Chronic Diseases and Injuries in Canada最新文献

Introduction: Elementary school active transportation programs aim to address physical inactivity in children by prompting a modal shift from travel by car to walking or cycling among children living a distance from school conducive to walking or cycling. The objectives of this study are to evaluate the risk of injury related to walking, cycling and travelling by car between home and school among elementary-school students in the Montréal area and to evaluate the impact on number of injuries of a modal shift from travel by car to walking or cycling.

Methods: The risk of injury was estimated for the 2003-2007 period by calculating the average annual rate of injury in children aged 5 to 12 years walking, cycling or being driven in a car, per 100 million kms travelled during the normal hours of travel between home and school. The impact of a modal shift from travel by car was evaluated for children living a distance from school conducive to walking and cycling (under 1.6 km), that is, the targets of active transportation programs. This evaluation was done using the regional rate of injury calculated for each travel mode.

Results: Between 2003 and 2007, an average of 168 children aged 5 to 12 years were injured each year while walking (n = 64), cycling (n = 28) and being driven in a car (n = 76) during the normal hours of travel between home and school in the Montréal area. The rate of injury was 69 children injured per 100 million kms for travel by car (reference group), 314 pedestrians (relative risk [RR] = 4.6; 95% confidence interval [CI]: 4.3-5.1) and 1519 cyclists (RR = 22.2; 95% CI: 14.3-30.0). A shift of 20% in the distance travelled by car to walking by children living less than 1.6 km from their school is estimated to result in an increase of 2.2% (n = 3.7) in the number of children injured each year in the area. In the case of a shift to cycling, the number of resulting injuries is estimated to be 24.4, an increase of 14.5%.

Conclusion: The risk of injury among elementary-school students during the normal hours of travel between home and school is higher for walking and cycling than for travel by car, and cyclists are at greater risk of injury than pedestrians. A modal shift from travel by car would increase the number of children injured in the area (minor injuries, for the most part) if no action were taken to reduce the risk of injury to pedestrians and cyclists.

Introduction: With the growing burden of chronic diseases, surveillance will play an essential role in improving their prevention and control. The Institut national de santé publique du Québec has developed an innovative chronic disease surveillance system, the Quebec Integrated Chronic Disease Surveillance System (QICDSS). We discuss the primary features, strengths and limitations of this system in this report.

Methods: The QICDSS was created by linking five health administrative databases. Updated annually, it currently covers the period from January 1, 1996, to March 31, 2012. The operational model comprises three steps: (1) extraction and linkage of health administrative data according to specific selection criteria; (2) analysis (validation of case definitions essentially) and production of surveillance measures; and (3) data interpretation, submission and dissemination of information. The QICDSS allows the surveillance of the following chronic diseases: diabetes, cardiovascular diseases, respiratory diseases, osteoporosis, osteoarticular diseases, mental disorders, Alzheimer's disease and related disorders. The system also lends itself to the analysis of multimorbidity and polypharmacy.

Results: For 2011-2012, the QICDSS contained information on 7 995 963 Quebecers with an average age of 40.8 years. Of these, 95.3% met at least one selection criterion allowing the application of case definitions for chronic disease surveillance. The actual proportion varied with age, from 90.1% for those aged 19 years or less to 99.3% for those aged 65 years or over.

Conclusion: The QICDSS provides a way of producing population-based data on the chronic disease burden, health services and prescription drug uses. The system facilitates the integrated study of several diseases in combination, an approach rarely implemented until now in the context of population surveillance. The QICDSS possesses all the essential features of a surveillance system and supports the dissemination of information to public health decision-makers for future actions.

Introduction: Knowledge of Canadians' experiences in making health behaviour changes (HBCs) in general, and among those at risk due to body mass index (BMI), would help inform health promotion / disease prevention programs. Selected self reported HBCs in the past 12 months by BMI category were examined in this secondary analysis of the Canadian Community Health Survey 4.1. These HBCs included increased sports/exercise, weight loss and improved eating habits. Barriers to HBC were also examined.

Methods: Descriptive analyses and forward stepwise logistic regression were completed on data from respondents 18 years and older. Self-reported BMI was corrected by the method of Connor Gorber et al. (2008).

