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Disordered gambling is best conceptualized as a continuum of severity. Previous research has demonstrated the utility of studying individuals at all points of this spectrum. The sequence of the development of gambling problems and change in gambling involvement along this continuum of severity is not well understood. The present study examined the interplay between cognitive distortions and gambling involvement in a population sample recruited in Alberta, Canada. Data from 1372 participants over 4 assessment waves (5 years) were used to generate a 2-factor latent structure using gambling fallacies and gambling involvement measurements. Structural equation modelling showed that cognitive distortions more strongly predicted future gambling involvement than the reverse relationship, using the comparative fit index (CFI) and the root mean square error of approximation (RMSEA) to assess the models. In addition, cognitive distortions declined over time, whereas gambling involvement remained stable. The ...

Introduction Le surpoids et l’obésité dépendent de l’interaction complexe entre facteurs liés à l’indivu et facteurs liés à l’environnement ayant une influence sur l’activité physique et une alimentation saine. Il existe pourtant peu d’information sur les perceptions des individus à l’égard de ces facteurs. Afin de combler cette lacune importante et de répondre aux besoins de nos partenaires des collectivités, nous examinons comment les individus perçoivent l’influence des facteurs micro- et macroenvironnementaux sur leur activité physique et leur alimentation. Méthodologie Nos partenaires des collectivités souhaitaient que les résultats de l’étude soient diffusés dans un format facile à utiliser par les décideurs locaux. Avec la méthode photovoix, nous avons motivé 35 membres issus de quatre collectivités de l’Alberta (Canada) à fournir leurs témoignages à propos de leur activité physique et d’une alimentation saine. Nous avons employé une combinaison d’analyses inductives et déductives pour classer les données par niveau (micro et macro) d’environnement et par type (environnement physique, politique, économique et socioculturel), à l’aide de la Grille d’analyse des environnements liés à l’obésité (ANGELO). Résultats Pour les participants, les facteurs liés à la santé étaient plus larges que l’activité physique et une alimentation saine, incluant la « santé sociocommunautaire ». Les participants ont parlé plus souvent de l’influence du microenvironnement (score de 792 après codage au moyen du cadre ANGELO) sur l’activité physique, une alimentation saine ou la santé sociocommunautaire que sur l’influence du macroenvironnement (score de 93). Les résultats obtenus avec la méthode photovoix ont fourni aux partenaires des collectivités et aux décideurs un témoignage visuel de la manière dont la capacité des individus à faire des choix sains peut être restreinte par des forces macroenvironnementales qui échappent à leur contrôle. Conclusion Axer les recherches ultérieures sur les influences macroenvironnementales et microenvironnementales ainsi que sur la santé sociocommunautaire locale sera utile, car cela alimentera les stratégies de changement en vue d’améliorer la santé des collectivités tout en garantissant que la recherche et les interventions font écho aux perceptions diverses de la population.

Background: Recently, the concept of addiction has expanded to include many types of problematic repetitive behaviors beyond those related to substance misuse. This trend may have implications for the way lay people think about addictions and persons struggling with addictive disorders. The aim of this study was to provide a better understanding of how the public understands a variety of substance-related and behavioral addictions. Methods: A representative sample of 4,000 individuals from Alberta, Canada completed an online survey. Participants were randomly assigned to answer questions about perceived addiction liability, etiology, and prevalence of problems with four substances (alcohol, tobacco, marijuana, and cocaine) and six behaviors (problematic gambling, eating, shopping, sexual behavior, video gaming, and work). Results: Bivariate analyses revealed that respondents considered substances to have greater addiction liability than behaviors and that most risk factors (moral, biological, or psychosocial) were considered as more important in the etiology of behavioral versus substance addictions. A discriminant function analysis demonstrated that perceived addiction liability and character flaws were the two most important features differentiating judgments of substance-related versus behavioral addictions. Perceived addiction liability was judged to be greater for substances. Conversely, character flaws were viewed as more associated with behavioral addictions. Conclusions: The general public appreciates the complex bio-psycho-social etiology underlying addictions, but perceives substance-related and behavioral addictions differently. These attitudes, in turn, may shape a variety of important outcomes, including the extent to which people believed to manifest behavioral addictions feel stigmatized, seek treatment, or initiate behavior changes on their own.

The objective of the current study was to examine the possible temporal associations between alcohol misuse and problem gambling symptomatology from adolescence through to young adulthood. Parallel-process latent growth curve modeling was used to examine the trajectories of alcohol misuse and symptoms of problem gambling over time. Data were from a sample of adolescents recruited for the Leisure, Lifestyle, and Lifecycle Project in Alberta, Canada (n = 436), which included 4 assessments over 5 years. There was an average decline in problem gambling symptoms followed by an accelerating upward trend as the sample reached the legal age to gamble. There was significant variation in the rate of change in problem gambling symptoms over time; not all respondents followed the same trajectory. There was an average increase in alcohol misuse over time, with significant variability in baseline levels of use and the rate of change over time. The unconditional parallel process model indicated that higher baseline levels of alcohol misuse were associated with higher baseline levels of problem gambling symptoms. In addition, higher baseline levels of alcohol misuse were associated with steeper declines in problem gambling symptoms over time. However, these between-process correlations did not retain significance when covariates were added to the model, indicating that one behavior was not a risk factor for the other. The lack of mutual influence in the problem gambling symptomatology and alcohol misuse processes suggest that there are common risk factors underlying these two behaviors, supporting the notion of a syndrome model of addiction. (PsycINFO Database Record

Major depression is among the most common comorbid conditions in problem gambling. However, little is known about the effects of comorbid depression on problem gambling. The present study examined the prevalence of current major depression among problem gamblers (N = 105) identified from a community sample of men and women in Alberta, and examined group differences in gambling severity, escape motivation for gambling, family functioning, childhood trauma, and personality traits across problem gamblers with and without comorbid depression. The prevalence of major depression among the sample of problem gamblers was 32.4 %. Compared to problem gamblers without depression (n = 71), problem gamblers with comorbid depression (n = 34) reported more severe gambling problems, greater history of childhood abuse and neglect, poorer family functioning, higher levels of neuroticism, and lower levels of extraversion, agreeableness, and conscientiousness. Furthermore, the problem gamblers with comorbid depression had greater levels of childhood abuse and neglect, worse family functioning, higher neuroticism, and lower agreeableness and conscientiousness than a comparison sample of recreational gamblers with depression (n = 160). These findings underscore the need to address comorbid depression in assessment and treatment of problem gambling and for continued research on how problem gambling is related to frequently co-occurring disorders such as depression.

HIV counseling and voluntary testing during antenatal care have been proven to reduce the risk of HIV transmission from mother to child, through increasing knowledge about safe behaviors, ascertaining HIV status and increasing coverage of effective antiretroviral regimens. However, it remains that, in developing countries where 95 % of mother-to-child HIV transmissions (MTCT) take place, such interventions are not widely accessible or available. Using a nationally representative cross-sectional household survey, the present study aimed to examine individual- and contextual-level influences on the receipt of HIV pre-test counseling and uptake of HIV testing during the antenatal care period in Swaziland, a country highly burdened by HIV/AIDS. The study sample was restricted to women aged 15-49 years with a live birth in the past five years preceding the survey and who received antenatal care for the most recent birth. The findings of this study indicated that only 62 % of women received pre-test counseling for the prevention of MTCT and no more than 56 % of women consented to be tested for HIV during antenatal care. The multilevel regression analysis revealed that the likelihood of receiving HIV pre-test counseling increases significantly with higher parity, education level, household wealth and antenatal visits while it is lower in areas where poverty is pervasive (OR = 0.474) and in rural regions (OR = 0.598) as well. Beyond all the significant predictors, undergoing pre-test counseling has emerged as an important determinant of HIV testing. Receiving pre-test counseling increases the odds of accepting an HIV test by 77 %. Evidence from this analysis underscores bottlenecks and challenges that persist in increasing the need for and uptake of HIV preventive and treatment services to stop new HIV infections among children.

