No abstract

A lthough obesity is a preventable condition, rates worldwide have doubled since 1980. 1 Being overweight or obese is the fifth leading risk factor for global deaths, 1 and excess weight significantly increases the risk of chronic illnesses such as cardiovascular disease, stroke, diabetes, and some cancers. 2,3 While it is perceived as a problem predominantly in industrialized nations, obesity is now a growing concern in developing countries 4 and poses a financial burden in many regions. In Canada, the estimated cost of obesity to the economy was $4.6 billion in 2008, up approximately 20% from the year 2000. 5 While province-specific Canadian data have been collected on an ongoing basis, and the epidemic rise in obesity has been noted in reports such as the recent Public Health Agency of Canada report, Obesity in Canada, 5 provincial obesity surveillance maps have not been published since 2002, when data from the 1995 to 1998 period were presented. 6 Our approach to data presentationusing colour-coded depictions of changes in obesity rates over time -is a graphic way to communicate the changing prevalence of obesity that is appropriate for both public and professional audiences. The purpose of this paper is to update Canada's obesity maps with data collected between 2000 and 2011 to more accurately reflect estimated obesity rates across Canada. METHODSSources of data were extracted from the Canadian Community Health Survey (CCHS); data included self-reported height and weight for 2000, 2003, 2005, and 2007-11. The data were drawn from annual health indicator profiles for each province as reported on the Statistics Canada website, 7 except for the year 2000, where data were provided in response to a request to Statistics Canada. 8 Body mass index (BMI) was calculated for all eligible respondents aged 18 and older based on their self-reported heights and weights,

were extracted from Canadian and American studies for population characteristics, study design, measures of smoking and acculturation, and findings regarding smoking rates and associations between smoking and acculturation. SYNTHESIS:The literature search identified 147 articles, and 14 met inclusion criteria. Three studies were based on Canadian samples and the remaining 11 were from the United States. Of the 14 papers, 3 reported findings for youth and 11 for adults. Among adults, daily smoking rates were consistently much higher in men than women; for men, rates varied from 9% to 30%. Language use and time in North America were the most common indicators of acculturation. Almost all studies found a relationship between acculturation and smoking, such that more acculturated men smoke less and more acculturated women smoke more. CONCLUSION:The findings suggest that the association between acculturation and smoking is gender-specific. This correlation is found in youth and adults and in both Canada and the US. Increased acculturation has a protective effect on smoking for Chinese North American men, but a harmful effect for women. Tobacco control interventions need to develop targeted strategies appropriate to these different populations. Smoking rates vary markedly internationally. For women, rates range from 1% (in Saudi Arabia) to 50% (in Nauru), and for men, rates go from a low of 8% (in Ethiopia) to 71% (in Kiribati). Rates in North America are intermediate, with 17% and 25% of women and 24% and 33% of men smoking in Canada and the United States respectively. 4 Individuals who emigrate from other parts of the world to North America often face many challenges in adjusting to their new homes, including differences in modal behaviours such as the prevalence of smoking. Immigrants from China comprise an interesting subgroup, since they are the largest group of immigrants to Canada (making up almost 13% of new Canadians) 5 and one of the largest groups in the US, accounting for 4.2% of new immigrants (after individuals from Mexico, India and the Philippines). 6 Smoking rates in China are 2% for women and 51% for men, both greatly different from North American rates. 4This paper reviews published literature on smoking rates in North Americans of Chinese origin, with an emphasis on understanding one of the most important factors affecting smoking in these individuals. Specifically, we focus on acculturation, which has been defined as "a complex, multidimensional process by which foreign born individuals adopt the values, customs, norms, attitudes, and behaviors of the mainstream culture".7 Acculturation plays a crucial role in many health behaviours, including smoking, diet and exercise.

BackgroundA primary goal of acute treatment for depression is clinical remission of symptoms. Most meta-analyses of remission rates involve randomized controlled trials (RCTs) using patients from psychiatric settings, but most depressed patients are treated in primary care. The goal of this study was to determine remission rates obtained in RCTs of treatment interventions for Major Depressive Disorder (MDD) conducted in primary care settings.MethodsPotentially relevant studies were identified using computerized and manual search strategies up to May 2003. Criteria for inclusion included published RCTs with a clear definition of remission using established outcome measures.ResultsA total of 13 studies (N = 3202 patients) meeting inclusion criteria were identified. Overall remission rates for active interventions ranged between 50% and 67%, compared to 32% for pill placebo conditions and 35% for usual care conditions.ConclusionsRemission rates in primary care studies of depression are at least as high as for those in psychiatric settings. It is a realistic goal for family physicians to target remission of symptoms as an optimal outcome for treatment of depression.

Objective: Electroconvulsive therapy (ECT) continues to be one of the most effective biological therapies for patients with mood disorders. Numerous studies address clinical response; however, few have examined psychosocial or occupational outcomes following ECT, especially in community settings. This study aimed to examine these outcomes in short- and long-term naturalistic follow-up of ECT conducted in a community hospital. Methods: A retrospective chart review was conducted of all patients who received ECT at Ridge Meadows Hospital in Maple Ridge, British Columbia, between January 1997 and December 2003. Charts were evaluated with the Clinical Global Impression (CGI), Global Assessment of Functioning, and Social and Occupational Functioning Assessment Scales prior to ECT and at 6 months, 1 year, and 2 years post-ECT. Results: A total of 90 patients with mood disorders underwent ECT; 86.5% were rated on the CGI as “markedly ill” to “among the most extremely ill” at baseline. All clinical ratings improved at every follow-up point, and by the end of 24 months, 56.6% of patients were rated as “much improved” or “very much improved” on the CGI. Similarly, the measures of psychosocial functioning also showed significant improvement throughout the follow-up period. Conclusions: These findings show that substantial and meaningful improvement occurred in clinical and psychosocial outcomes after ECT conducted in a community hospital. These changes were robust and stable over the 2-year follow-up period. Limitations of the study include the retrospective ratings, the open-label use of ECT, and the naturalistic treatment in follow-up.