗
PubMed1997

The effect of question structure on self-reports of heavy drinking: closed-ended versus open-ended questions.

OBJECTIVE: We compared open-ended versus closed-ended questions on the frequency of consuming five or more drinks in a single sitting. METHOD: From a general population survey of Ontario adults (N = 2,022, 62% male), we analyzed a subsample of 649 respondents who reported drinking five or more drinks in a single sitting at least once in the past year. Differences in agreement between the two questions and rates of missing data were evaluated. RESULTS: For the most part, the two measures were not consistent, with the closed-ended question eliciting higher rates of heavier drinking. Rates of missing data were also higher for the open-ended question. CONCLUSIONS: Open-ended question may not necessarily be more suitable than closed-ended questions for estimating the frequency of heavy alcohol use.

Adult↗
PubMed1996

Overview of studies on drinking patterns and consequences.

Research on selected consequences of alcohol use are reviewed in terms of how alcohol use is measured and reported in research designs common to that area of study. In addition, evidence of the probable underlying mechanisms by which alcohol leads to the various consequences is examined, particularly in relation to the aspects of drinking pattern which are theoretically most relevant to the outcome. There is considerable variation in the degree to which research in these areas stresses pattern of drinking (as opposed to average amount consumed or total dose). Ideally, theoretical consideration of underlying causal links should determine data collection and analysis techniques.

Alcohol Drinking↗
PubMed1995

The risk of harm to oneself from drinking, Canada 1989.

In a national sample of 11,634 Canadians aged 15 years and above, risk curves for harm to six life-areas from one's own drinking and for assault by another drinker rose steadily with the respondent's volume of alcohol consumption. While drinking five or more drinks on an occasion at least once a month substantially raised the risk at a given volume of drinking, the risk rose with volume even among those not regularly drinking five or more drinks. These relationships remained in logistic regressions which controlled for gender, age and educational level. Younger respondents, those without higher education and men reported more harm for a given level of their own drinking although differences by gender disappeared above one-third of one drink per day. Three sets of guidelines for low-risk drinking--two from Canada, and one generally used in Britain--were compared in terms of the proportions of respondents reporting harm from their own drinking among those who had kept within the guideline in the previous 7 days' drinking. More restrictiveness in the guidelines was associated with substantial reductions in reported drinking-related harm.

Adolescent↗
PubMedDate not supplied

Low-risk drinking guidelines: the scientific evidence.

In 1997 the Addiction Research Foundation of Ontario and Canadian Centre on Substance Abuse released updated guidelines for low-risk alcohol consumption. This paper presents the scientific rationale behind this statement. Important comprehensive overviews on the consequences of alcohol use were studied. Formal meta-analyses on morbidity and mortality were examined wherever possible. Individual elements from similar guidelines were investigated for their scientific foundation. Limited original analyses defined risk levels by average weekly consumption. The evidence reviewed demonstrated that placing limits on both daily intake and cumulative intake over the typical week is justifiable for the prevention of important causes of morbidity and mortality. Gender-specific limits on weekly consumption were also indicated. In these updated guidelines intended for primary prevention, days of abstinence are not necessarily recommended. Intoxication should be avoided and abstinence is sometimes advisable. Available evidence does not strongly favour one alcoholic beverage over another for cardiovascular health benefits.

Adult↗
PubMedDate not supplied

Do Ontarians drink in moderation? a baseline assessment against Canadian low risk drinking guidelines.

We used the 1997 Ontario Drug Monitor, a population-based, random-digit dialing survey of 2,776 adults, to obtain a baseline assessment of alcohol drinking by Ontarians against the 1997 low-risk drinking guidelines of the Addiction Research Foundation and the Canadian Centre on Substance Abuse. Average weekly alcohol consumption and the frequency of exceeding the daily limit, estimated using the graduated frequency scale, were determined for the population overall, and by sex and age group (18-44 and 45+ years). Most Ontarians drank alcohol in a pattern associated with a low risk of health consequences. About 10% of women and 25% of men drank in a style associated with some increase in acute or long-term risk. Younger men were most likely to drink in a risky pattern. Most drinkers of middle age or older, for whom cardiovascular disease is a significant health risk, consumed alcohol in a pattern associated with cardiovascular benefit.

Adolescent↗
PubMedDate not supplied

Smoking in Ontario, 1991 to 1996.

Surveys by the Addiction Research Foundation of Ontario have produced annual estimates on smoking prevalence since 1991. This report describes the three series of telephone surveys from which these data are drawn as well as future plans to monitor tobacco use in Ontario. In addition to provision of updated descriptive results, the methodology and limitations of the data are discussed. Prevalence data for 1996 are presented from the Ontario Drug Monitor, a telephone survey of Ontario adults (n = 2721). The overall prevalence of smoking in Ontario was 27% (95% confidence interval: 25% to 29%); 23% smoked daily (95% confidence interval: 21% to 25%). There is no evidence of any decline in the prevalence of smoking since 1991, and no sex differences were found in smoking prevalence. Future reports will update trend data and provide robust regional estimates.

Adolescent↗
PubMedDate not supplied

Review of Canadian low-risk drinking guidelines and their effectiveness.

This study compared 18 low-risk drinking guidelines that were gathered from Canadian government agencies, non-government agencies, medical bodies, and public and private agencies involved in the treatment of addictions. The results show that two sets of guidelines are predominantly used in Ontario. The formulation of these guidelines was entirely independent and their intended audiences are also different. However, a direct comparison of the two guidelines shows that differences are more apparent than real. This study also examines the literature evaluating low-risk drinking guidelines Very little literature exists on evaluating low-risk drinking guidelines as vehicles for primary prevention and it is not known to what extent such guidelines influence knowledge and drinking behaviour. Future low-risk drinking recommendations should be evaluated for knowledge about standard drink units, awareness of the guidelines, use of materials and aids included in the dissemination program, and changes in behaviour from campaign exposure.

Adult↗