Chronic Diseases And Injuries In Canada[JOURNAL]

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 p... 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.

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Agreement between survey data and Régie de l'assurance maladie du Québec (RAMQ) data with respect to the diagnosis of asthma and medical services use for asthma in children.

Plante C, Goudreau S, Jacques L … +1 more , Tessier F

Chronic Dis Inj Can · 2014 Nov · PMID 25408185

INTRODUCTION: The goal of this study was to assess the agreement between the results of a respiratory health survey conducted in Montréal on children aged 6 months to 12 years and the Régie de l'assurance maladie du Québ... INTRODUCTION: The goal of this study was to assess the agreement between the results of a respiratory health survey conducted in Montréal on children aged 6 months to 12 years and the Régie de l'assurance maladie du Québec (RAMQ, Quebec health insurance board) database in terms of the diagnosis of asthma and medical services use. A secondary aim was to evaluate the effect of the survey method used (Internet-based survey or telephone survey). METHODS: We assessed whether a diagnosis of asthma was made for 7922 children. In addition, we compared the use of medical services for asthma (emergency department visits and hospitalizations) in the 12 months preceding the survey for the 402 children considered to have asthma, using 2 groups of respiratory diagnoses and 2 data linkage periods. The agreement between the 2 data sources was evaluated using the kappa statistic (κ) and sensitivity and specificity, as well as percentages of agreement, overreporting and under-reporting with respect to health services use. RESULTS: Moderate agreement was found between the 2 data sources (survey and RAMQ data) in terms of the diagnosis of asthma (κ = 0.54 and κ = 0.60 depending on the definition used). Specificity was high (93% and 96%), but sensitivity varied (50% and 65%). Respondents over-reported health services use, resulting in moderate kappa values (0.49 for emergency department visits and 0.48 for hospitalizations). However, when more diagnoses were included in the definition and when the linkage period was extended (15 rather than 12 months), the kappa values increased (0.59 for emergency department visits and 0.64 for hospitalizations) and sensitivity and specificity were high. Slightly higher agreement was obtained for the Internet-based survey relative to the telephone survey. CONCLUSION: The findings validate the use of survey data with respect to the diagnosis of pediatric asthma and major health services use for this disease.

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Self-reported health behaviour change in adults: analysis of the Canadian Community Health Survey 4.1.

Haberman C, Brauer P, Dwyer JJ … +1 more , Edwards AM

Chronic Dis Inj Can · 2014 Nov · PMID 25408184

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 progra... 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.

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Awakening professionals' critical awareness of health literacy issues within a francophone linguistic-minority population in Ontario.

Zanchetta MS, Maheu C, Fontaine C … +2 more , Salvador-Watts L, Wong N

Chronic Dis Inj Can · 2014 Nov · PMID 25408183

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 li... 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.

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Quebec Integrated Chronic Disease Surveillance System (QICDSS), an innovative approach.

Blais C, Jean S, Sirois C … +10 more , Rochette L, Plante C, Larocque I, Doucet M, Ruel G, Simard M, Gamache P, Hamel D, St-Laurent D, Emond V

Chronic Dis Inj Can · 2014 Nov · PMID 25408182

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... 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.

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Multimorbidity disease clusters in Aboriginal and non-Aboriginal Caucasian populations in Canada.

Kuwornu JP, Lix LM, Shooshtari S

Chronic Dis Inj Can · 2014 Nov · PMID 25408181

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 Abor... 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.

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Chronic disease and chronic disease risk factors among First Nations, Inuit and Métis populations of northern Canada.