The Irvine-Minnesota Inventory (IMI) is an audit tool used to record properties of built environments. It was designed to explore the relationships between environmental features and physical activity. As published, the IMI does not provide scoring to support this use. Two papers have since been published recommending methods to form scales from IMI items. This study examined these scoring procedures in new settings. IMI data were collected in two urban settings in Alberta in 2008. Scale scores were calculated using the methods presented in previous papers and used to test whether the relationships between IMI scales and walking behaviors were consistent with previously reported results. The scales from previous work did not show expected relationships with walking behavior. The scale construction techniques from previous work were repeated but scales formed in this way showed little similarity to previous scales. The IMI has great potential to contribute to understanding relationships between built environment and physical activity. However, constructing reliable and valid scales from IMI items will require further research.

As the world's population ages, there is an increasing need for community environments to support physical activity and social connections for older adults. This exploratory study sought to better understand older adults' usage and perceptions of community green spaces in Taipei, Taiwan, through direct observations of seven green spaces and nineteen structured interviews. Descriptive statistics from observations using the System for Observing Play and Recreation in Communities (SOPARC) confirm that older adults use Taipei's parks extensively. Our analyses of interviews support the following recommendations for age-friendly active living initiatives for older adults: make green spaces accessible to older adults; organize a variety of structured activities that appeal to older adults particularly in the morning; equip green spaces for age-appropriate physical activity; and, promote the health advantages of green spaces to older adults.

Objective To assess the impact of a 3 year (2006–2009) community-based intervention for obesity and chronic disease prevention in four diverse “Healthy Alberta Communities” (HAC). Methods Targeted intervention development incorporated the ANGELO conceptual framework to help community stakeholders identify environmental determinants of obesity amenable to intervention. Several inter-related initiatives were implemented. To evaluate, we surveyed separate samples of adults in HAC communities before and after the interventions and compared responses to identical survey questions asked of adults living in Alberta in two waves of the Canadian Community Health Survey (CCHS). Results The HAC sample included 4761 (2006) and 4733 (2009) people. The comparison sample included 9775 and 9784 respondents in 2005 and 2009–10 respectively. Self-reported body mass index showed no change, and neither were there significant changes in behaviors relative to secular trends. Most significant outcomes were relevant to social conditions, specifically sense of belonging to community in the intervention communities. Conclusion Health outcome indicators at the community level may not be sufficiently sensitive to capture changes which, over a relatively short term, would only be expected to be incremental, given that interventions were directed primarily to creating environmental conditions supportive of changes in behavioral outcomes rather than toward health outcome change directly.

Adolescence is a period of rapid biological and behavioral changes that may increase the risk of mental health problems. This study investigates the path between self-reported mental health, feeling of alienation, and self-reported physical health by examining the role of demographic factors and socioeconomic variables. Participants were recruited from high schools in Stockholm, Sweden. In total, 445 students participated, aged 15–19 years (SD = 1.01, mean = 17.00); 263 (59.4%) were female and 180 were (40.6%) male. The Nottingham Health Profile and Jessor and Jessor alienation scale were used, and statistical analysis was performed by using regression and path analysis. The results revealed a significant correlation between feeling of alienation and mental health, and found alienation to be a mediating factor between mental health problems and physical health. Female students reported more problems than males. The relationship between neighborhood characteristics (geographical location and type of home) ...

Objective maternal mortality represents the single greatest health disparity between high and low income countries. This inequity is especially felt in low income countries in sub Saharan Africa and Southeast Asia where 99% of the global burden of maternal death is borne. A goal of MDG 5 is to reduce maternal mortality and have a skilled attendant at every birth by 2015. A critical skill is ongoing intrapartum monitoring of labour progress and maternal/fetal well-being. The WHO partograph was designed to assess these parameters. Design and setting a retrospective review of charts ( n =1,845) retrieved consecutively over a 2 month period in a tertiary teaching hospital in Ghana was conducted to assess the adequacy of partograph use by skilled birth attendants and the timeliness of action taken if the action line was crossed. WHO guidelines were implemented to assess the adequacy of partograph use and how this affected maternal neonatal outcomes. Further, the timeliness and type of action taken if action line was crossed was assessed. Findings partographs were adequately completed in accordance with WHO guidelines only 25.6% (472) of the time and some data appeared to be entered retrospectively. Partograph use was associated with less maternal blood loss and neonatal injuries. When the action line was crossed (464), timely action was taken only 48.7% of the time and was associated with less assisted delivery and a fewer low Apgar scores and NICU admissions. Conclusion when adequately used and timely interventions taken, the partograph was an effective tool. Feasibility of partograph use requires more scrutiny; particularly identification of minimum frequency for safe monitoring and key variables as well as a better understanding of why skilled attendants have not consistently ‘bought in' to partograph use. Frontline workers need access to ongoing and current education and strategically placed algorhythims.

Background Despite common usage of the back beliefs questionnaire (BBQ) in a variety of studies, important validity evidence is missing. The objective of this study was to examine the validity of the BBQ in the general population. Methods A population-based, cross-sectional study design was used. Adult residents in two Canadian provinces were randomly sampled. To examine structural validity, items from the BBQ were subjected to factor analysis. Construct validity was tested by examining two hypotheses: BBQ scores would be most pessimistic in those with a recent history of back pain and in those who utilized passive treatments for back pain. Multiple linear regression was used to analyse the two hypotheses. Results Complete data were available for 6171 subjects. The best structure for the BBQ was to use eight or nine of the 14 items for scoring, which is consistent with the structure reported by the BBQ developers. BBQ scores varied based on participants’ history of low back pain (LBP) and depended on pain severity. Those with severe pain and a recent history of LBP had the most pessimistic BBQ scores. In addition, participants who utilized passive management behaviours such as bed rest and activity avoidance had more pessimistic BBQ scores compared with those that did not. Conclusions This study provides strong validity evidence supporting the current structure and scoring of the BBQ. In addition, construct validity was evidenced by the behaviour of BBQ scores in a manner congruent with our hypotheses, further supporting use of the BBQ in the general population.

Background We describe the epidemiology of pertussis in Alberta, Canada by person, place, and time between 2004 and 2015, identify outbreak years, and examine vaccination coverage and vaccination timeliness. Methods We used health data from Alberta’s Communicable Disease Registry System for the period of January 1, 2004 through August 31, 2015 to identify unique cases of pertussis. Unique cases were deterministically linked to data in Alberta’s immunization repository and health care insurance plan registry. Population estimates and vaccination coverage were extracted from Alberta’s online Interactive Health Data Application. We estimated pertussis incidence rates per 100,000 persons by year, age group, gender, and health zone. Outbreak years were identified using a one-sided cumulative sum (CUSUM) analysis by comparing annual incidence rates to baseline rates. Results Over the period, 3510 cases of pertussis were confirmed by laboratory testing or epidemiological linkage. Incidence rates per 100,000 persons were highest in 2004 (20.5), 2005 (13.6), and 2015 (10.4) for all age groups. Incidence rates were highest among the youngest age groups and decreased as age groups increased. Based on CUSUM analysis, 2008 and 2012 met the criteria for outbreak years. Vaccination coverage was over 90% among the general population, however only 61% of cases received at least one dose. About 60% of cases were diagnosed 5+ years after receiving the vaccine. Approximately 87–91% of vaccinated cases did not receive the first three vaccine doses in a timely manner. Conclusion Pertussis incidence rates fluctuated over the period across all age groups. The majority of cases had no record of vaccination or were delayed in receiving vaccines. CUSUM analysis was an effective method for identifying outbreaks. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4468-4) contains supplementary material, which is available to authorized users.

