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Feature Articles |
|
1. Personal factors influencing agreement between expert
and self-reported assessments of an occupational
exposure |
PDF version |
2. Services for children and youth with chronic health
conditions: Views of pediatricians in British
Columbia |
PDF version |
3. Pharmacists' attitudes,
role perceptions and interventions regarding smoking cessation:
Findings from four Canadian provinces |
PDF version |
4. Eliciting Canadian population
preferences for health states using the Classification and
Measurement System of Functional Health (CLAMES) |
PDF version |
5. Population health impact of
cancer in Canada, 2001 |
PDF version |
6. Variations in injury among
Canadian adolescents by urban-rural geographic
status |
PDF version |
7. Determinants of high birth
weight by geographic |
PDF version |
Chronic Diseases in Canada (CDIC) is a quarterly scientific journal focussing on current evidence relevant to the control and prevention of chronic (i.e. non-communicable) diseases and injuries in Canada. Since 1980 the journal has published a unique blend of peer-reviewed feature articles by authors from the public and private sectors and which may include research from such fields as epidemiology, public/community health, biostatistics, the behavioural sciences, and health services or economics. Only feature articles are peer reviewed. Authors retain responsibility for the content of their articles; the opinions expressed are not necessarily those of the CDIC editorial committee nor of the Public Health Agency of Canada.
Authors: Heather K Neilson,
Andrea Sass-Kortsak, WY Wendy Lou and
James T Purdham
Abstract:
This study aimed to identify personal
factors associated with expert and respondent agreement on past
occupational exposure. Epidemiologic data was collected from 1995
to 1998 in a community-based, case-control study of prostate
cancer. Using longest jobs and excluding agreement on
“never” exposure, self-reported and expert estimates of
ever/ never exposure, by skin or ingestion, to polycyclic aromatic
hydrocarbons were compared. Agreement between respondents and the
expert was 53.9% (N=1,038), with overreporting being more common
than underreporting relative to the expert (31.8% versus 14.4%). In
multiple logistic regression models, white-collar occupational
status was significantly associated with overreporting (odds ratio
[OR] = 0.142; 95% confi dence interval [CI]: 0.095-0.211;
blue-collar versus white-collar), while age was associated with
underreporting (OR=1.077; 95% CI: 1.043-1.112; one-year increase).
Neither job satisfaction nor risk perception appeared to confound
other associations. In future studies, overreporting by
white-collar workers might be avoided by providing clearer
definitions of exposure, whereas elderly respondents may require
aids to enhance exposure recall.
Authors: Anton R Miller, Magda Recsky, Mojgan Ghazirad, Michael Papsdorf and Robert W Armstrong
Abstract:
Canadian research on health services
for children and youth with chronic health conditions (CHC) is
limited. In a postal survey, pediatricians in British Columbia
rated the quality and safety of health care services for children
with chronic medical conditions (Ch-Med) lower (mean rating
± SD on a seven-point scale: 4.86 ± 1.02 ) than
services for children with acute conditions/injuries (5.97 ±
1.01), and lowest for children with chronic developmental,
behavioural and mental health conditions (Ch-DBM; 3.06 ±
1.17). To improve health care services for CHC, respondents
especially favoured improving access to community-based services
and resources and to medical specialists and specialized
facilities, and the implementation of alternative models of care.
Respondents indicated that physician care of children with CHC
could be enhanced by extending the physician's role, better
integrating medical with other aspects of care and adopting more
flexible payment mechanisms. Findings suggest the need for
enhancement and innovation in medical services for children with
CHC, especially Ch-DBM, but also that solutions need to take
account of CHC subcategory, geographic factors and differences in
practitioner readiness to embrace change.
Authors: Mary Jane Ashley, J Charles Victor and Joan Brewster
Abstract:
Pharmacists in Ontario, Quebec,
Saskatchewan and Prince Edward Island were surveyed in 2002
regarding their professional involvement in smoking cessation. In
all provinces, at least 70% had positive attitudes toward smoking
cessation. At least 50% thought that pharmacists have important
roles in motivating patients to quit and in most aspects of
motivating, assisting and referring patients. However, in all
provinces, less than 40% had intervened in various ways in the past
year with more than one half of their patients who smoked. Advising
cutting down or quitting, attempting to increase motivation to quit
and suggesting the use of nicotine replacement therapy were the
most often performed interventions. Consistent inter-provincial
patterns of differences in attitudes, role perceptions and
interventions were not found. Some differences in attitudes and
role perceptions were found between pharmacists practicing in
provinces either banning or not banning tobacco sales in
pharmacies, but there was no difference in overall interventions.
The findings provide a baseline for provincial monitoring of
pharmacists' professional smoking cessation attitudes, role
perceptions and interventions. They also may inform tobacco control
initiatives.
