Prevalence of self-reported visual impairment among people in Canada with and without diabetes: findings from population-based surveys from 1994 to 2014.

BACKGROUND: Diabetes, a leading cause of visual impairment, is on the rise in Canada. We assessed trends in the prevalence of visual impairment among people in Canada with and without diabetes to inform the development of strategies and policies for the management of visual impairment. METHODS: We analyzed self-reported data from respondents aged 45 years and older in 7 cycles of nationwide surveys (National Population Health Survey and Canadian Community Health Survey) from 1994/95 to 2013/14. The age- and sex-standardized prevalence of visual impairment was calculated. We assessed comparisons by levels of education and income, using sex-standardized prevalence owing to sparse data. RESULTS: Among people in Canada with diabetes, the age- and sex-standardized prevalence of visual impairment was 7.37% (95% confidence interval [CI] 5.31%-9.43%) in 1994/95 and 1996/97 combined, decreasing to 3.03% (95% CI 2.48%-3.57%) in 2013/14, giving a standardized prevalence ratio of 0.41 (95% CI 0.30-0.56) comparing 2013/14 with 1994/95 and 1996/97 combined. Among people in Canada without diabetes, visual impairment prevalence decreased from 3.72% (95% CI 3.31%-4.14%) in 1994/95 and 1996/97 combined to 1.69% (95% CI 1.52%-1.87%) in 2013/14, with a standardized prevalence ratio of 0.45 (95% CI 0.40-0.52). Decreased sex-standardized prevalence of visual impairment was observed among people with high and low education levels and incomes among those with and without diabetes. INTERPRETATION: Visual impairment prevalence was roughly 2 times higher among those with versus without diabetes in all survey years; from 1994 to 2014, visual impairment prevalence decreased among those with and without diabetes irrespective of education and income levels. These results suggest effective collective efforts by clinicians, researchers, the public and government.

Cataract prevalence following a nationwide policy to shorten wait time for cataract surgery.

Background: Cataract is an age-related eye disease. Visual impairment from cataract can be restored by cataract surgery. In 2004 the Canadian federal government invested in a multibillion dollar wait time strategy to shorten the wait time for cataract surgery, a government-insured health service in all Canadian jurisdictions. We assessed if this nationwide policy reduced the number of Canadians waiting for cataract surgery as more individuals with cataract were free of cataract following the rapidly conducted surgery. Methods: In this cross-sectional study we analyzed data from randomly selected individuals aged ≥ 45 years responding to the Canadian Community Health Survey (CCHS) in 2000/2001, 2003, 2005, and the CCHS Healthy Aging in 2008/2009. Information on cataract was obtained from self-reported questionnaire. The age- and sex-standardized prevalence of cataract was calculated for comparisons. Results: Cataract was reported by 0.93 million Canadians in 2000/2001, 0.99 million in 2003, 1.10 million in 2005, and 1.34 million in 2008/2009. This corresponds to an age- and sex-standardized prevalence of 8.9% in 2000/2001, 9.0% in 2003, 9.5% in 2005, and 10.2% (P <0.05) in 2008/2009. The increase in age- and sex-standardized prevalence was greater in individuals without secondary school graduation than those with secondary school graduation or higher (4.3% versus 1.3%, P < 0.05) and was seen in all Canadian provinces. The largest increase was documented in a province (Saskatchewan, from 9.8% in 2000/2001 to 12.6% in 2008/2009, P < 0.05) with the longest median wait times for cataract surgery (118 days in 2008) and the lowest number of ophthalmologists per 100 000 population (1.96 versus 3.35 national average). Conclusions: The age- and sex-standardized prevalence of cataract increased 4‒5 years after the multibil- lion-dollar wait time strategy was launched in 2004. A lower threshold to diagnose cataract may be one potential reason for this finding. Further research is needed to understand the true reasons for the increase.

Visual impairment and the Ontario Disability Support Program.