Overweight and obesity are influenced by a complex interplay of individual and environmental factors that affect physical activity and healthy eating. Nevertheless, little has been reported on people's perceptions of those factors. Addressing this critical gap and community partner needs, this study explored how people perceived the influence of micro- and macroenvironmental factors on physical activity and healthy eating.Community partners wanted the study results in a format that would be readily and easily used by local decision makers. We used photovoice to engage 35 community members across four municipalities in Alberta, Canada, and to share their narratives about their physical activity and healthy eating. A combination of inductive and deductive analysis categorized data by environmental level (micro vs. macro) and type (physical, political, economic, and sociocultural), guided by the Analysis Grid for Environments Linked to Obesity Framework.Participants conceptualized health-influencing factors more broadly than physical activity and healthy eating to include "community social health." Participants spoke most often about the influence of the microenvironment (n = 792 ANGELO Framework coding tallies) on their physical activity, healthy eating and community social health in comparison to the macroenvironment (n = 93). Photovoice results provided a visual narrative to community partners and decision makers about how people's ability to make healthy choices can be limited by macroenvironmental forces beyond their control.Focussing future research on macro- and microenvironmental influences and localized community social health can inform practice by providing strategies on how to implement healthy changes within communities, while ensuring that research and interventions echo diverse people's perceptions.Le surpoids et l’obésité dépendent de l’interaction complexe entre facteurs liés à l’indivu et facteurs liés à l’environnement ayant une influence sur l’activité physique et une alimentation saine. Il existe pourtant peu d’information sur les perceptions des individus à l’égard de ces facteurs. Afin de combler cette lacune importante et de répondre aux besoins de nos partenaires des collectivités, nous examinons comment les individus perçoivent l’influence des facteurs micro- et macroenvironnementaux sur leur activité physique et leur alimentation.Nos partenaires des collectivités souhaitaient que les résultats de l’étude soient diffusés dans un format facile à utiliser par les décideurs locaux. Avec la méthode photovoix, nous avons motivé 35 membres issus de quatre collectivités de l’Alberta (Canada) à fournir leurs témoignages à propos de leur activité physique et d’une alimentation saine. Nous avons employé une combinaison d’analyses inductives et déductives pour classer les données par niveau (micro et macro) d’environnement et par type (environnement physique, politique, économique et socioculturel), à l’aide de la Grille d’analyse des environnements liés à l’obésité (ANGELO).Pour les participants, les facteurs liés à la santé étaient plus larges que l’activité physique et une alimentation saine, incluant la « santé sociocommunautaire ». Les participants ont parlé plus souvent de l’influence du microenvironnement (score de 792 après codage au moyen du cadre ANGELO) sur l’activité physique, une alimentation saine ou la santé sociocommunautaire que sur l’influence du macroenvironnement (score de 93). Les résultats obtenus avec la méthode photovoix ont fourni aux partenaires des collectivités et aux décideurs un témoignage visuel de la manière dont la capacité des individus à faire des choix sains peut être restreinte par des forces macroenvironnementales qui échappent à leur contrôle.Axer les recherches ultérieures sur les influences et macroenvironnementales et microenvironnementales ainsi que sur la santé sociocommunautaire locale sera utile, car cela alimentera les stratégies de changement en vue d’améliorer la santé des collectivités tout en garantissant que la recherche et les interventions font écho aux perceptions diverses de la population.

Little is known about risk factors for problem gambling (PG) within the rapidly growing urban Aboriginal population in North America. Racial discrimination may be an important risk factor for PG given documented associations between racism and other forms of addictive behaviour. This study examined associations between racial discrimination and problem gambling among urban Aboriginal adults, and the extent to which this link was mediated by post traumatic stress. Data were collected via in-person surveys with a community-based sample of Aboriginal adults living in a mid-sized city in western Canada (N = 381) in 2010. Results indicate more than 80 % of respondents experienced discrimination due to Aboriginal race in the past year, with the majority reporting high levels of racism in that time period. Past year racial discrimination was a risk factor for 12-month problem gambling, gambling to escape, and post traumatic stress disorder (PTSD) symptoms in bootstrapped regression models adjusted for confounders and other forms of social trauma. Elevated PTSD symptoms among those experiencing high levels of racism partially explained the association between racism and the use of gambling to escape in statistical models. These findings are the first to suggest racial discrimination may be an important social determinant of problem gambling for Aboriginal peoples. Gambling may be a coping response that some Aboriginal adults use to escape the negative emotions associated with racist experiences. Results support the development of policies to reduce racism directed at Aboriginal peoples in urban areas, and enhanced services to help Aboriginal peoples cope with racist events.

Background context Spinal stenosis is one of the most commonly diagnosed pathologies of the lumbar spine and the leading indication for spine surgery in adults aged 65 years and older. Yet, the burden of lumbar spinal stenosis (LSS) alone, and in combination with common comorbidities, on health-related quality of life (HRQL) is unknown as are comorbidities specifically associated with this chronic condition. Purpose To estimate the illness burden of LSS on HRQL, adjusting for the effects of specific comorbidities, age, and gender, and investigate whether specific comorbidities are associated with the condition. Study design/setting A community-based cohort of 245 patients diagnosed with LSS was assembled and compared with a representative sample of 7,489 adults from the base population of Albertans responding to the Canadian Community Health Survey on HRQL and comorbidities. Methods Health-related quality-of-life data were acquired through interviews for both groups using the Health Utilities Index Mark 3 (HUI3). Both groups were also queried about the presence of 13 specific chronic conditions. Linear regression was used to model HUI3 scores as a function of group, age, gender, and specific comorbid conditions. Logistic regression was used to compare the odds of having particular comorbid conditions between the LSS and general population groups. Results The mean unadjusted overall HUI3 scores were 0.60 for the LSS group and 0.85 for the general population (1=perfect health). After adjustment, HRQL deficits four times that deemed a clinically important difference remained between the groups. Controlling age and gender, the prevalence of arthritis, migraines, hypertension, and incontinence was significantly greater in the LSS group as compared with the general population sample. Conclusions Diagnosed LSS is associated with a very substantial burden of illness that is compounded by associated comorbidities, with implications for clinical care, health-care policy decisions, and research. Attention to comorbidities is particularly important in LSS.

The Community Health and the Built Environment (CHBE) project investigated the role of place in interventions for chronic disease prevention in order to identify contextual factors that may foster or inhibit intervention success. This paper presents a project model comprising objective-outsider and subjective-insider perspectives in a multi-method, community-based participatory research approach with an emphasis on knowledge exchange. The collaborative process generated valuable lessons concerning effective conduct of community-based research. The CHBE project model contributes a mechanism for investigating how place influences health behaviours and the outcomes of health promotion interventions. Language: en

From mitigating complications during hospital stay to reducing the incidence of chronic pain, improving pain management positively impacts short- and long-term outcomes of treatment. Quality assurance has become the focus of many health care programs in an effort to confront the challenges presented by pain and its management. The analysis of treatment strategies and patient responses form the basis of a reflective, evidence-based practice, which can raise awareness of about the importance of adequate pain management. The capabilities of an electronic database can be exploited to organize large amounts of data, which can then be used to characterize symptoms and analyze treatment responses. However, the types of data to collect, the burden of data collection on workers, and costs must be considered before implementing an electronic database for research and/or everyday practice. This study tested the relevance and usability of an electronic database in an acute pain service by assessing several variables important to database development and evaluation.BACKGROUND: Quality assurance is increasingly important in the current health care climate. An electronic database can be used for tracking patient information and as a research tool to provide quality assurance for patient care.OBJECTIVE: An electronic database was developed for the Acute Pain Service, University of Alberta Hospital (Edmonton, Alberta) to record patient characteristics, identify at-risk populations, compare treatment efficacies and guide practice decisions.METHOD: Steps in the database development involved identifying the goals for use, relevant variables to include, and a plan for data collection, entry and analysis. Protocols were also created for data cleaning quality control. The database was evaluated with a pilot test using existing data to assess data collection burden, accuracy and functionality of the database.RESULTS: A literature review resulted in an evidence-based list of demographic, clinical and pain management outcome variables to include. Time to assess patients and collect the data was 20 min to 30 min per patient. Limitations were primarily software related, although initial data collection completion was only 65% and accuracy of data entry was 96%.CONCLUSIONS: The electronic database was found to be relevant and functional for the identified goals of data storage and research.

