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General internal medicine (GIM), like other generalist specialties, has struggled to maintain its identity in the face of mounting sub-specialization over the past few decades. In Canada, the path to licensure for general internists has been through the completion of an extra year of training after three core years of internal medicine. Until very recently, the Royal College of Physicians and Surgeons of Canada (RCPSC) did not recognize GIM as a distinct entity. In response to a societal need to train generalist practitioners who could care for complex patients in an increasingly complex health care setting, the majority of universities across Canada voluntarily developed structured GIM training programs independent of RCPSC recognition. However, interest amongst trainees in GIM was declining, and the GIM workforce in Canada, like that in many other countries, was in danger of serious shortfalls. After much deliberation and consultation, in 2010, the RCPSC recognized GIM as a distinct subspecialty of internal medicine. Since this time, despite the challenges in the educational implementation of GIM as a distinct discipline, there has been a resurgence of interest in this field of medicine. This paper outlines the journey of the Canadian GIM to educational implementation as a distinct discipline, the impact on the discipline, and the implications for the international GIM community. [ABSTRACT FROM AUTHOR]

Evidence is building regarding the association between government implemented public health measures aimed at combating COVID-19 and their impacts on health. This study investigated the relationship between the stringency of public health measures implemented in Canada and self-reported mental health, physical health, stress, and wellbeing among a random sample of 6647 Canadians 18 years of age and older. The analysis was based on self-reported health data from the Canadian Perspectives on Environmental Noise Survey. This data was combined with the Oxford COVID-19 Government Response Tracker database, which included overall stringency index (SI), and four of its sub-components, i.e., school and business closures, restrictions on gatherings, and stay at home policies. Adjusted multivariate logistic regression models indicated that the magnitude of the overall SI was associated with higher or lower odds of reporting worse physical health, mental health, stress and/or overall wellbeing, depending on the measure evaluated. Similarly, policy directed at the four sub-components had varying impacts on the odds of reporting worse health, depending on the sub-component, the strength of the policy restriction, and the health outcome evaluated. The association between the strength of the public health measures and self-reported health, and how this may inform future policy, is discussed. [ABSTRACT FROM AUTHOR]

Rabies is endemic throughout arctic areas including the region of Nunavik, situated north of the 55th parallel of Québec, Canada, and raises public health concerns. The aim of this paper is to provide a descriptive overview of the temporal and regional distributions of three important components of arctic rabies in Nunavik from 1999 to 2012, following a 'One Health' approach: animal rabies tests and confirmed cases, dog vaccination, and human consultations for potential rabies exposures. Forty-four cases of rabies, involving mainly arctic and red foxes, were confirmed in animals during this period. The mean number of dogs vaccinated per 1,000 inhabitants was highly variable and lower in the Hudson region than the Ungava region. 112 consultations for potential rabies exposure were analyzed, of which 24 were exposure to a laboratory confirmed rabid animal. Children less than 10 years of age were the age group most commonly exposed. The median time between potential exposure and administration of the first post-exposure prophylaxis dose was four days. This study confirms that the risk of human exposure to rabid animals in Nunavik is present and underlines the need to follow a 'One Health' approach to prevent rabies in humans in similar contexts worldwide. [ABSTRACT FROM AUTHOR]

From a holistic perspective, health literacy is a requirement for the well-being of entire populations. It moves beyond the focus on individuals to consider the role of organizations and systems. This perspective offers a context for discussing best practices in health literacy, and implications for research and policy development. This paper offers an overview of the best practices that were presented at the Second Canadian Conference on Literacy and Health. It discusses clear writing in some detail because it was emphasized at the conference. It also considers practices that were addressed less emphatically, such as oral communication between patients and health care professionals, training for health care professionals, non-written means of communication (such as video), and building capacity through action-research. The paper critiques some practices. It also notes the lack of research on the links between health literacy and oral understanding, on the impact of verbal and non-written interventions, and on the effectiveness of these practices on the health outcomes of the population. It briefly discusses policy issues and suggests some future directions. [ABSTRACT FROM AUTHOR]

