Chronic Diseases and Injuries in Canada最新文献

Introduction: Accurate ascertainment of pregnant women with pre-existing diabetes allows for the comprehensive surveillance of maternal and neonatal outcomes associated with this chronic disease.

Method: To determine the accuracy of case definitions for pre-existing diabetes mellitus when applied to a pregnant population, a cohort of women who were pregnant in Nova Scotia, Canada, between 1991 and 2003 was obtained from a population-based provincial perinatal database, the Nova Scotia Atlee Perinatal Database (NSAPD). Person-level data from administrative databases using hospital discharge abstract data and outpatient physician services data were linked to this cohort. Various algorithms for defining diabetes mellitus from the administrative data, including the algorithm suggested by the National Diabetes Surveillance System (NDSS), were compared to a reference standard definition from the NSAPD.

Results: Validation of the NDSS case definition applied to this pregnant population demonstrated a sensitivity of 87% and a positive predictive value (PPV) of 66.4%. Use of ICD-9 and ICD-10 diagnostic codes among hospitalizations with diabetes mellitus in pregnancy showed important increases in sensitivity and PPV, especially for those pregnancies delivered in tertiary centres. In this population, pregnancy-related administrative data from the hospitalization database alone appear to be a more accurate data source for identifying pre-existing diabetes than applying the NDSS case definition, particularly when pregnant women are delivered in a tertiary hospital.

Conclusion: Although the NDSS definition of diabetes performs reasonably well compared to a reference standard definition of diabetes, using this definition for evaluating maternal and perinatal outcomes associated with diabetes in pregnancy will result in a certain degree of misclassification and, therefore, biased estimates of outcomes.

Introduction: Public health professionals have become concerned that spit tobacco (ST) use among athletes is increasing. However, little is known about the issue in Canada, particularly among youth.

Methods: The Not to Kids Coalition and the Coaches Association of Ontario surveyed coaches regarding ST knowledge and awareness and their perceived roles as coaches in influencing ST use among their athletes. Surveys were distributed electronically to individuals who coached male and female youth aged 9 to 18 years in baseball, basketball, football, soccer, and track and field, in Ontario.

Results: Almost all of the surveyed coaches responded correctly to questions about the health effects of ST use, and about 80% of respondents answered correctly to the question about legislation associated with ST and youth.

Conclusion: Most coaches are interested in receiving information about ST, particularly the health effects of ST use and how to prevent ST use among athletes. Multiple formats should be used to provide information to coaches, including both electronic and hard copy materials.

Introduction: Studies suggest that hypertension is more prevalent in the most deprived. Our objective was to examine the association between incident hypertension and deprivation in Quebec based on different modes of case identification, using two administrative databases.

Methods: We identified new incident cases of hypertension in 2006/2007 in the population aged 20 years plus. Socio-economic status was determined using a material and social deprivation index. Negative binomial regression analyses were carried out to examine the association between incident hypertension and deprivation, adjusting for several covariates.

Results: We found a positive and statistically significant association between material deprivation and incident hypertension in women, irrespective of the identifying database. Using the hospitalization database, the incidence of hypertension increased for both sexes as deprivation increased, except for social deprivation in women. However, whether using the physician billing data base or the validated definition of hypertension obtained by combining data from the two databases, the incidence of hypertension decreased overall as deprivation increased.

Conclusions: Associations between hypertension and deprivation differ based on the database used: they are generally positively associated with the hospitalization database and inversely with the standard definition and the physician billing database, which suggests a consultation bias in favour of the most socio-economically advantaged.

Introduction: Cancer is the leading cause of disease-related death in children aged 1 to 14 years in Canada. Despite the importance to public health of childhood cancer, there have been few reports on Canadian trends published in the peer-reviewed literature. This study examines childhood cancer trends by age, sex, and province of residence using the most current cancer registration data.

Methods: Data from the population-based Canadian Cancer Registry were used to compute incidence trends in primary cancers diagnosed between 1992 and 2006 in children (0-14 years) for the 12 major diagnostic groups of the International Classification of Childhood Cancer, 3rd Edition.

Results: Between 1992 and 2006, incidence rates for all cancers remained stable, although trends varied by cancer type. We observed a significant decrease in retinoblastoma in boys for the entire period (-6.5% per year) and an increase in leukemia from 1992 to 1999 (+3.5% per year). In girls, there was a significant decrease in renal tumours from 1998 to 2006 (-5.7% per year) and an increase in hepatic tumours from 1997 to 2006 (+8.1% per year). Differences by age and province were also apparent. Some caution should be exercised when interpreting trends involving a small number of cases per year and those with wide 95% confidence intervals.

Conclusions: Our findings suggest an ongoing need for population-based surveillance and etiologic research.

Introduction: Immigration continues to transform the ethnic composition of the Canadian population. We investigated whether longitudinal trends in mental distress vary between seven cultural and ethnic groups and whether mental distress within the same ethnic group varies by demographic (immigrant status, sex, age, marital status, place and length of residence), socio-economic (education, income), social support and lifestyle factors.