Bruce SG, Riediger ND, Lix LM

Chronic Dis Inj Can · 2014 Nov · PMID 25408180

INTRODUCTION: Aboriginal populations in northern Canada are experiencing rapid changes in their environments, which may negatively impact on health status. The purpose of our study was to compare chronic conditions and r... INTRODUCTION: Aboriginal populations in northern Canada are experiencing rapid changes in their environments, which may negatively impact on health status. The purpose of our study was to compare chronic conditions and risk factors in northern Aboriginal populations, including First Nations (FN), Inuit and Métis populations, and northern non-Aboriginal populations. METHODS: Data were from the Canadian Community Health Survey for the period from 2005 to 2008. Weighted multiple logistic regression models tested the association between ethnic groups and health outcomes. Model covariates were age, sex, territory of residence, education and income. Odds ratios (ORs) are reported and a bootstrap method calculated 95% confidence intervals (CIs) and p values. RESULTS: Odds of having at least one chronic condition was significantly lower for the Inuit (OR = 0.59; 95% CI: 0.43-0.81) than for non-Aboriginal population, but similar among FN, Métis and non-Aboriginal populations. Prevalence of many risk factors was significantly different for Inuit, FN and Métis populations. CONCLUSION: Aboriginal populations in Canada's north have heterogeneous health status. Continued chronic disease and risk factor surveillance will be important to monitor changes over time and to evaluate the impact of public health interventions.

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Developing injury indicators for First Nations and Inuit children and youth in Canada: a modified Delphi approach.

Pike I, McDonald RJ, Piedt S … +1 more , Macpherson AK

Chronic Dis Inj Can · 2014 Nov · PMID 25408179

INTRODUCTION: The purpose of this research was to take the initial step in developing valid indicators that reflect the injury issues facing First Nations and Inuit children and youth in Canada. METHODS: Using a modified... INTRODUCTION: The purpose of this research was to take the initial step in developing valid indicators that reflect the injury issues facing First Nations and Inuit children and youth in Canada. METHODS: Using a modified-Delphi process, relevant expert and community stakeholders rated each indicator on its perceived usefulness and ability to prompt action to reduce injury among children and youth in indigenous communities. The Delphi process included 5 phases and resulted in a refined set of 27 indicators. RESULTS: Indicators related to motorized vehicle collisions, mortality and hospitalization rates were rated the most useful and most likely to prompt action. These were followed by indicators for community injury prevention training and response systems, violent and inflicted injury, burns and falls, and suicide. CONCLUSION: The results suggest that a broad-based modified-Delphi process is a practical and appropriate method, within the OCAP™ (Ownership, Control, Access and Possession) principles, for developing a proposed set of indicators for injury prevention activity focused on First Nations and Inuit children and youth. Following additional work to validate and populate the indicators, it is anticipated that communities will utilize them to monitor injury and prompt decisions and action to reduce injuries among children and youth.

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Active and safe transportation of elementary-school students: comparative analysis of the risks of injury associated with children travelling by car, walking and cycling between home and school.

Lavoie M, Burigusa G, Maurice P … +2 more , Hamel D, Turmel E

Chronic Dis Inj Can · 2014 Nov · PMID 25408178

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 scho... 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.

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Health inequalities associated with neighbourhood deprivation in the Quebec population with hypertension in primary prevention of cardiovascular disease.

Vanasse A, Courteau J, Asghari S … +2 more , Leroux D, Cloutier L

Chronic Dis Inj Can · 2014 Nov · PMID 25408177

INTRODUCTION: Although a number of studies look at prevalence, incidence, treatment, mortality and morbidity in relation to hypertension, few have taken into account the effect of residential neighbourhood on these healt... INTRODUCTION: Although a number of studies look at prevalence, incidence, treatment, mortality and morbidity in relation to hypertension, few have taken into account the effect of residential neighbourhood on these health indicators in the population diagnosed with hypertension. OBJECTIVES: The objective of this study was to measure and compare prevalence, mortality, morbidity, use of medical resources and treatments in relation to the level of material and social deprivation of the area of residence, in a population with a diagnosis of hypertension in primary prevention for cardiovascular disease (CVD) in Quebec in 2006-2007. METHODS: This study is based on a secondary analysis of the medical administrative data of the Quebec health insurance board, the Régie de l'assurance maladie du Québec, for a cohort of 276 793 patients aged 30 years or older who had been diagnosed with hypertension in 2006 or 2007, but who did not have a known diagnosis of CVD. The health indicators adjusted for age and sex are prevalence, death, a cardiovascular event, physician visits, emergency department visits and use of antihypertensives. Twenty-five types of areas of residence were obtained by crossing the material and social deprivation quintiles. RESULTS: Compared with patients living in materially and socially advantaged areas, those living in deprived areas were at 46% higher risk of a cardiovascular event, 47% higher risk of being frequent emergency department visitors and 31% higher risk of being frequent users of a general practitioner's services, but 25% lower risk of being frequent users of medical specialists' services. Little or no variation was observed in the use of antihypertensives. CONCLUSION: This study reveals the existence, in a CVD primary prevention context, of large variations in a number of health indicators among hypertensive patients owing to the material and social deprivation of residential neighbourhood. It is therefore important to take the socioeconomic context into account when planning interventions to prevent CVDs and their consequences.

