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Feature Articles |
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1. Risk factors for falling among community-dwelling seniors using home-care services: An extended hazards model with time-dependent covariates and multiple events |
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2. Gender and the smoking behaviour of Ethiopian immigrants in Toronto |
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3. Ethnicity and mental health: Conceptualization, definition and operationalization of ethnicity from a Canadian context |
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4. Association of comorbid mood disorders and chronic illness with disability and quality of life in Ontario, Canada |
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5. Costs associated with mood and anxiety disorders, as evaluated by telephone survey |
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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: BS Leclerc, MSc; C Bégin, MSc; É Cadieux, MSc; L Goulet, MD, PhD; N Leduc, PhD; M-J Kergoat, MD; P Lebel, MD
Abstract:
The identification of risk factors for falls in longitudinal studies becomes difficult because
of exposures that change during the follow-up and also because individual subjects may
experience an event more than once. These issues have been neglected and improper
statistical techniques have been used. The typical approaches have been to report the
proportion of fallers or the time to first fall. Both avoid the underlying assumption of
independence between events and discard pertinent data. We review the existing methods
and propose a Cox hazards extension. We exemplify it in the study of potential risk factors
associated with all falls in 959 seniors. Finally, we compare the results of the proposed
Wei, Lin, & Weissfeld (WLW) method with those of several other techniques. Stable
exposure variables measured at baseline and updated time-varying exposures include
socio-demographic characteristics, BMI, nutritional risk, alcohol consumption, home
hazards, gait and balance, and medications. Results demonstrate that the usual methods
of analyzing risk factors for falling are inappropriate, as they produce considerable
biases relative to the WLW model using time-dependent covariates. Results also show
that modeling for first events may be inefficient, given that the risk of occurrence varies
between falls.
Authors: I Hyman, PhD; H Fenta, PhD; S Noh, PhD
Abstract:
The objective of this paper is to present descriptive data on gender and smoking among
Ethiopian immigrants in Toronto, Canada. The study used a cross-sectional epidemiological
survey design (N = 342). The main outcome measures identified subjects as current
(regular or occasional) smokers, daily smokers and former smokers. Overall, 20.8% of the
individuals in the sample were current smokers and 15.7% were daily smokers. Although
smoking rates (current and daily) were significantly higher among males compared to
females, nearly twice as many female as male daily smokers reported that they began
smoking post-migration (60.0% vs. 30.2%). Furthermore, 80.0% of female compared to
nearly 56% of male daily smokers reported that they were smoking more post-migration.
A significantly higher proportion of males compared to females were former daily smokers
(17.8% vs. 4.4%). These findings present a challenge for public health professionals in
terms of preventing the adoption of smoking among Ethiopian females and facilitating
smoking cessation among Ethiopian males. Correlates with current smoking suggested
that smoking prevention and cessation programs in newcomer immigrant communities
may benefit from incorporating social, economic and religious contexts of these newcomers'
lives from a gender-specific perspective.
Authors: DE Clarke, PhD; A Colantonio, PhD; AE Rhodes, PhD; M Escobar, PhD
Abstract:
The current study provides a critical review of Canadian studies on ethnicity and mental
health with respect to the definition, conceptualization and operationalization of ethnicity.
It provides a discussion on the methodological issues related to these factors and their
implications to guide future research and enable comparability of results across studies.
Sociological Abstracts, PsycINFO, MEDLINE and CINAHL were used to identify relevant
Canadian articles published between January 1980 and December 2004. The review
highlights a number of key issues for future researchers to consider such as the need for:
1) clear rationales as to why ethnicity is important to their outcome of interest; 2) clarity
on the definition of ethnicity, which affects its conceptualization and operationalization;
3) a theoretically driven conceptualization of ethnicity, which should be related to the
research question of interest; and 4) clear rationales for the decisions made regarding the
data source used, the operationalization of ethnicity, and the ethnic categories included
in their studies.
Authors: T Gadalla, PhD
Abstract:
Mood disorders are more prevalent in individuals with chronic physical illness compared
to individuals with no such illness. These disorders amplify the disability associated with
the physical condition and adversely affect its course, thus contributing to occupational
impairment, disruption in interpersonal and family relationships, poor health and
suicide. This study used data collected in the Canadian Community Health Survey, cycle
3.1 (2005) to examine factors associated with comorbid mood disorders and to assess
their association with the quality of life of individuals living in Ontario. Results indicate
that individuals with chronic fatigue syndrome, fibromyalgia, bowel disorder or stomach
or intestinal ulcers had the highest rates of mood disorders. The odds of having a comorbid
mood disorder were higher among women, the single, those living in poverty, the Canadian
born and those between 30 and 69 years of age. The presence of comorbid mood disorders
was significantly associated with short-term disability, requiring help with instrumental
daily activities and suicidal ideation. Health care providers are urged to proactively screen
chronically ill patients for mood disorders, particularly among the subgroups found to
have elevated risk for these disorders.
Authors: SB Patten, MD, PhD; JVA Williams, MSc; C Mitton, MSc
Abstract:
Costing studies are central to health policy decisions. Available costing estimates for mood
and anxiety disorders in Canada may, however, be out of date. In this study, we estimated
a set of direct health care costs using data collected in a provincial telephone survey of
mood and anxiety disorders in Alberta. The survey used random digit dialing to reach a
sample of 3394 household residents aged 18 to 64. A telephone interview included items
assessing costs without reference to whether these were incurred by the respondent,
government or a health plan. The survey interview also included the Mini Neuropsychiatric
Diagnostic Interview (MINI). Costs for antidepressant medications appear to have
increased since the last available estimates were published. Surprisingly, most medication
costs for antidepressants were incurred by respondents without an identified disorder.
Also, an unexpectedly large proportion of medication costs were for psychotropic
medications other than antidepressants and anxiolytic-sedative-hypnotics. These results
suggest that major changes have occurred in the costs associated with antidepressant
treatment. Available cost-of-illness data may be outdated, and some assumptions made
by previous studies may now be invalid.