Several studies have shown that atmospheric conditions can affect well-being or disease, and that some individuals seem to be more sensitive to weather than others. Since epidemiological data on the prevalence of weather-related health effects are lacking, two representative weather sensitivity (WS) surveys were conducted independently in Germany and Canada. The objectives of this paper are: (1) to identify the prevalence of WS in Germany and Canada, (2) to describe weather-related symptoms and the corresponding weather conditions, and (3) to compare the findings in the two countries. In Germany 1,064 citizens (age >16 years) were interviewed in January 2001, and in Canada 1,506 persons (age >18 years) were interviewed in January 1994. The results showed that 19.2% of the German population thought that weather affected their health “to a strong degree,” 35.3% that weather had “some influence on their health” (sum of both = 54.5% weather sensitive), whereas the remaining 45.5% did not consider that weather had an effect on their health status. In Canada 61% of the respondents considered themselves to be sensitive to the weather. The highest prevalence of WS (high + some influence) in Germans was found in the age group older than 60 years (68%), which was almost identical in the Canadian population (69%). The highest frequencies of weather-related symptoms were reported in Germany for stormy weather (30%) and when it became colder (29%). In Canada mainly cold weather (46%), dampness (21%) and rain (20%) were considered to affect health more than other weather types. The most frequent symptoms reported in Germany were headache/migraine (61%), lethargy (47%), sleep disturbances (46%), fatigue (42%), joint pain (40%), irritation (31%), depression (27%), vertigo (26%), concentration problems (26%) and scar pain (23%). Canadian weather-sensitive persons reported colds (29%), psychological effects (28%) and painful joints, muscles or arthritis (10%). In Germany 32% of the weather-sensitive subjects reported themselves to be unable to do their regular work because of weather-related symptoms at least once in the previous year, and 22% of them several times. Co-morbidity was significantly higher in weather-sensitive subjects both in Germany and Canada. These results clearly showed the important impact of WS on public health and the economy. These findings prompted us to start studies on the causal factors of weather-related health effects. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Studies in Population is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

A growing body of evidence indicates that extraintestinal pathogenic E. coli (ExPEC) readily survive wastewater treatment, raising concerns about the public health risks associated with exposure to wastewater-contaminated environments. In this study, E. coli isolates recovered from chlorinated sewage or treated wastewater effluents in Canada were screened for ExPEC virulence markers. Eighty-six isolates were identified as presumptive ExPEC, clustering within major pandemic lineages including ST131, ST95, and ST73 according to multilocus sequence typing analyses. Across the whole, core, and accessory genome, 37 isolates were extremely similar to clinical bloodborne E. coli (BBEC) and neonatal meningitic E. coli (NMEC) strains, suggesting that these wastewater isolates may exhibit a similar phenotypically related pathogenic potential. Interestingly, ExPEC strains also shared accessory gene content with naturalized wastewater strains, suggesting a common genetic capacity for surviving water treatment. Collectively, these findings suggest that E. coli strains that may cause septicemia and meningitis are surviving wastewater treatment and may be transmissible through wastewater effluents. [ABSTRACT FROM AUTHOR]

This is a summary report of the Aboriginal content of the Language and Culture theme at the Canadian Public Health Association's Second Canadian Conference on Literacy and Health. Our key premise is that Indigenous conceptualizations of literacy need to build on Indigenous understandings and perspectives. We support this premise through a review of the relevant literature in the disciplines of Aboriginal literacy, Indigenous education, health literacy, health promotion, and knowledge translation and our synthesis of the presentations, workshops, and discussions at the meeting. Key emergent themes include: the unique and culturally determined ways in which Aboriginal peoples and their languages conceptualize learning, education, and health; and the recognition that self-determination of language and learning are human rights. Aboriginal concepts of and approaches to literacy naturally link to and overlap with Aboriginal concepts of and approaches to health. The paper includes an overview of gaps in the field and an example of the way that research and practice can be brought together in the context of one First Nations community. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Public Health is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

By many measures of health, Canada's First Nations compare very poorly to the non- Native population as a whole. The need to explain, and to correct, this disparity has led public health researchers to consider a wide variety of community characteristics. One area that is as yet under-utilized, but may yield important insights into the complex question of First Nations health, is history. This paper presents an overview of the potential uses of historical methods in the study of the health of First Nations communities in Manitoba. It also introduces the major historical data sources available to public health researchers involved in such research. There are three main benefits to the inclusion of history in public health research. First, we may learn about the impact of health changes on Aboriginal groups in the past. Second, we may better understand the origins of presentday health concerns, many of which emerged out of the events of the recent or not so recent past. Finally, we may gain important insights into the nature of the disease process, and the diseases themselves, by employing the past as a laboratory. The addition of an historical approach can enhance health research directed towards First Nations communities in Manitoba. [ABSTRACT FROM AUTHOR]

Background: The SF-36 is widely used to assess health-related quality of life (HRQOL), but with few longitudinal studies in healthy populations, it is difficult to quantify its natural history. This is important because any measure of change following an intervention may be confounded by natural changes in HRQOL. This paper assesses mean changes in SF-36 scores over a 3-year period in men and women between the ages of 40 and 59 years at baseline. Methods: Subjects were randomly selected from nine Canadian cities. Mean SF-36 changes over a 3-year period (1996/1997-1999/2000) were calculated for each gender within 5-year age categories. Multiple imputation was used to correct for potential bias due to missing data. Results: The baseline cohort included 1,974 women and 975 men between 40 and 59 years. Mean changes in HRQOL tended to be small. Women demonstrated small average declines in 22 of the 32 age and domain groupings (4 age groups, 8 SF-36 domains) while men showed declines in 14/32. Most participants stayed within 10 points of their original baseline score. Interpretation: Mean SF-36 scores change only slightly over three years in middle-aged Canadians, although there is much individual variation. It may be necessary to adjust for the natural evolution of SF-36 scores when interpreting results from longitudinal studies. [ABSTRACT FROM AUTHOR]