Results: Our final sample was n = 111 449. Overall, 58% of respondents had made an HBC, with increased sports/exercise as the most important HBC in 29% of the sample, followed by improved eating habits (10%) and weight loss (7%). Half (51%) experienced barriers to HBC; lack of will power was most commonly cited, followed by work and family responsibilities. Obese respondents reported HBC more frequently than normal-weight respondents (60% vs. 55%), but the prevalence of increased sports/ exercise and improved eating habits was similar across BMI categories. Regression models accounted for only 6%-10% of the total variance.

Conclusion: That a majority of respondents had made at least one HBC bodes well for positively shifting population health. Additional work to further characterize the population, and to improve on population indicators, is needed to assess the impact of health promotion/disease prevention efforts. These findings provide important first population benchmarks for future work.

Introduction: We carried out a qualitative evaluation of immediate learning and attitudinal change among health care and social services professionals who attended a workshop promoting critical reflection about health literacy among linguistic-minority Franco-Ontarians.

Methods: The study involved 41 francophone health care and social services professionals. The workshop facilitator used evocative objects to elicit reflection on health literacy. Data sources were audio-recordings of group discussions and feedback forms completed by participants.

Results: The study found that the workshop awakened participants' awareness of health literacy and stimulated them to promote health literacy in their professional practice. The workshop also broadened participants' vision of health literacy as a social determinant of health that interacts synergistically with culture, age, immigration status, social support, and socioeconomic status.

Conclusion: Professionals expressed their awakened awareness of health literacy as collective accountability. This corroborates our claim that critical pedagogy applied to in-service education effectively stimulates professionals' awareness of their potential to change their practice and work environment.

Introduction: Roll-your-own (RYO) cigarettes, or "rollies," represent an affordable alternative to manufactured cigarettes, especially among youth with a lower disposable income. This study characterizes changes in the prevalence of RYO tobacco current use between 2008 and 2010 in Canadian youth and examines the sociodemographic characteristics associated with RYO use in 2010.

Methods: This study uses representative data collected from grade 9 to 12 students as part of the 2008/2009 and 2010/2011 cycles of the Canadian Youth Smoking Survey (YSS).

Results: Among current smokers, 30.5% currently use RYO cigarettes. Youth with a disposable income of more than $100 each week were less likely to be current RYO users (OR = 0.49, 95% CI: 0.34-0.71). Current RYO tobacco users were more likely to be current alcohol users (OR = 2.01, 95% CI: 1.09-3.72) or marijuana users (OR = 2.63, 95% CI: 1.73-4.01).

Conclusion: RYO cigarettes continue to provide an affordable alternative to youth smokers. Targeted school-based prevention programs that address the use of RYO cigarettes may offer additional reductions to the use of RYO cigarettes.

Introduction: Patterns of multimorbidity, the co-occurrence of two or more chronic diseases, may not be constant across populations. Our study objectives were to compare prevalence estimates of multimorbidity in the Aboriginal population in Canada and a matched non-Aboriginal Caucasian population and identify the chronic diseases that cluster in these groups.

Methods: We used data from the 2005 Canadian Community Health Survey (CCHS) to identify adult (≥ 18 years) respondents who self-identified as Aboriginal or non-Aboriginal Caucasian origin and reported having 2 or more of the 15 most prevalent chronic conditions measured in the CCHS. Aboriginal respondents who met these criteria were matched on sex and age to non-Aboriginal Caucasian respondents. Analyses were stratified by age (18-54 years and ≥ 55 years). Prevalence was estimated using survey weights. Latent class analysis (LCA) was used to identify disease clusters.

Results: A total of 1642 Aboriginal respondents were matched to the same number of non-Aboriginal Caucasian respondents. Overall, 38.9% (95% CI: 36.5%-41.3%) of Aboriginal respondents had two or more chronic conditions compared to 30.7% (95% CI: 28.9%-32.6%) of non-Aboriginal respondents. Comparisons of LCA results revealed that three or four clusters provided the best fit to the data. There were similarities in the diseases that tended to co-occur amongst older groups in both populations, but differences existed between the populations amongst the younger groups.

Conclusion: We found a small group of younger Aboriginal respondents who had complex co-occurring chronic diseases; these individuals may especially benefit from disease management programs.