Aims To assess the impact of gambling above the low-risk gambling limits developed by Currieet al. (2006) on future harm. To identify demographic, behavioural, clinical and environmental factors that predict the shift from low- to high-risk gambling habits over time. Design Longitudinal cohort study of gambling habits in community-dwelling adults. Setting Alberta, Canada. Participants A total of 809 adult gamblers who completed the time 1 and time 2 assessmentsseparatedbya14-monthinterval.Measurements Low-riskgamblinglimitsweredefinedasgamblingno morethanthreetimespermonth,spendingnomorethanCAN$1000peryearongamblingandspendinglessthan1% of gross income on gambling. Gambling habits, harm from gambling and gambler characteristics were assessed by the CanadianProblemGamblingIndex.Ancillarymeasuresof substanceabuse,gamblingenvironment,majordepression, impulsivity and personality traits assessed the influence of other risk factors on the escalation of gambling intensity. Findings Gamblers classified as low risk at time 1 and shifted into high-risk gambling by time 2 were two to three times more likely to experience harm compared to gamblers who remained low risk at both assessments. Factors associated with the shift from low- to high-risk gambling behaviour from time 1 to time 2 included male gender, tobacco use, older age, having less education, having friends who gamble and playing electronic gaming machines. Conclusions An increase in the intensity of gambling behaviour is associated with greater likelihood of future gambling related harm in adults.

PurposeThe objective of the study is to investigate the social alienation status of Swedish high school students with respect to gender and immigrant background.Design/methodology/approachThe sample was randomly selected from high school students aged 15‐19, and 446 students participated in the study. The Jessor and Jessor general alienation questionnaire was used to explore feelings of social alienation. Sequential multiple regression analyses were performed to examine the relationships between alienation, age, sex, and immigrant background.FindingsThe results demonstrated a significant association between immigrant background and alienation. It was found that first‐generation immigrants felt more alienated than second‐generation immigrants and second‐generation immigrants felt more alienated than natives. Adolescents who were first‐generation immigrants had higher scores on the social isolation subscale than second generation immigrants and native Swedes. However, second generation immigrants had higher scores on the meaninglessness subscale than first‐generation immigrants and native Swedes. Age proved to have a significant quadratic component. The research found feeling of alienation significantly higher among youngest and oldest students but lower for those aged 17.Research limitations/implicationsThe study was limited by the number of participants with different cultural background in the immigrant samples. As such, it was unable to compare feeling of alienation between students with different cultural background.Originality/valueAs the authors could not identify any studies that specifically address feelings of social alienation among adolescents in Sweden, thus this study is believed to be the first one in this context.

Debates about EBs (gambling, Internet use, shopping, working, exercising, eating, video game playing and sex) have gained momentum among researchers, clinicians, and the media. Controversy exists in the scientific literature about whether EBs are primary psychiatric disorders and, if so, where they fit into current and emerging diagnostic classification systems. The lack of consensus and associated confusion was the impetus for this systematic review. The key search terms were: abuse/misuse, dependence, addiction, impulse control, compulsivity, pathological, and excessive, in combination with: buying/shopping, work, gaming/video games, exercise, Internet, sex, eating, and gambling. 361 articles were analyzed according to their conceptualization. In total, 47% adopted an addiction conceptualization, 9% adopted an impulse control conceptualization, and 2% an obsessive compulsive spectrum conceptualization. Alternative or blended conceptualizations were utilized by 27% and 16% did not specify a particular conceptualization. The findings were also broken down by excessive behaviour. Almost half of the articles were review articles (49%), 34% were empirical articles, and the remaining 17% were commentaries. There was a general lack of agreement regarding conceptualization and a lack of consistency in nomenclature, definitions, and use of language. The addiction conceptualization was most prevalent consistent with the common use of the term behavioural addiction, and in line with proposed changes to the DSM-5.

Albertans representing five age cohorts (13–15, 18–20, 23–25, 43–45 and 63–65) were surveyed (n = 1809) to assess their attitudes toward gambling in general, gambling in Alberta and legal gambling's impacts in the province. Age, gender and problem gambling status were found to be reliable predictors of gambling attitudes in that younger male, non-problem gamblers were most approving of the activity. Results also indicate that Albertans are ambivalent about gambling and that gambling and public policy are mis-aligned to the extent that gambling's harms are thought to outweigh its benefits. Likely reasons for the gap between gambling policy and public opinion are that gambling issues lack the salience of ongoing high-profile topics such as the economy, health care, education and the environment, and gambling dependent special interest groups can exert considerable influence on gambling policy in ways that may not harmonise with the public interest.

Published population estimates of the prevalence of chronic pain have been highly variable due, in part, to differences in definitions and study methodologies. Designing health care delivery models that address chronic pain and reduce its impact, however, require accurate, up-to-date prevalence data. This article first reviews studies that examined the prevalence of chronic pain both internationally and in Canada. The ensuing sections describe a telephone-based survey of a well-defined population of adults using a detailed and sequential definition of chronic pain, and well-validated and reliable data collection tools for establishing the prevalence of chronic pain in Canada.BACKGROUND: While chronic pain appears to be relatively common, published population prevalence estimates have been highly variable, partly due to differences in the definition of chronic pain and in survey methodologies.OBJECTIVES: To estimate the prevalence of chronic pain in Canada using clear case definitions and a validated survey instrument.METHODS: A telephone survey was administered to a representative sample of adults from across Canada using the same screening questionnaire that had been used in a recent large, multicountry study conducted in Europe.RESULTS: The prevalence of chronic pain prevalence for adults older than 18 years of age was 18.9%. This was comparable with the overall mean reported using identical survey questions and criteria for chronic pain used in the European study. Chronic pain prevalence was greater in older adults, and females had a higher prevalence at older ages compared with males. Approximately one-half of those with chronic pain reported suffering for more than 10 years. Approximately one-third of those reporting chronic pain rated the intensity in the very severe range. The lower back was the most common site of chronic pain, and arthritis was the most frequently named cause.CONCLUSIONS: A consensus is developing that there is a high prevalence of chronic pain within adult populations living in industrialized nations. Recent studies have formulated survey questions carefully and have used large samples. Unfortunately, a substantial proportion of Canadian adults continue to live with chronic pain that is longstanding and severe.

Résumé Nous avons examiné la variabilité géographique de l’information générée à partir de différentes définitions de cas d’asthme infantile, provenant des données administratives sur la santé utilisées en Alberta, au Canada. Notre objectif était de déterminer si les analyses fondées sur différents algorithmes de détermination des cas permettent ou non de définir les groupes géographiques dans la même région que celle sur laquelle porte l’étude. Notre groupe d’étude reposait sur une cohorte fermée d’enfants asthmatiques nés en 1988. Nous avons utilisé une statistique sur l’analyse spatiale pour établir les variations de l’emplacement approximatif des groupes géographiques liés à l’asthme selon différentes définitions de cas. Nos résultats indiquent que l’algorithme de détermination des cas et la source de données n’ont pas une très grande incidence sur les profils géographiques. Par exemple, les asthmatiques identifiés à partir des données sur les réclamations au titre de frais médicaux ont démontré un regroupement semblable à celui des asthmatiques définis à partir des données sur l’hospitalisation et provenant du service d’urgence. Cependant, il faut bien prendre en considération les estimations de la prévalence et de l’incidence et les valider par rapport aux autres sources de données.