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Authors' response.

Wanigaratne S, Holowaty E, Jiang H … +2 more , Norwood T, Pietrusiak MA

Chronic Dis Inj Can · 2014 Jul · PMID 24991783

Abstract loading — click title to view on PubMed.

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Letter to the editor. Canadian tritium study misleading to the public.

Vakil C, Harvey L

Chronic Dis Inj Can · 2014 Jul · PMID 24991782

Abstract loading — click title to view on PubMed.

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Report summary. Seniors' Falls in Canada: Second Report: key highlights.

Stinchcombe A, Kuran N, Powell S

Chronic Dis Inj Can · 2014 Jul · PMID 24991781

Injury in Canada is a serious public health concern. Injuries are a leading cause of hospitalization for children, young adults and seniors and a major cause of disability and death. Falls remain the leading cause of inj... Injury in Canada is a serious public health concern. Injuries are a leading cause of hospitalization for children, young adults and seniors and a major cause of disability and death. Falls remain the leading cause of injury-related hospitalizations among Canadian seniors, and data from the Canadian Community Health Survey - Healthy Aging indicate that 20% of seniors living in the community reported a fall in the previous year, with a higher prevalence among older seniors, i.e., those aged over 80 years. Falls and associated outcomes not only harm the injured individuals but also affect their families, friends and care providers; they also place considerable pressure on the health care system. However, we do know that these personal and economic costs can be avoided through injury prevention activities. The Seniors' Falls in Canada: Second Report provides policy makers, researchers, community programmers and practitioners with current data and trends on falls, injuries and hospitalizations among Canadian adults aged 65 years and over. This report is intended for use in public health research, policy development and practice.

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Short communication. The role of animal-sourced insulin in the treatment of type 1 diabetes and its availability.

Klein AV, Taylor E, Legaré C … +2 more , Vu D, Griffiths E

Chronic Dis Inj Can · 2014 Jul · PMID 24991780

As a result of a number of factors, the treatment of insulin-dependent diabetes has moved away from using insulin of beef or pork origin to using recombinant (biosynthetic) insulin preparations. However, some people with... As a result of a number of factors, the treatment of insulin-dependent diabetes has moved away from using insulin of beef or pork origin to using recombinant (biosynthetic) insulin preparations. However, some people with type 1 diabetes can manage their diabetes better using animal-sourced insulin. Despite dwindling options and decreased production, animal-sourced insulin (and pork insulin in particular) is still available on the Canadian market. This communication describes the actions taken by Health Canada with respect to the availability of animal insulin.

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Epidemiology of allergic rhinitis in Quebec: from a 2008 population-based survey.

