Objective: The first national survey to assess the prevalence of generalized anxiety disorder (GAD) in Canada was the 2012 Canadian Community Health Survey: Mental Health and Well-Being (CCHS-MH). The World Mental Health Composite International Diagnostic Interview (WMH-CIDI), used within the representative sample of the CCHS-MH, provides the best available description of the epidemiology of this condition in Canada. This study uses the CCHS-MH data to describe the epidemiology of GAD. Method: The analysis estimated proportions and odds ratios and used logistic regression modelling. All results entailed appropriate sampling weights and bootstrap variance estimation procedures. Results: The lifetime prevalence of GAD is 8.7% (95% CI, 8.2% to 9.3%), and the 12-month prevalence is 2.6% (95% CI, 2.3% to 2.8%). GAD is significantly associated with being female (OR 1.6; 95% CI, 1.3 to 2.1); being middle-aged (age 35-54 years) (OR 1.6; 95% CI, 1.0 to 2.7); being single, widowed, or divorced (OR 1.9; 95% CI, 1.4 to 2.6); being unemployed (OR 1.9; 95% CI, 1.5 to 2.5); having a low household income (<$30 000) (OR 3.2; 95% CI, 2.3 to 4.5); and being born in Canada (OR 2.0; 95% CI, 1.4 to 2.8). Conclusions: The prevalence of GAD was slightly higher than international estimates, with similar associated demographic variables. As expected, GAD was highly comorbid with other psychiatric conditions but also with indicators of pain, stress, stigma, and health care utilization. Independent of comorbid conditions, GAD showed a significant degree of impact on both the individual and society. Our results show that GAD is a common mental disorder within Canada, and it deserves significant attention in health care planning and programs. Abré gé Objectif : La première enquête nationale qui a évalué la prévalence du trouble d'anxiété généralisée (TAG) au Canada a été l'Enquête sur la santé dans les collectivités canadiennes-Santé mentale (ESCC-SM) de 2012. L'entrevue WMH-CIDI, utilisée dans l'échantillon représentatif de l'ESCC-SM, offre la meilleure description disponible de l'épidémiologie de cette affection au Canada. Cette étude décrit l'épidémiologie du TAG à l'aide des données de l'ESCC-SM. Mé thode : L'analyse a estimé les proportions, les rapports de cotes, et utilisé les modèles de régression logistique. Tous les résultats produits utilisaient les procédures de poids d'échantillonnage appropriées et d'estimation de variance bootstrap.

BackgroundCortisol is frequently used as a marker of physiologic stress levels. Using cortisol for that purpose, however, requires a thorough understanding of its normal longitudinal variability. The current understanding of longitudinal variability of basal cortisol secretion in women is very limited. It is often assumed, for example, that basal cortisol profiles do not vary across the menstrual cycle. This is a critical assumption: if cortisol were to follow a time dependent pattern during the menstrual cycle, then ignoring this cyclic variation could lead to erroneous imputation of physiologic stress. Yet, the assumption that basal cortisol levels are stable across the menstrual cycle rests on partial and contradictory evidence. Here we conduct a thorough test of that assumption using data collected for up to a year from 25 women living in rural Guatemala.MethodologyWe apply a linear mixed model to describe longitudinal first morning urinary cortisol profiles, accounting for differences in both mean and standard deviation of cortisol among women. To that aim we evaluate the fit of two alternative models. The first model assumes that cortisol does not vary with menstrual cycle day. The second assumes that cortisol mean varies across the menstrual cycle. Menstrual cycles are aligned on ovulation day (day 0). Follicular days are assigned negative numbers and luteal days positive numbers. When we compared Models 1 and 2 restricting our analysis to days between −14 (follicular) and day 14 (luteal) then day of the menstrual cycle did not emerge as a predictor of urinary cortisol levels (p-value >0.05). Yet, when we extended our analyses beyond that central 28-day-period then day of the menstrual cycle become a statistically significant predictor of cortisol levels.SignificanceThe observed trend suggests that studies including cycling women should account for day dependent variation in cortisol in cycles with long follicular and luteal phases.

IntroductionAlthough vitamin B12 deficiency is a well-known cause of hematological and neuropsychiatric illness, the presentation of combined severe pancytopenia, demyelination and prominent psychiatric impairment is rare.Case presentationWe present a case of a previously healthy 55-year-old East African man with severe vitamin B12 deficiency (serum vitamin B12 22pmol/L) secondary to pernicious anemia. He had a severe hypoproliferative megaloblastic anemia with hemolysis (hemoglobin 61g/L, mean corpuscular volume 99fL, reticulocytes 0.8%, haptoglobin undetectable), leukopenia (2.7×109/L), thrombocytopenia (96×109/L), ataxia with central demyelination, and megaloblastic madness. The patient’s anemia, myelopathy and psychiatric condition responded well to parenteral vitamin B12 replacement therapy, with significant improvement seen within weeks.ConclusionHematological manifestations of vitamin B12 deficiency are typically inversely correlated with the presence and severity of neuropsychiatric impairment. Although uncommon, a presentation with severe hematological and neuropsychiatric disease can occur, as illustrated by this case. Its presence may help guide diagnosis as well as provide clinically important prognostic information.

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The results suggest that these guidelines are appropriate and, at least for the major criteria, achievable. Although many Canadian schools offer individual components, the majority of schools have yet to develop formally structured concentration programs. By better articulating guidelines, a standardized framework can aid in the establishment and refinement of future programs.

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