Method: The study population consisted of 14 713 respondents 15 years and older from the first six cycles of the National Population Health Survey (NPHS); 20% reported themselves to be immigrant at Cycle 1, in 1994/1995. The logistic regression model was fitted by modifying a multivariate quasi-likelihood approach, and robust variance estimates were obtained by using balanced repeated replication techniques.

Results: Based on the multivariable model and self-reported data, we observed that female respondents were more likely to report moderate/high mental distress than male respondents; younger respondents more than older respondents; single respondents more than those in a relationship; urban-dwellers more than rural-dwellers; less educated respondents more than more educated respondents; current and former smokers more than non-smokers; and those living in a smoking household more than those living in non-smoking households. The relationship between ethnicity and mental distress was modified by immigrant status, sex, social involvement score and education. Confirming other research, we found an inverted U-shaped relationship between length of stay and mental distress: those who had lived in Canada for less than 2 years were less likely to report moderate/high mental distress, while those who had lived in Canada for 2 to 20 years were significantly more likely to report moderate/high mental distress than those who had lived in Canada for more than 20 years.

Conclusion: There is a need to develop ethnicity-specific mental health programs targeting those with low education attainment and low social involvement. Policies and programs should also target women, the younger age group (15-24 years) and low-income adequacy groups.

Introduction: Though the cultural factors that may contribute to the diabetes epidemic in First Nations are frequently discussed, little is known about the factors that may help prevent it. In this ethnonursing study, we explore the cultural factors that help maintain health behaviours in Algonquin women who had received a diagnosis of gestational diabetes 2 to 10 years before this study.

Methods: The data were collected in two Algonquin communities through semi-structured interviews with key informants (n = 7) and general informants (n = 8) and through cultural immersion, with detailed observations being recorded into logbooks.

Results: The cultural factors that are likely to affect the prevention of diabetes are the importance of family and social ties, the possibility of preserving cultural values, the opportunity to learn behaviours through educational resources adapted to needs and culture, the chance of saving money through better diet and access to blood sugar data as a means of control.

Conclusion: In the long term, these cultural factors could influence health behaviours and thus help prevent type 2 diabetes.

Introduction: The Public Health Agency of Canada, in collaboration with bone health and osteoporosis experts from across Canada (n = 12), selected a core set of indicators for the public health surveillance of osteoporosis using a formal consensus process.

Methods: A literature review identified candidate indicators that were subsequently categorized into an osteoporosis-specific indicator framework. A survey was then administered to obtain expert opinion on the indicators' public health importance. Indicators that scored less than 3 on a Likert scale of 1 (low) to 5 (high) were excluded from further consideration. Subsequently, a majority vote on the remaining indicators' level of public health importance was sought during a face-to-face meeting.

Results: The literature yielded 111 indicators, and 88 were selected for further consideration via the survey. At the face-to-face meeting, more than half the experts considered 39 indicators to be important from the public health perspective.

Conclusion: This core set of indicators will serve to inform the development of new data sources and the integration, analysis and interpretation of existing data into surveillance products for the purpose of public health action.

Introduction: We know little about how the 2006 Canadian Clinical Practice Guidelines for the management and prevention of obesity relate to Canadians' weight management experiences or whether these experiences reflect the recommendations in the Guidelines.

Methods: We used data from a general population omnibus survey to understand these two issues, particularly in relation to chronic disease. The survey included 23 questions related to weight management practices as well as those related to demographic characteristics.

Results: Of 2004 respondents, 33% were classified as overweight and 20% as obese. In the 12 months before the survey, 48% of overweight and obese respondents reported asking their physician about weight loss, while 30% reported that their physician advised them to lose weight without them specifically asking. With regard to the recommendations within the Guidelines, 14% of overweight and 18% of obese respondents reported having their waist circumference measured, 82% of overweight and 87% of obese respondents reported having their blood pressure measured, and 36% of overweight and 50% of obese respondents reported having a test for diabetes.

Conclusion: These findings have implications for chronic disease identification and management.

Introduction: Early identification of autism spectrum disorders (ASD) is important, since earlier exposure to behavioural intervention programs may result in better outcomes for the child. Moreover, it allows families timely access to other treatments and supports.

Methods: Using generalized linear modeling, we examined the association between child and family characteristics and the age at which 2180 children were diagnosed with ASD between 1997 and 2005 in six Canadian regions.

Results: A diagnosis of pervasive developmental disorder-not otherwise specified (PDD-NOS) or Asperger syndrome, rural residence, diagnosis in more recent years, and foreign birthplace were associated with a later age at diagnosis. Children who are visible minorities or who have siblings with ASD were more likely to be diagnosed earlier. Collectively, these factors explained little of the variation in age at diagnosis, however.

Conclusion: While it is encouraging that ethnocultural identity, neighbourhood income, urban or rural residence, and sex of the child were not major contributors to disparities in the age when children were identified with ASD, more work is needed to determine what does account for the differences observed. Regional variations in the impact of several factors suggest that aggregating data may not be an optimal strategy if the findings are meant to inform policy and clinical practice at the local level.