OBJECTIVES: To report on the 2003-2013 trends in sociodemographics, financial support, and use of vision care benefits by visually impaired (VI) individuals in the Ontario Disability Support Program (ODSP). DESIGN: Retrospective analysis. PARTICIPANTS: ODSP recipients with a VI diagnosis from 2003 to 2013. METHODS: ODSP administrative data were analyzed. VI diagnoses were identified using International Classification of Diseases, 9th Revision codes. Diabetes was excluded and then included as part of the VI definition. RESULTS: Per 100 000 population, the age-standardized number of VI recipients increased from 35 in 2003 to 39 (p < 0.05) in 2013 when diabetes was excluded from the analyses. The mean age of VI recipients increased from 43 to 46 years. Females and married/common-law status consistently represented 42% and 23% of VI individuals, respectively. The financial value of in-kind benefits (e.g., providing shelter cost) and "cash" assistance grew in parallel over the 11 years. The total financial support in 2013 Canadian dollars increased from 81 million dollars in 2003 to 102 million dollars in 2013. Use of ODSP-provided vision care benefits ranged from 0.6% to 1.9% for eye examinations and eyeglasses, from 0.3% to 0.8% for optical visual aids, and from 3.4% to 4.2% for guide dogs. Results were strongly similar when diabetes was included in the analyses. CONCLUSIONS: The ODSP-supported VI recipients and related financial support increased significantly from 2003 to 2013. The ODSP-provided vision care benefits were seldom used. Studies are needed to understand reasons for the reported increased number of VI recipients and the low use of vision care benefits.

Renal Infarct After Endovascular Abdominal Aortic Aneurysm Repair: Consider in Back Pain Differential.

As hypertension, obesity, and hyperlipidemia become more widespread, the prevalence of abdominal aortic aneurysms (AAA) has also increased.1 Traditionally those with multiple comorbidities - also those with greatest AAA mortality - were considered too high risk for operative repair. In recent decades, however, endovascular abdominal aortic aneurysm repair (EVAR) has become a popular option, especially for high-risk patients. Overall, short-term outcomes are comparable to traditional open repair despite higher patient baseline risk. However, EVAR comes with its own risks, which the emergency physician should be aware of. Here, we present a rare complication of EVAR: device thrombosis with subsequent renal infarct.

Adding Insult to Injury: Asymptomatic Fat Embolism Identified on Computed Tomography.

Fat embolism (FE) is a classically taught complication of long bone fractures, with the potential to cause high morbidity and mortality; however, it is rarely apparent on emergency department (ED) presentation or imaging. If recognized by the ED clinician, development of symptoms of FE may be avoided by early surgical fixation and potentially by corticosteroid administration.

Impact of immigration status on health behaviors and perceptions in cancer survivors.

BACKGROUND: Health behaviors including smoking cessation, physical activity (PA), and alcohol moderation are key aspects of cancer survivorship. Immigrants may have unique survivorship needs. We evaluated whether immigrant cancer survivors had health behaviors and perceptions that were distinct from native-born cancer survivors. METHODS: Adult cancer patients from Princess Margaret Cancer Centre were surveyed on their smoking, PA, and alcohol habits and perceptions of the effects of these behaviors on quality of life (QoL), 5-year survival, and fatigue. Multivariable models evaluated the association of immigration status and region-of-origin on behaviors and perceptions. RESULTS: Of the 784 patients, 39% self-identified as immigrants. Median time of survey was 24 months after histological diagnosis. At baseline, immigrants had trends toward not meeting Canadian PA guidelines or being ever-drinkers; patients from non-Western countries were less likely to smoke (aORcurrent  = 0.46, aORex-smoker  = 0.47, P = 0.02), drink alcohol (aORcurrent  = 0.22, aORex-drinker  = 0.52, P < 0.001), or meet PA guidelines (aOR = 0.44, P = 0.006). Among immigrants, remote immigrants (migrated ≥40 years ago) were more likely to be consuming alcohol at diagnosis (aOR = 5.70, P < 0.001) compared to recent immigrants. Compared to nonimmigrants, immigrants were less likely to perceive smoking as harmful on QoL (aOR = 0.58, P = 0.008) and survival (aOR = 0.56, P = 0.002), and less likely to perceive that PA improved fatigue (aOR = 0.62, P = 0.04) and survival (aOR = 0.64, P = 0.08). CONCLUSIONS: Immigrants had different patterns of health behaviors than nonimmigrants. Immigrants were less likely to perceive continued smoking as harmful and were less likely to be aware of PA benefits. Culturally tailored counselling may be required for immigrants who smoke or are physically sedentary at diagnosis.