Breaking Down Barriers to Detection and Care in Early-Age-Onset Colorectal Cancer in Canada.

The second Early-Age-Onset Colorectal Cancer Symposium, convened in October 2022, sought solutions to the barriers to early detection and care for colorectal cancer in Canada. This meeting built on a previous symposium, held in 2021 and reported in this journal. Early-age-onset colorectal cancer (EAOCRC) affects increasing numbers of people under the age of 50 in Canada and throughout the developed world. Two main themes emerged from the meeting: the importance of timely detection, and the need for a tailored approach to the care of EAOCRC. Early detection is crucial, especially in light of the later stage at diagnosis and unique tumour characteristics. Symposium participants were strongly in favour of reducing the age of eligibility for screening from 50 to 45, and promoting the development of non-invasive screening techniques such as testing for circulating tumour DNA and biomarkers. Leading approaches to care were described and discussed, which meet the unique treatment needs of younger CRC patients. Multidisciplinary practices within and outside Canada address such factors as fertility, family roles, education, careers and financial responsibilities. These models can be applied in treatment centres across the country.

Mental health services in Canada: Barriers and cost-effective solutions to increase access.

In this article, an overview of the barriers to accessing mental health services in Canada is provided and the recent federal funding commitments toward increasing the availability of evidence-based and cost-effective solutions to improve access to mental health services are highlighted. Barriers pertain mainly to costs, not knowing where to get help, excessive wait times, and insufficient funding. Through the Common Statement of Principles on Shared Health Priorities agreement, action is being taken by all jurisdictions in Canada to increase community-based mental health promotion programs and early interventions, especially those targeting children and youth. A growing body of evidence is demonstrating how specific community and primary care-based interventions are both effective and cost-effective. These integrated community solutions, shown to be effective for increasing access to appropriate services for patients while saving costs to the healthcare system, would benefit from the recent funding investments put in place by the federal government.

A model for exercise behavior change regulation in patients with heart disease.

Despite the known benefits of habitual exercise in patients with heart disease, less than half of these patients exercise regularly and many of those who initiate programs fail to maintain physical activity routines over the long term. The aim of this research was to examine processes related to short- and long-term regulation of exercise to gain a clearer understanding of why people might fail to maintain intended behavioral changes. We modeled intention formation and plan formulation to investigate the distinct roles of self-efficacy and motivation (self-determination) in different phases of behavior change. Our results showed self-efficacy to be more relevant to exercise intentions and motivation to exercise planning. This research provides evidence supporting the proposition that the psychological processes related to short- and long-term regulation of behavior change differ and suggests that people might fail to continue regulating intended behavior owing to a lack of self-determined motivation.

"A heart for Vienna"--the prevention program for the big city. Blue-collar workers as a special target group.

OBJECTIVES: To create awareness of cardiovascular health status by screening for cardiovascular risk factors, and thereby motivate people to improve their life style habits. This was carried out in form of a project within the framework of the government prevention programme "A Heart for Vienna" focussing on urban blue-collar workers, a population at greatest risk for developing cardiovascular disease. RESULTS: The prevalence of hypertension, overweight, obesity, abdominal obesity and smoking were 29.7 %, 62.4 %, 16.4 %, 29.3 %, and 49.8 %, respectively. 87.6 % presented at least one of the screened cardiac risk factors. The prevalence of hypertension, overweight, obesity and abdominal obesity increased with age. Hypertension, overweight and abdominal obesity were significantly more prevalent among unskilled compared to skilled male bluecollar workers. The prevalence of obesity and abdominal obesity was more than 1.5 times higher among female compared to male blue-collar workers. CONCLUSION: Blue-collar workers represent a population where health promotion and prevention of cardiovascular disease should have high priority. Within the bluecollar group itself the cardiovascular risk profile worsened with reduction in skill level.

Stepped care approach to smoking cessation in patients hospitalized for coronary artery disease.

PURPOSE: Smoking cessation is an important goal for smokers with coronary artery disease (CAD) because it reduces cardiac morbidity and mortality. Effective interventions for cigarette smokers with CAD exist, but they often are considered to be intensive and expensive. Stepped-care interventions have been proposed as a promising way to allocate smoking cessation treatments in a cost-effective manner. Stepped care refers to the practice of initiating treatment with low-intensity intervention and then exposing treatment failures to successively more intense interventions. METHODS: To address the efficacy of this approach, 254 cigarette smokers hospitalized with CAD were provided a brief cessation intervention. The participants then were assigned randomly to either a more intensive stepped-care treatment (counseling and nicotine patch therapy) or no additional treatment. Outcomes were point-prevalent abstinence measured 3 months and 1 year after hospital discharge. RESULTS: Stepped-care treatment increased smoking cessation rates from 42% to 53% during a 3-month follow-up period (P =.05), but showed little effect at the 1-year follow-up assessment, as evidenced by a cessation rate for the minimal intervention group of 36% versus 39% for the stepped-care group (P =.36). CONCLUSIONS: A stepped-care approach to smoking cessation increased short-but not long-term point-prevalent abstinence in patients with CAD. For improvement of long-term effectiveness, refinement of the timing and content of stepped-care interventions needs to occur.

Dietary counselling for dyslipidemia in primary care: results of a randomized trial.

This study compared the effectiveness of physician advice versus dietitian advice for a fat-reduced diet, and of dietitian advice for a fat-reduced diet versus a soluble fibre-enhanced diet in patients with moderate dyslipidemia. A total of 111 men and women took part in this 26-week, three-group, randomized, clinical trial. The physician advice fat-reduced diet group (n = 38) and the dietitian advice fat-reduced diet group (n = 35) received dietary advice based on the American Heart Association (AHA) Step II guidelines. The dietitian advice soluble fibre-enhanced diet group (n = 38) consumed one-third cup per day of psyllium-containing cereal and was advised to increase soluble fibre intake to over 10 grams a day. LDL-C, TC/HDL-C ratio and body weight reductions over six months were -5.3%, -4.6%, and -1.9%, respectively, regardless of whether a physician or a dietitian provided advice, or whether advice was focused on a fat-reduced diet or a soluble fibre-enhanced diet. Both dietitians and physicians can help moderately dyslipidemic patients make clinically meaningful changes in blood lipid levels. Soluble fibre enhancement of the usual diet leads to similar reductions in LDL-C and TC/HDL-C ratio compared to interventions focused on fat reduction.