Women's College Hospital is a teaching hospital in downtown Toronto, Ontario, Canada. It is located at the north end of Hospital Row, a section of University Avenue where several major hospitals are located. It currently functions as an independent ambulatory care hospital. The Chief of Staff is Dr. Sheila Laredo and the physician-in-chief is Dr. Paula Harvey.[citation needed]Women's College Hospital maintains a focus on women's health, research in women's health, and ambulatory care. It was recognized as the only collaborating centre in women's health the Western Hemisphere designated by the World Health Organization.Women's College Hospital is associated with Women's College Research Institute, Women's College Hospital Foundation and Women's Health Matters, a bilingual consumer website on women's health and lifestyle issues.
Systemic inequities create barriers to person-centred healthcare for cisgender and transgender women living with HIV. Building on the evidence-based Women-Centred HIV Care Model, the Women-Centred HIV Care Pocketbook was developed as a communication tool to support health self-advocacy and strengthen patient–provider communication. This pre-implementation study examined barriers and facilitators influencing its use in clinical and community settings. We conducted a community-based qualitative study to explore factors shaping implementation. Semi-structured interviews were conducted from January to July 2024 with 35 participants: 15 women living with HIV, 10 healthcare providers, and 10 community-based organization providers. Interviews were audio-recorded, supplemented by a demographic survey, and analyzed using a hybrid rapid and traditional qualitative approach. Themes were mapped to the Consolidated Framework for Implementation Research 2.0. Themes spanned all Consolidated Framework for Implementation Research 2.0 domains. Participants viewed the Women-Centred HIV Care Pocketbook as relevant and acceptable but recommended revisions, including content on aging, infant feeding, and newcomer health. Women emphasized collaborative use with providers rather than placing responsibility solely on them. Across outer and inner settings, participants noted the Women-Centred HIV Care Pocketbook could strengthen connections between agencies, and providers and women expressed willingness to integrate it into practice. Key considerations included limited appointment time, challenges building community connections, and the need for organizational support. Stakeholders expressed strong support for the Women-Centred HIV Care Pocketbook but highlighted factors shaping implementation readiness. Addressing these factors through structured training, leadership engagement, and peer-supported introduction may support successful uptake and long-term sustainability.
To examine the combined and separate impacts of traumatic brain injury (TBI) and interpersonal violence on new and severe mental illness in the postpartum period. We undertook a population-based cohort study of 1,090,139 births in Ontario, Canada, 2012–2021. We stratified the cohort by pre-delivery history of mental health care to identify (i) new episodes of mental illness and (ii) severe mental illness within 365 days of childbirth. Modified Poisson regression was used to calculate adjusted relative risks (aRR) of these outcomes in individuals with a history of TBI and violence, TBI alone, and violence alone versus neither (referent). Then, we calculated adjusted relative excess risk due to interaction (aRERI) to quantify the super-additive risk related to the presence of both factors. The risk of any new episode of mental illness postnatally was greatest in individuals with a history of both TBI and violence (aRR 1.58; 95
BACKGROUND:Migraine is a common risk factor for adverse perinatal outcomes, showing the importance of studying migraine in pregnancy. Despite the growing use of routinely collected administrative data in health research, the validity of such data to detect migraine in pregnant populations is unestablished. We validated algorithms to identify a history of migraine among pregnant individuals using health administrative data and population-representative self-report data. METHODS:We included N = 8824 females in Ontario, Canada with a documented pregnancy with an estimated conception date from 1 September 2005 to 31 December 2021 who completed the Canadian Community Health Survey (CCHS) within 5 years before conception. We created algorithms using different combinations of diagnostic codes for headache disorders and migraine-specific drug claims with varying lookback periods before conception. We compared their performance to self-reported migraine diagnoses from the CCHS. Measures of validity were sensitivity, specificity, predictive values, and agreement. RESULTS:The prevalence of self-reported migraine from the CCHS was 18% (95% confidence interval [CI]: 16%, 19%). The prevalence using administrative data depended on the definition (range: 2%-25%). All algorithms had high specificity (81.7%-98.9%), while sensitivity varied (6.1%-53.2%). The algorithm requiring ≥2 physician visits or ≥1 hospitalizations or emergency department visits with diagnostic codes International Classification of Diseases, Ninth Revision: 346/International Classification of Diseases, Tenth Revision: G43, with a lifetime lookback, had high specificity (94.0%; 95% CI: 93.1%, 94.8%) and negative predictive value (86.3%; 95% CI: 85.0%, 87.6%) and modest sensitivity (30.4%; 95% CI: 27.3%, 33.6%) and positive predictive value (51.9%; 95% CI: 46.8%, 57.0%). Agreement was fair ( κ = 0.29; 95% CI: 0.25, 0.33). CONCLUSION:Longitudinally linked health administrative data are effective at identifying pregnant individuals with migraine, with high specificity and reasonable sensitivity.