Limitations associated with the under-reporting of enteric illnesses have long been recognized but the extent and variation of this under-reporting in Canada has not been examined. Given the public health value of surveillance data, a closer examination of under-reporting of enteric illnesses in Canada was warranted. Paper-based surveys were administered (a) to all laboratories in Canada licensed to process stool specimens and (b) to all local public health authorities in two provinces. Of the laboratories surveyed, 67% (n=274) conducted on-site testing of stool specimens for enteric bacteria, 31% (n=126) for parasites and 10% (n=42) for viruses. In the year 2000, these laboratories processed 459,982 stool specimens, of which 5%, 15%, 8% and 19% were positive for enteric bacteria (excluding C. difficile), C. difficile, parasites and viruses, respectively. Variations in laboratory testing and health authority reporting protocols and policies were identified. Of the laboratory-confirmed cases of AGI reported to local public health authorities, 5% (n=846) were not reported to provincial counterparts. A significant proportion of AGI cases submitting stool specimens are not captured in Canada's passive surveillance system due to unknown etiology. A much smaller proportion of laboratory-confirmed cases reported to local public health authorities are not captured at the provincial or national level. Given that the number of laboratory-confirmed AGI cases represents such a small fraction of all community cases, strategies to compensate for under-reporting and efforts directed at harmonizing laboratory and local public health authority policies and practices would be welcomed. [ABSTRACT FROM AUTHOR]

This paper reviews recent research using Statistics Canada data to compare immigrant health with that of the Canadian-born. A number of Statistics Canada studies have been used for such comparisons, including the National Population Health Survey and the Canadian Community Health Survey. Across the range of indicators studied, compared to the Canadian-born, immigrants are generally in as good or better health, have similar or better health behaviours, and similar or less frequent health service use (the "healthy immigrant effect"). These indications appear to be strongest among recent and non-European immigrants. These studies have established baseline patterns and identified that important distinctions exist among immigrant subgroups. Future research on more detailed subgroups that uses longitudinal data and cross-culturally validated instruments is needed. [ABSTRACT FROM AUTHOR]

The paper reviews current knowledge on the health of Canadian immigrants, examines evidence, and identifies research gaps. The information presented is derived from two recent literature reviews. Most literature suggests that Canadian immigrants, particularly recent arrivals, enjoy health advantages over long-term immigrants and the Canadian-born population in terms of overall health status and the prevalence of certain chronic diseases. Immigrants with infectious diseases may experience improvements in health over time. Patterns of immigrant mental health are less clear. More research is needed on specific health problems, how to address determinants of health, and the types of programs and services necessary to maintain immigrants in good health over time. Steps must be taken to strengthen existing databases and develop new ones. [ABSTRACT FROM AUTHOR]

The paper reviews current knowledge on the health of Canadian immigrants, examines evidence, and identifies research gaps. The information presented is derived from two recent literature reviews. Most literature suggests that Canadian immigrants, particularly recent arrivals, enjoy health advantages over long-term immigrants and the Canadian-born population in terms of overall health status and the prevalence of certain chronic diseases. Immigrants with infectious diseases may experience improvements in health over time. Patterns of immigrant mental health are less clear. More research is needed on specific health problems, how to address determinants of health, and the types of programs and services necessary to maintain immigrants in good health over time. Steps must be taken to strengthen existing databases and develop new ones. [ABSTRACT FROM AUTHOR]