To determine the effect of adjunctive epidural local anesthetic and opioid infusion on disease recurrence following radical prostatectomy for adenocarcinoma under general anesthesia.This article describes a secondary analysis of subjects undergoing radical prostatectomy who had participated previously in a randomized controlled trial evaluating pain control, blood loss, and the need for perioperative allogeneic blood transfusion. The patients were randomly allocated to receive either general anesthesia alone (control group; n = 50) or combined general/epidural anesthesia (study group; n = 49). A long-term follow-up chart review was undertaken to determine clinically evident or biochemical (Prostate Specific Antigen0.2 ng x mL(-1)) recurrence of prostate cancer. Comparison by group was undertaken using survival analysis.Median disease-free survival for the study as a whole was 1644 days, and the longest recorded survival was 3403 days. Biochemical recurrence of prostate cancer was observed in 11/49 study subjects and 17/50 control subjects. There was one death from prostate cancer in each group and a total of five deaths in the study group and six deaths in the control group. The hazard ratio for recurrence in the study group compared with the control group was 1.33 (95% confidence intervals 0.64-2.77; P = 0.44 by log-rank test).No difference was observed between the epidural and control groups in disease-free survival at a median follow-up time of 4.5 years. There is a need for large randomized controlled trials to determine the ability of epidural analgesia to alter disease recurrence rates following radical prostatectomy.

This study was designed to analyse the reliability of using urinary and blood trichloroacetic acid (TCAA) as a biomarker of exposure. A total of 46 healthy women consumed supplied TCAA-containing tap water for 15 days and provided urine and blood samples for TCAA measurements. The findings revealed that the reliability of measurements was excellent by using measures of TCAA ingestion, blood concentration and urinary excretion (intraclass correlation coefficients (ICC)0.75, p0.001). Volume of tap water consumption (ICC = 0.69) and creatinine-adjusted urinary concentration (ICC = 0.72) were less reliable. This indicated that the intraindividual variability was small and the interindividual reliability was high by using these measures in this cohort study. Laboratory variability did not significantly contribute to total variance (ICC0.95, p0.001). Other possible sources of variation such as bathing, showering, dishwashing and physical activities were unlikely to contribute significantly to total variance. For sampling strategies, 1-day blood sampling and 2-day urine sampling are sufficient to achieve reliability for an epidemiological study if a quasi-steady-state TCAA level in the body is reached. The results suggest that TCAA ingestion, TCAA loading in blood and urinary TCAA excretion are reliable measures for use as biomarkers in epidemiological studies.

Objective: To analyze trends in antidepressant (AD) prescription rates among the elderly (aged 65 years and older) in Alberta during 1997 to 2004. Method: Numerical data on AD prescriptions were obtained from Alberta Blue Cross. Age-standardized prescription rates were calculated according to type of AD. Results: The prescription rate for all ADs combined increased by 59% for men and 55% for women. This change was due entirely to serotonin reuptake inhibitors (SSRIs) and other recently-introduced ADs, that by 2004 accounted for 72% of AD prescriptions for men and 69% for women. For each year and type of AD, the prescription rate for women was almost double that for men. Conclusions: In the elderly in Alberta, prescription rates for ADs increased markedly during 1997 to 2004, especially for SSRIs and other recently introduced ADs.

Longitudinal research on the determinants of gambling behavior is sparse. This article briefly reviews the previous seventeen longitudinally designed studies, focusing on the methodology for each study. This is followed by a description of our ongoing longitudinal study entitled the Leisure, Lifestyle, and Lifecycle Project (LLLP). Participants for the LLLP were recruited from four locations in Alberta, Canada, including both rural and urban populations. In the LLLP most participants were recruited using random digit dialing (RDD), with 1808 participants from 5 age cohorts at baseline: 13-15, 18-20, 23-25, 43-45, and 63-65. Individuals completed telephone, computer, and face-to-face surveys at baseline, with the data collection occurring between February and October, 2006. At baseline, a wide variety of constructs were measured, including gambling behavior, substance use, psychopathology, intelligence, family environment, and internalizing and externalizing problems. Finally, the conclusions that can be drawn thus far are discussed as well as the plans for three future data collections.

Objective: Population-based data about depression treatment are largely restricted to estimates of the frequency of antidepressant (AD) use. Such frequencies are difficult to interpret in the absence of information about dosages, reasons for taking the medications, and participation in nonpharmacologic treatment. The objective of this study was to describe the pattern of treatment for major depression (MD) in Alberta. Method: Telephone survey methods were employed. Random digit dialing was used to select a sample of 3345 household residents aged 18 to 64 years in Alberta. A computer-assisted telephone interview that included the Mini Neuropsychiatric Diagnostic Interview and questions about pharmacotherapy and psychotherapy was administered. Estimates were weighted for design features and population demographics. Results: The point prevalence of MD was 4.4% (95% confidence interval [CI], 3.4% to 5.5%), and the overall prevalence of current AD use was 7.4% (95%CI, 6.2% to 8.6%). The ADs taken most commonly, serotonin-specific reuptake inhibitors, were taken at therapeutic dosages 87.4% of the time. Most (80.7%) of those taking ADs reported taking them for more than 1 year. The frequency of receiving counselling, psychotherapy, or talk therapy was 3.9% overall and 14.3% in respondents with MD. However, most of these subjects were unable to name the type of counselling they were receiving. Conclusions: When compared with previous estimates, these results suggest continued progress in the delivery of evidence-based care to the population. There is room for additional improvement, especially in the provision of nonpharmacologic treatment. (Can J Psychiatry 2007;52:780-789) Information on funding and support and author affiliations appears at the end of the article. Clinical Implications * The frequency of AD treatment is now greater than the prevalence of depressive disorders. This appears to be partially owing to the use of these medications for reasons other than depression and partially owing to maintenance treatment. * Most users of ADs are taking them at standard dosages and for adequate durations. * The health care system appears to be more effective in its delivery of pharmacologic than nonpharmacologic treatments for depression. There appears to be much room for improvement in nonpharmacologic treatment delivery. Limitations * This was a telephone survey and may have been vulnerable to selection bias. * Only a brief diagnostic measure could be included in the survey interview. * The study relied on self-report data concerning medication use. Key Words: depressive disorder, antidepressive agents, cross-sectional studies Abbreviations used in this article AD antidepressant CBT cognitive-behavioural therapy CI confidence interval CIDI Composite International Diagnostic Interview DDD defined daily dosage MD major depression MINI Mini Neuropsychiatric Diagnostic Interview NCS National Comoribidity Survey SRI serotonin reuptake inhibitors TCA tricyclic antidepressants The impact of MD on population health is considerable, partially because of its high prevalence: about 5% of the general population will experience an episode of MD in any given year.1-3 However, its impact is magnified by a peak prevalence in individuals aged under 45 years,3 a critical period for education, establishment of careers and relationships, as well as economic productivity. Although effective treatments for MD exist, it has generally been felt that MD is undertreated. The replication of the NCS-R in the United States reported that only 57.3% of respondents with past-year major depressive disorder received treatment.1 Comparable estimates have been reported for Canada.4 Estimates in other countries have generally been lower.5,6 Deficiencies in depression care relate to under diagnosis, inadequate treatment, and lack of patient follow-up. …

OBJECTIVE: To describe mortality, cause of death and life expectancy among Chinese (both immigrant and Canadian-born) and other Canadians in the Province of Alberta. METHODS: A Chinese surname list was applied to the Alberta Health Insurance Plan and Vital Statistics Birth registry databases to define the Chinese population, and to the Vital Statistics Death registry to determine deaths among Chinese in Alberta from 1995 to 2003. Age- and sex-specific mortality, cause of death and life expectancy were calculated. RESULTS: Of nearly 3 million Alberta residents, about 4% were Chinese in 2003. The ageadjusted mortality for Chinese was 4.2 per 1000 and for non-Chinese 6.2 per 1000 population. Infant mortality was lower for Chinese (4.9/1000 live births) than non-Chinese (6.2/1000 live births). Life expectancy at birth was 6.3 years longer for Chinese males compared to non-Chinese males (83.3 versus 77.0), and 5.4 years longer for Chinese females compared to non-Chinese females (87.9 versus 82.5). Cancer, heart disease and stroke were the leading causes of death for both Chinese and non-Chinese Albertans. CONCLUSIONS: The Chinese ethnic population of Alberta had lower mortality and longer life expectancy than remaining Albertans, suggesting that the Chinese population has better health status than other Albertans. Reasons for the health gap between Chinese and non- Chinese populations should be further explored.