Accumulating evidence indicates that diabetes is associated with increased risk of several cancers. The strongest evidence has been reported for cancers of the breast, colorectum, endometrium, liver, pancreas, and gallbladder. However, distinguishing causal relationships from associations driven by shared risk factors such as obesity, aging, and lifestyle behaviors remains challenging. Several biological mechanisms have been proposed to explain these associations. Key pathways include the effects of insulin resistance and compensatory hyperinsulinemia on mitogenic signaling pathways, including PI3K/AKT/mTOR and MAPK, as well as the influence of adiposity, chronic inflammation, and altered metabolic substrates on tumor initiation and progression. Hyperglycemia may also contribute by promoting tumor metabolism and cellular proliferation, although its independent contribution remains debated. These mechanisms likely interact to create a protumorigenic metabolic environment in individuals with diabetes. Obesity, which frequently co-occurs with diabetes, further amplifies these risks through altered adipokine secretion and increased estrogen production, highlighting the interrelated contributions of metabolic and hormonal factors. The relationship between diabetes and cancer has important clinical implications. Diabetes has been associated with worse cancer prognosis and higher cancer-related mortality, highlighting the importance of integrated management strategies. The impact of antihyperglycemic therapy on cancer risk and progression has been extensively studied, and ongoing research continues to evaluate potential protective or tumor-modifying effects. In this article, we summarize the epidemiologic and pathophysiologic evidence describing the relationship between diabetes and cancer and discuss strategies for risk mitigation, screening, and management.
Women with unilateral breast cancer continue to choose (unilateral or bilateral) mastectomy. We aim to determine decision regret and its relationship with psychosocial outcomes after breast cancer surgery. We performed a prospective cohort study of women with unilateral, sporadic stage 0-III breast cancer at University Health Network (Toronto, Canada) who underwent unilateral lumpectomy (UL), unilateral mastectomy (UM), or bilateral mastectomy (BM). Unilateral mastectomy was further categorized into oncologically indicated (UMO) versus patient choice (UMC). Participants completed the Decision Regret Scale (DRS), BREAST-Q, Impact of Event Scale, and Hospital Anxiety and Depression Scale at 12 or 18 months after surgery. Univariable and multivariable linear regression models were adjusted for demographic, clinical, and treatment-related factors. P < 0.05 was deemed significant. In total, 217 women were included, including 51 UL, 95 UM (71 UMO, 24 UMC), and 71 BM. There was a difference in DRS scores between UL and UM (8.3 vs. 17.4; P <0.01). Bilateral mastectomy was not associated with higher regret. After adjustment for covariates, UMC remained significantly associated with greater decision regret (β = 16.0, SE = 7.6, P = 0.04). Among women having UMC, women with higher regret had lower scores of breast satisfaction (β = −1.0, SE = 0.5, P = 0.03) and psychosocial well-being (β = −0.8, SE = 0.4, P = 0.02). Decision regret is influenced by surgical procedure in women with unilateral breast cancer. Women who have unilateral mastectomy, particularly those who choose the procedure when eligible for lumpectomy, report higher decision regret and worse breast satisfaction and psychosocial well-being.