Canuel M, Lebel G

Chronic Dis Inj Can · 2014 Jul · PMID 24991779

INTRODUCTION: Our objective was to estimate the prevalence of symptoms and the proportion of a lifetime physician-based diagnosis of allergic rhinitis (AR) in the province of Quebec among people aged 15 years and older.... INTRODUCTION: Our objective was to estimate the prevalence of symptoms and the proportion of a lifetime physician-based diagnosis of allergic rhinitis (AR) in the province of Quebec among people aged 15 years and older. METHODS: The 2008 Quebec Population Health Survey provided data on the prevalence of symptoms and proportion of lifetime physician-based diagnoses of AR. The prevalence of symptoms was defined as the proportion of individuals who, in the absence of a cold or the flu, had nasal and ocular symptoms in the 12 months before the survey. RESULTS: The reported prevalence of AR symptoms was 17%, although 9% did not have a diagnosed condition. Reported prevalence was lowest in those aged 65 years and older (12%) and was more common among women (19%) than men (15%). The estimated prevalence of lifetime physician-based diagnosis was 17%. CONCLUSION: AR prevalence is high in Quebec with about 1 in 6 people experiencing symptoms. The condition is underdiagnosed and might also be undertreated.

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Building knowledge development and exchange capacity in Canada: lessons from Youth Excel.

Riley B, Wong K, Manske S

Chronic Dis Inj Can · 2014 Jul · PMID 24991778

INTRODUCTION: Youth Excel was a 3-year pan-Canadian initiative to advance youth health through improving knowledge development and exchange (KDE) capacity. KDE capacity refers to an improvement cycle linking evidence and... INTRODUCTION: Youth Excel was a 3-year pan-Canadian initiative to advance youth health through improving knowledge development and exchange (KDE) capacity. KDE capacity refers to an improvement cycle linking evidence and action. Capacities include local surveillance of youth behaviours; knowledge exchange; skills, resources and a supportive environment to use knowledge; and evaluation. METHODS: Interviews were conducted with Youth Excel members, including 7 provincial teams and 2 national organizations. Interviews explored participant experiences with building KDE capacity. RESULTS: Local surveillance systems were considered the backbone to KDE capacity, strengthened by co-ordinating surveys within and across jurisdictions and using common indicators and measures. The most effective knowledge exchange included tailored products and opportunities for dialogue and action planning. Evaluation is the least developed KDE component. Building KDE capacity requires frequent dialogue, mutually beneficial partnerships and trust. It also requires attention to language, vision, strategic leadership and funding. CONCLUSION: Youth Excel reinforces the need for a KDE system to improve youth health that will require new perspectives and sustained commitment from individual champions and relevant organizations.

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Performance of administrative case definitions for comorbidity in multiple sclerosis in Manitoba and Nova Scotia.

Marrie RA, Fisk JD, Stadnyk KJ … +6 more , Tremlett H, Wolfson C, Warren S, Bhan V, Yu BN, CIHR Team in the Epidemiology and Impact of Comorbidity on Multiple Sclerosis

Chronic Dis Inj Can · 2014 Jul · PMID 24991777

INTRODUCTION: As the population ages and the prevalence of comorbid conditions increases, the need for feasible, validated methods of comorbidity surveillance in chronic diseases such as multiple sclerosis (MS) increases... INTRODUCTION: As the population ages and the prevalence of comorbid conditions increases, the need for feasible, validated methods of comorbidity surveillance in chronic diseases such as multiple sclerosis (MS) increases. METHODS: Using kappa (k) statistics, we evaluated the performance of administrative case definitions for comorbidities commonly observed in MS by comparing agreement between Manitoba (MB) administrative data and self-report (n = 606) and Nova Scotia (NS) administrative data and self-report (n = 1923). RESULTS: Agreement between the administrative definitions and self-report was substantial for hypertension (k = 0.69 [NS], 0.76 [MB]) and diabetes (k = 0.70 [NS], 0.66 [MB]); moderate for hyperlipidemia (k = 0.53 [NS], 0.51 [MB]) and heart disease (k = 0.42 [NS], 0.51 [MB]) and fair for anxiety (k = 0.27 [NS], 0.26 [MB]). In NS, agreement was substantial for inflammatory bowel disease (k = 0.71) and moderate for epilepsy (k = 0.48). CONCLUSION: Administrative definitions for commonly observed comorbidities in MS performed well in 2 distinct jurisdictions. This suggests that they could be used more broadly across Canada and in national studies.

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Chronic Diseases And Injuries In Canada[JOURNAL]

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