Rationale and objective A research translation strategy for chronic pain was developed that has significant potential to advance the usefulness of systematic reviews (SRs) in clinical practice. Method The strategy used interactive case-based workshops that summarize current evidence on treatments for chronic non-cancer pain. Health technology assessment researchers and clinicians collaborated to translate SR evidence into education aids, but this proved far from straightforward. Results Sourcing and selecting the SR evidence required maintaining a credible balance between the diametrical concepts of comprehensiveness and efficiency, and relevance and validity. On examination of the collated evidence base, further challenges were encountered in dealing with the lack of consistency among the SRs in the quality of execution, the scales used to rate the quality of the evidence, and the conclusions on common topic areas. Strategies for overcoming these difficulties are discussed. Conclusions The key elements for creating clinically relevant knowledge from SRs are: a flexible, consistent and transparent methodology; credible research; involvement of renowned content experts to translate the evidence into clinically meaningful guidance; and an open, trusting relationship among all contributors.

Contexte : La sclerose en plaques (SEP) serait rare chez les autochtones nord-americains malgre des mariages interethniques frequents, avec des individus dont les ancetres etaient europeens. Cependant il y a eu peu d'etudes de population sur ce sujet. Le but de cette etude etait de determiner la prevalence de la SEP chez les autochtones des Premieres Nations de l'Alberta, au Canada, et de la comparer a celle de la population en general. Methodes : Les donnees concernant les patients hospitalises et les donnees de facturation des medecins entre 1994 et 2002 comportant un diagnostic de SEP ont ete extraites des bases de donnees de soins de sante du gouvernement de la province d'Alberta. Les individus des Premieres Nations peuvent etre identifies parce que le gouvernement federal (Sante Canada) paie les primes d'assurance sante en leur nom. La prevalence de la SEP par 100 000 habitants pour les individus des Premieres Nations et pour la population en general a ete calculee annuellement. Resultats : Chez les Premieres Nations de l'Alberta, la prevalence de la SEP etait de 56,3 par 100 000 en 1994 et de 99,9 par 100 000 en 2002, soit une augmentation de 43,6%. La prevalence en 2002 etait de 158,1 chez les femmes et de 38,0 chez les hommes, soit un ratio de 4,2 : 1. La prevalence de la SEP dans la population en general de l'Alberta etait de 262,6 par 100 000 en 1994 et de 334,0 par 100 000 en 2002, soit une augmentation de 21,6%. La prevalence en 2002 etait de 481,5 pour les femmes et de 187,5 pour les hommes, soit un ratio de 2,6 : 1. En 2002, la prevalence la plus elevee chez les femmes, tant chez les Premieres Nations que dans la population en general a ete observee chez les femmes de 50 a 59 ans, alors que chez les hommes la prevalence la plus elevee a ete observee chez les hommes de 50 a 59 ans chez les Premieres Nations et dans la population en general. Conclusion : En Alberta, la prevalence de la SEP chez les Premieres Nations est plus faible que celle de la population en general. Cependant, cette maladie n'est pas rare par rapport aux standards mondiaux.

BACKGROUND: This study's objectives were to investigate the prevalence of self-reported knee and hip osteoarthritis (OA) stratified by age and sex and to examine the association of modifiable factors with knee and hip OA prevalence. The study was conducted using randomly sampled data gathered from four communities in the province of Alberta, Canada.METHODS: A large adult population sample (N = 4733) of individuals ≥18 years were selected. Health-related information was collected through telephone interviews and community measurement clinics for which a sub-sample (N = 1808) attended. Participants self-reported OA during telephone interviews. Clinic interviews further assessed if the diagnosis was made by a health care professional. Statistical analyses compared prevalence of OA between sexes and across age categories. Associations between modifiable factors for OA and the prevalence of knee and hip OA were assessed using binary logistic regression modelling.RESULTS: Overall prevalence of self-reported OA in the total sample was 14.8 %, where 10.5 % of individuals reported having knee OA and 8.5 % reported having hip OA. Differences in prevalence were found for males and females across age categories for both knee and hip OA. In terms of modifiable factors, being obese (BMI >30 kg/m2) was significantly associated with the prevalence of knee (OR: 4.37; 95 % CI: 2.08,9.20) and hip (OR: 2.52; 95 % CI: 1.17,5.43) OA. Individuals who stand or walk a lot, but do not carry or lift things during their occupational activities were 2.0 times less likely to have hip OA (OR: 0.50; 95 % CI: 0.26,0.96). Individuals who usually lift or carry light loads or have to climb stairs or hills were 2.2 times less likely to have hip OA (OR: 0.45; 95 % CI: 0.21,0.95). The odds of having hip OA were 1.9 times lower in individuals consuming recommended or higher vitamin C intake (OR: 0.52; 95 % CI: 0.29,0.96). Significant differences in prevalence were found for both males and females across age categories.CONCLUSION: The prevalence of knee and hip OA obtained in this study is comparable to other studies. Females have greater knee OA prevalence and a greater proportion of women have mobility limitations as well as hip and knee pain; it is important to target this sub-group.

Background: This study examined mortality due to multiple sclerosis (MS) in Canada, 1975-2009 to determine whether there has been a change in age at death relative to the general population and decrease in MS mortality rates. Methods: Mortality rates/100,000 population for MS and all causes were calculated using data derived from Statistics Canada, age-standardized to the 2006 population. Results: The average annual Canadian MS mortality rate, 1975-2009 was 1.23/100,000. Five-year rates for 1975-79, 1980-84, 1985-89, 1990-94, 1995-99, 2000-04, 2005-09 were: 1.16, 0.94, 1.01, 1.16, 1.30, 1.43, 1.33. Trend analysis showed mortality rates over the entire 35 years were stable (average annual percent change of less than one percent). The average annual 1975-2009 rates for females and males were 1.45 and 0.99. Five-year female rates were always higher than males. Regardless of gender, there was a decrease in MS mortality rates in the 0-39 age group and increases in the 60-69, 70-79, and 80+ groups over time. In contrast, there were decreases in all-cause mortality rates across each age group. The highest MS mortality rates for 1975-2009 were consistently in the 50-59 and 60-69 groups for both genders, while the highest all-cause mortality rates were in the 80+ group. Conclusions: Changes in the age distribution of MS mortality rates indicate a shift to later age at death, possibly due to improved health care. However MS patients remain disadvantaged relative to the general population and changes in age at death are not reflected in decreased mortality rates.

This study investigated the degree to which facets of impulsiveness predicted future binge eating and problem gambling, 2 theorized forms of behavioral addiction. Participants were 596 women and 406 men from 4 age cohorts randomly recruited from a Canadian province. Participants completed self-report measures of 3 facets of impulsiveness (negative urgency, sensation seeking, lack of persistence), binge-eating frequency, and problem-gambling symptoms. Impulsiveness was assessed at baseline, and assessments of binge eating and problem gambling were followed up after 3 years. Weighted data were analyzed using zero-inflated negative binomial and Poisson regression models. We found evidence of transdiagnostic and disorder-specific predictors of binge eating and problem gambling. Negative urgency emerged as a common predictor of binge eating and problem gambling among women and men. There were disorder-specific personality traits identified among men only: High lack-of-persistence scores predicted binge eating and high sensation-seeking scores predicted problem gambling. Among women, younger age predicted binge eating and older age predicted problem gambling. Thus, there are gender differences in facets of impulsiveness that longitudinally predict binge eating and problem gambling, suggesting that treatments for these behaviors should consider gender-specific personality and demographic traits in addition to the common personality trait of negative urgency.