Authors: Cameron N McIntosh, Sarah Connor Gorber, Julie Bernier and Jean-Marie Berthelot
Abstract:
A major objective of the Population
Health Impact of Disease in Canada (PHI) research program was to
obtain Canadian-specific preferences for health states associated
with various diseases, in order to estimate the morbidity component
of summary measures of population health embodying the Canadian
experience of disease. In this study, preferences for health states
were elicited from lay panels (N=146) in nine Canadian communities
(Vancouver, Edmonton, Saskatoon, Toronto, Ottawa, Montréal,
Québec, Moncton and Halifax); the study was conducted from
January to June of 2003. Information on health states was presented
to raters using the CLAssification and MEasurement System of
Functional Health (CLAMES), which assesses functional capacity
using 11 health status attributes, each with four to five levels
ranging from normal to severely limited functioning. Preferences
for 238 health states classified by CLAMES were elicited using the
standard gamble (SG) technique in both individual and group
exercises. Mean preferences for these health states were then used
to estimate the parameters of a log-linear scoring function for
CLAMES. The function provides a convenient method of computing
preference scores for any health state classified by CLAMES,
without the need for direct measurement in surveys. Further, the SG
appears feasible in group settings.
Authors: Jane Boswell-Purdy, William M Flanagan, Hélène Roberge, Christel Le Petit, Kathleen J White and Jean-Marie Berthelot
Abstract:
Summary measures of population health
that incorporate morbidity provide a new perspective for health
policy and priority setting. Health-adjusted life years (HALYs)
lost to a disease combine the impact of years of life lost to
premature mortality and morbidity, measured as year-equivalents
lost to reduced functioning. HALYs for 25 cancers were estimated
from mortality and incidence in 2001 in Canada;
population-attributable fractions were estimated for major risk
factors contributing to these cancers. Results from this analysis
indicate that Canadians would lose an estimated 905,000
health-adjusted years of life to cancer for 2001, including 771,000
to premature mortality and 134,000 to morbidity from incident cases
(years discounted at 3%). Most of the estimated premature mortality
was due to lung cancer; morbidity was largely due to breast,
prostate and colorectal cancers. An estimated one quarter of HALYs
lost to cancer were attributable to smoking and almost one quarter
were attributable to alcohol consumption, lack of fruit and
vegetables, obesity and physical inactivity combined. These results
are a significant advance in measuring the population health impact
of cancer in Canada because they incorporate morbidity as well as
mortality.
Authors: Xuran Jiang, Dongguang Li, William Boyce and William Pickett
Abstract:
Injuries are the leading cause of
morbidity and mortality among Canadian adolescents. Rural
adolescents may be disproportionally affected by these traumatic
events. Differences in risk for injury between rural and urban
adolescents remain understudied. We compared adolescent reports of
medically attended injury by urban-rural geographic status using a
representative national sample of Canadian adolescents. The study
involved an analysis of a national sample of Canadian adolescents
aged 11 to 15 years (N=7,235) from the 2001-2002 WHO/Health
Behaviour in School-aged Children survey. Respondents were
classified into five geographic categories according to school
addresses. Several differences in risk for injury were documented
by urban-rural geographic status. Adolescents from rural regions
were more likely to report medically treated injury compared with
the reference population from large metropolitan areas. These
patterns of medically attended injury suggest that prevention and
intervention programs could be better targeted to the needs of
specific geographic populations of Canadian youth.
Authors: Lise Dubois, Manon Girard and Fabiola Tatone-Tokuda
Abstract:
This study aims to analyze the
determinants of high birth weight (> 4000 grams) by various
geographic regions of Canada. Analyses were performed using the
data from cycles 1 to 4 (1994-2001; N=20,002 children) of the
Canadian National Longitudinal Survey of Children and Youth
(NLSCY). Children were grouped into five geographic residential
area categories: the Atlantic provinces, Quebec, Ontario, the
Prairie provinces and British Columbia. Determinants analyzed in
the study include sex, gestational age and birth rank of children;
maternal age and education; maternal smoking during pregnancy;
family type; family socioeconomic status (SES) and maternal health
(postpartum depression; hypertension and prescription drug use
during pregnancy). In comparison to Quebec, the odds of giving
birth to a high-birth-weight child were 25% higher in Ontario, 41%
higher in the Atlantic provinces and 53% higher in British
Columbia. In Quebec, non-smoking mothers of higher SES had
increased odds of delivering a baby weighing more than 4000 grams,
while in British Columbia, the odds of having a birth weight
greater than 4000 grams doubled for children of non-smoking mothers
from the lowest SES quintiles. The relationship between social
disparities and macrosomia was found to vary by geographic
region.