BACKGROUND: This paper applies a method for modelling the spatial variation of West Nile virus (WNv) in humans using bird, environmental and human testing data. METHODS: We used data collected from 503 Alberta municipalities. In order to manage the effects of residual spatial autocorrelation, we used generalized linear mixed models (GLMM) to model the incidence of infection. RESULTS: There were 275 confirmed cases of WNv in the 2003 calendar year in Alberta. Our spatial model indicates that living in the grasslands natural region and levels of human testing are significant positive predictors of WNv; living in an urban area is a significant negative predictor. CONCLUSION: Infected bird data contribute little to our model. The variability of West Nile virus incidence in Alberta may be partly confounded by the variations in the rate of testing in different parts of the province. However, variation in infection is also associated with known environmental risk factors. Our findings are consistent with existing knowledge of WNv in North America.

STUDY DESIGN Population-based survey. OBJECTIVES To assess the back pain beliefs in 2 provinces in Canada to inform a population-based educational campaign. SUMMARY OF BACKGROUND DATA Beliefs, attitudes, and recovery expectations appear to influence recovery from back pain, yet prevailing public opinions about the condition have been little studied. METHODS Telephone surveys were conducted with 2400 adults in 2 Canadian provinces. Surveys included the Back Beliefs Questionnaire, and additional questions concerning age, gender, recent and lifetime back pain, coping strategies for back pain, and awareness and persuasiveness of media information concerning back pain. RESULTS A high prevalence of back pain was reported, with a lifetime prevalence of 83.8%, and 1-week prevalence of 34.2%. Generally, a pessimistic view of back pain was held. Most agreed that back pain makes everything in life worse, will eventually stop one from working, and will become progressively worse with age. Mixed opinions were observed regarding the importance of rest and staying active. A significant minority (12.3%) reported taking time off from work for their last back pain episode. Those individuals taking time off from work held more negative back pain beliefs, including the belief that back pain should be rested until it gets better. CONCLUSIONS Public back pain beliefs in the 2 Canadian provinces sampled are not in harmony with current scientific evidence for this highly prevalent condition. Given the mismatch between public beliefs and current evidence, strategies for reeducating the public are needed.

Background: The World Health Organization in 2000 cited specific chronic diseases (chronic obstructive pulmonary disease, heart disease, diabetes and certain cancers) as major and preventable health hazards. There have subsequently been calls for increased investment in prevention activities. Currently there is no information on the economic magnitude of these promotion activities. In this study, we present an estimate of the investment in Alberta, by public organization, for chronic disease prevention activities which provide information that promotes behaviour changes in adults at risk. Methods: We surveyed board members of the Alberta Healthy Living Network (AHLN) to obtain economic data and information on activities related to chronic disease (primary) prevention. We also asked for further contacts on programs in other agencies. We continued the (“snowball”) process until no new agencies were identified. Agencies provided the information on a survey form. Results: In 2003 in Alberta, the cost of publicly provided information to change risk behaviours related to chronic diseases for persons over 20 was $24.9 million. This investment was diffused over a large number of bodies. Anti-smoking programs used the largest proportion of the money. The total cost per person at risk was about $15. Regional Health Authorities spend about 1/10th of 1% of their budget on these activities. Discussion: There are difficulties in collecting and organizing society-level data on chronic disease prevention. Nevertheless, all indications are that the amount of resources devoted in this area is small, and much smaller than has been suggested.

Surnames have the potential to accurately identify ancestral origins as they are passed on from generation to generation. In this study, we developed and validated a Chinese surname list to define Chinese ethnicity.We conducted a literature review, a panel review, and a telephone survey in a randomly selected sample from a Canadian city in 2003 to develop a Chinese surname list. The list was then validated to data from the Canadian Community Health Survey. Both surveys collected information on self-reported ethnicity and surname.Of the 112,452 people analyzed in the Canadian Community Health Survey, 1.6% were self-reported as Chinese. This was similar to the 1.5% identified by the surname list. Compared with self-reported Chinese ethnicity (reference standard), the surname list had 77.7% sensitivity, 80.5% positive predictive value, 99.7% specificity, and 99.6% negative predictive value. When stratifying by sex and marital status, the positive predictive value was 78.9% for married women and 83.6% for never married women.The Chinese surname list appears to be valid in identifying Chinese ethnicity. The validity may depend on the geographic origins and Chinese dialects in given populations.

BACKGROUND: Agricultural work continues to be a dangerous occupation. Older farmers experience high risks for work-related injury. The purpose of this research was to determine if there is a relationship between medication use and injury among older male farmers in Alberta. METHODS: Using probabilistic linkage between an Alberta Agriculture government registry of farm operators and the Alberta Health Plan registry file, older farmers (aged 66 and older) were identified. Farm related injuries were identified using an E-code search of both hospitalization and emergency department separations for a 3-year period. Cases were matched to controls on age, geographic health region, and index injury date at a ratio of 1:5. Co-morbidity and medication use for each of the cases and controls were derived from population based health system utilization files. Conditional logistic regression was used to determine which medications were related to injury. RESULTS: Overall, a total of 282 farm related injuries were suffered by the linked group. Controlling for co-morbidity, farmers who had stopped taking narcotic pain killers (OR = 9.37 [95% CI:4.95, 17.72]) and non-steroidal anti-inflammatories (OR = 2.40 [95% CI:1.43, 4.03]) 30 days prior to the date of injury were at risk of injury. Those farmers taking sedatives up until the date of injury were also at risk (OR = 3.01 [95 CI:1.39, 6.52]). In addition, those suffering from incontinence/urinary tract disorders (OR = 2.95 [95% CI:1.30, 6.71]), and prior injury (OR = 1.42 [95% CI:1.04, 1.95]) were also at greater risk of injury. CONCLUSIONS: The relationship of medication use and injury in this population is different from those observed in studies of falls in older persons. We hypothesize that distraction from either pain or co-morbidity may play an important role in the etiology of injuries suffered in this active older working population. Further investigations in this area are required to confirm these findings.

L'administration du systeme de sante canadien necessite l'accumulation d'une grande quantite de donnees. Quelques chercheurs dans le domaine de la sante ont utilise ces donnees pour determiner la distribution geographique de differentes maladies. Les auteurs discutent de la difficulte a separer les variations geographiques legitimes concernant la sante et les maladies des differences geographiques dans la facon dont les problemes de sante sont diagnostiques, ainsi que la facon dont ces diagnostiques sont representes dans un systeme de gestion de donnees. Bien que ce probleme ait ete aborde a lechelle internationale, peu de recherches a ce sujet ont ete effectuees aux echelles intra-nationale ou intra-provinciale. Plusieurs strategies sont disponibles pour aider a distinguer la composante geographique des maladies de facteurs non-medicaux pouvant l'influencer. Cependant, de telles strategies n'ont pas ete rigoureusement testees en geographie medicale. Toute recherche dans ce domaine devrait etudier lechelle du probleme et l'efficacite des approches existantes pour reduire les effets de l'inconsistance des diagnostiques geographiques sur la representation spatiale de statistiques sur la sante. Introduction In Canada, provinces manage and (for the most part) fund their health care systems in accordance with a loose set of standards set out in the Canada Health Act. The administration of these provincial systems is based largely on a fee-for-service payment arrangement between the physicians and the province. Health care professionals (mostly physicians) who provide services covered by the provincial health care plans bill their provincial governments for the services they provide to the public. Each billed service (or 'claim') is then entered into a centralised (and usually electronic) administrative data system. Within each claim record is information on the type of service performed, the doctor who performed the service, the patient who received the service (usually identified by a unique numeric identifier such as a personal health number) and some sort of diagnostic information indicating what condition the patient was suffering from. In most provinces, this diagnostic information is reduced from chart notation (notes that physicians make on patient charts) to one or more alpha-numeric codes corresponding to the International Classification of Diseases (ICD). These large administrative health data systems often cover large areas, and as a result, offer opportunities for geographers to analyse disease at a large geographic scale. From a medical geographer's perspective, one of the first tasks when working with these kinds of data is to represent disease incidence (a measure of new cases) or prevalence (an indication of the total number of people with the disease) spatially. This can provide clues to disease aetiology, identify social or environmental factors associated with disease and locate areas where risk is particularly high. Most medical geographers are well aware of the statistical challenges associated with the analysis and representation of aggregate geographic data--the small numbers problem, the modifiable areal units problem and the ecological fallacy are perhaps most often of concern. What is less often addressed is the uncertainty associated with representing disease in a discrete electronic data system, and how this uncertainty affects the representation of disease in space. Despite the aims of the ICD as an international standard for disease identification, the process of diagnosing illness, transcribing diagnoses onto medical charts and then converting that chart information into alpha-numeric codes is not an exercise that is easily standardised. Administrative data differ, sometimes considerably, from other types of disease information (Hunt et al. 1999; Tirschwell and Longstreth 2002; Spettell et al. 2003). Under circumstances when these differences occur geographically (independent of actual spatial variations in disease), the representation and analysis of health statistics across these geographies may be biased, or obscured by factors unrelated to an illness itself. …

The purpose of this paper is to estimate the long term medical costs attributable to motor vehicle accidents (MVAs) for all persons in Alberta, Canada in 1999, primarily using observational data. Injury claims with personal identifiers for 1999 were reported by the automobile insurance companies. These records were linked to the provincial health registry which covers the entire population. The registry is linked to databases which identify all inpatient and outpatient (including emergency room) visits, physician services, and other health records. Utilization and costs were derived for all casualties who were admitted to hospital or seen in an emergency room, and for a large sample of other (low severity) cases; a sample of matched controls was derived and their costs were also estimated. Actual costs were obtained for 3 years, and longer term costs were projected for subsequent years. Total costs attributable to MVAs were estimated at over $117 million for 1999. Average net costs per casualty, reported by severity group, were: $22.9 thousand for hospital cases; $3.6 thousand for emergency room-only cases; and $157 for other cases. Long term costs were 65% of first year costs for hospitalized cases and 250% for emergency room cases. Overall, aggregate costs for all non-hospital cases exceeded those for hospitalized cases.

Study Design. A retrospective, population-based analysis. Objectives. To analyze the relation between health outcomes and resources used by persons with back problems in an everyday setting. Summary of Background Data. The Canadian Community Health Survey (2000) contains self-reported variables on change in health status, use of health resources, and socioeconomic characteristics of a population sample. Methods. We use a health production function approach, in which we explore the association between change in health status and a series of utilization variables for persons with a single diagnosis of back pain using a regression equation. The independent variables include use of family physicians, chiropractors, physiotherapists, and exercise. Results. Change in health status was negatively and significantly associated with family practice, chiropractic, and physiotherapy visits and positively associated with physical activity. The magnitudes of the results were small. Conclusions. Our results indicate that exercise is an important factor in back problems, while persons who seek formal care do not improve.

Study design: Cohort study with 6-years follow-up. Objective: To describe the utilization of health services by persons with spinal cord injury (SCI) and compare it with that of the general population. Setting: Alberta, Canada. Methods: All persons who sustained an SCI in Alberta between April 1992 and March 1994 were followed from date of injury to 6 years postinjury. Cases were matched (1:5) with controls randomly selected from the general population and matched for age, gender, and region of residence. Administrative data from centralized health care databases were compiled to provide a complete picture of health care use, including hospitalizations, physician contacts, long-term care admissions, home care services, and the occurrence of secondary complications. Results: In all, 233 individuals with SCI and 1165 matched controls were followed for 6 years. Compared with the control group, persons with SCI were rehospitalized 2.6 times more often, spent 3.3 more days in hospital, were 2.7 times more likely to have a physician contact, and required 30 times more hours of home care services. Of those with SCI, 47.6% were treated for a urinary tract infection, 33.8% for pneumonia, 27.5% for depression, and 19.7% for decubitus ulcer. Conclusion: SCI places a heavy burden on the health care system. Persons with SCI have greater rates of contact with the health system compared with the general population. Secondary complications continue to affect persons with SCI long after the acute trauma.

Objective. We describe the frequency and patterns of injury affecting 96 359 children between 0 and 10 years old and living in Alberta, Canada. Design. This population-based, longitudinal study involved children born in the 3 fiscal years of April 1, 1985 to March 31, 1988, recruited before age 1, and who remained in the study until at least age 5. We used the International Classification of Diseases, Ninth Revision, Clinical Modification chapter-17 diagnostic codes provided by physicians. Codes were grouped into 17 categories; injury episodes were calculated, and age- and gender-specific incidence rates for each category were calculated. The age, pattern, times of greatest risk, and the effect of gender on the type and incidence of injury were determined. Setting. Health care administrative data were obtained from all fee-for-service health care venues in Alberta between April 1, 1985 and March 31, 1998 providing services to children registered with the Alberta Health Care Insurance Plan and otherwise meeting entrance criteria. Results. Nearly 84% of children received care for an injury during the study period, and in any given year ∼21% of the population studied had at least 1 injury. Repeat injury was common (73%), and boys were more likely than girls to be injured and to have repeat injury. The most common injuries were dislocations and sprains, open wounds, and superficial injuries and contusions. Burns, poisoning, intracranial injury, and foreign bodies were the next most common, and fractures were least common. Approximately 10% of injuries were multiple-category injuries. Rates varied greatly by injury category, age, and gender. Hospitalization rates varied in a similar manner and commonly accounted for ∼10% of all services. Males were most likely to have an injury, and aboriginal children or children who had received welfare at some time were at greatest risk. Conclusions. Administrative data can be used to estimate the incidence of injury in a pediatric population. Distinct patterns of injury occur at different ages. Recurrent injury is common. Almost identical proportions of injury (46%) are treated in emergency departments and physicians’ offices.

Children who begin but do not fully complete the recommended series of childhood vaccines by 2 y of age are a much larger group than those who receive no vaccines. While parents who refuse all vaccines typically express concern about vaccine safety, it is critical to determine what influences parents of ‘partially’ immunized children. This case-control study examined whether parental concern about vaccine safety was responsible for partial immunization, and whether other personal or system-level factors played an important role. A random sample of parents of partially and completely immunized 2 y old children were selected from a Canadian regional immunization registry and completed a postal survey assessing various personal and system-level factors. Unadjusted odds ratios (OR) and adjusted ORs (aOR) were calculated with logistic regression. While vaccine safety concern was associated with partial immunization (OR 7.338, 95% CI 4.138– 13.012), other variables were more strongly associated and reduced the strength of the relationship between concern and partial immunization in multivariable analysis (aOR 2.829, 95% CI 1.151 – 6.957). Other important factors included perceived disease susceptibility and severity (aOR 4.629, 95% CI 2.017 – 10.625), residential mobility (aOR 3.908, 95% CI 2.075 – 7.358), daycare use (aOR 0.310, 95% CI 0.144 - 0.671), number of needles administered at each visit (aOR 7.734, 95% CI 2.598 – 23.025) and access to a regular physician (aOR 0.219, 95% CI 0.057 – 0.846). While concern about vaccine safety may be addressed through educational strategies, this study suggests that additional program and policy-level strategies may positively impact immunization uptake.

Objective Because of a lack of a control group, a case-series study is considered one of the weaker study designs from which to obtain evidence on treatment effectiveness. Under certain circumstances, however, this is the only available evidence to inform health-care decisions. This study's intent was to develop and validate a quality appraisal checklist specifically for case-series studies. Study design and setting A modified Delphi process was used to develop the checklist, which was then used by multiple researchers to appraise a random sample of 105 case-series studies. A principal component analysis of these appraisals was conducted to further refine the checklist. Results The modified Delphi process resulted in a 20-criterion checklist. The principal component analysis of the appraisals for the 105 case-series studies revealed two components. The first component (10 criteria) indicated the extent to which a case series presented traditional features of a statistical hypothesis-testing paradigm. The second component (seven criteria) indicated whether detailed descriptions of the subjects' characteristics that might feature in the experimental design were present, particularly in judgments about the likelihood of confounding. Conclusion This quality appraisal checklist may be useful in assessing case-series studies, but further validation of the checklist is required.