Background: According to Canadian public health recommendations, newborns should be fed exclusively with breast milk during their first 4 to 6 months of life. The aim of this paper is to identify the main social determinants of initiation, duration and exclusivity of breastfeeding from birth to 4 months, at the population level. The results will help the development of public health interventions aimed at improving the prevalence of exclusive breastfeeding for at least the first 4 to 6 months of babies' life. Methods: The analyses were performed with the data of the Longitudinal Study of Child Development in Quebec (ELDEQ 1998–2002). The study follows a representative sample (n=2,223) of the children born in 1998 in the province of Quebec, in Canada. The relations between breastfeeding (all and exclusive) and mothers' education level, annual family income, family type, parents' working situation and mothers' age group have been evaluated by crude and adjusted odds ratios. Multivariate analyses were used to identify the most influential factors. Results: In 1998, nearly three quarters (72%) of the Quebec newborns were breastfed at birth. When they reached 4 months, only 6% of the Quebec children were exclusively breastfed, thus following public health recommendations. Mothers' education level remains the strongest factor of influence on breastfeeding from birth to 3 months, and its impact increases with baby's age. At 4 months, it is also the most important factor for all breastfeeding, but mothers' age is more important for exclusive breastfeeding. When all the studied factors are considered equal for all children, being breastfed in accordance with public health recommendations, which refers to exclusive breastfeeding for at least 4 months, is mainly influenced by mothers' age, followed by mothers' education level. Family income, family type and parents' working situation do not influence exclusive breastfeeding at 4 months. It should be noted that when considering all breastfed children, if mothers' age and education level are equal, annual family income shows a negative relationship with breastfeeding at any of the studied ages. This negative relationship is also observed at 2 months for exclusive breastfeeding ($40,000–$59,999). Conclusion: From a public health perspective, it is important that newborns be breastfed at birth and exclusively breastfed during their first 4 to 6 months of life. The analysis indicates that once the decision to breastfeed is made, different social factors influence the duration of breastfeeding and its exclusivity. Public policy targets are necessary to evaluate whether the situation is improving from one year to another and whether disparities are increasing or decreasing for newborns accumulating the impact of material and social deprivation early in life. [ABSTRACT FROM AUTHOR]

Canada has a long history of welcoming immigrants and a longstanding immigration policy framework. The historic principles that govern immigration selection and processing also include regulatory policies in the area of health. Based on historical principles that pre-date Confederation, Canadian immigration health policy has remained relatively constant. Policies are based on the identification of specific individuals and the exclusion, if appropriate, of the affected individuals - an approach that continues today. During the past three decades, however, evolutionary changes in the patterns, volume and demography of immigration have created situations that may necessitate changes to existing policy frameworks. This paper reviews current immigration health policies and practices in Canada, describes the nature and impact of existing challenges, and proposes some alternatives for future consideration. This is another test abstract.

Background: The McMaster Health Utilities Index Mark 3 (HUI3) is a generic multi-attribute, preference-based system for assessing health-related quality of life (HRQOL). This study describes the translation procedures and cultural adaptation of the Japanese HUI3 and its measurement properties in a community sample. Methods: The Japanese HUI3 was developed through forward and back translations in cooperation with the developers of the HUI. Acceptability, comprehensibility of questionnaires, and test-retest reliability were assessed. In a community survey of a total of 3860 people (age: 41 ± 14.3, male/female: 2651/1209), the Canadian scoring function was used to calculate utility scores. Construct validity was assessed by examining the relationship between 20 personal characteristics and utility scores. Results: Linear regression estimates demonstrated a significant negative relation between HUI3 utility score and low education, male gender, poor interpersonal relationships, older age, and a higher number of chronic diseases. Single-attribute utility scores were associated with chronic conditions in the manner expected. The community samples were relatively healthy. More than 90% of the respondents were distributed in levels 1 and 2 in all attributes except cognition. Interpretability of utility score was assessed by estimation of the relationship between visual analogue scale (VAS) and the self-rated health and utility score. Independence of attributes was assessed. For only 3 of the 28 possible cross-comparisons among the 8 attributes were correlations coefficients greater than 0.25. Conclusion: Translation and adaptation of the HUI3 questionnaire into Japanese was successful, but the sample size and selection bias limit the interpretation of our study conclusions. [ABSTRACT FROM AUTHOR]

Background: The risk of gastric carcinoma (GC) varies around the world and between females and males. We aimed to compare the risk of GC among immigrants to Ontario, Canada, to the risk of GC in its general population.Methods: This was a retrospective population-based matched cohort study from 1991 to 2014. We identified immigrants who were first eligible for the Ontario Health Insurance Plan at age 40 years or older, and matched 5 controls by year of birth and sex. We calculated crude rates and relative rates of GC stratified by sex. We modeled GC hazard using multivariable Cox proportional hazards regression, where a time-varying coefficient was incorporated to examine changes in the association of immigrant status with GC hazard over time.Results: Among females, 415 GC cases were identified among 209,843 immigrants and 1872 among 1,049,215 controls. Among males, 596 GC cases were identified among 191,792 immigrants and 2998 among 958,960 controls. Comparing immigrants from East Asia and Pacific with the controls, the crude relative rate of GC was 1.54 for females and 1.32 for males. The adjusted hazard ratio (HR) for GC among female immigrants was 1.29 [95% confidence interval (CI) 1.12, 1.48] within 10 years and 1.19 (1.01, 1.40) beyond 10 years; for males, the HR was 1.17 (1.04, 1.31) within 10 years and 1.00 (0.87, 1.15) beyond 10 years.Conclusion: The risk of GC among immigrants is elevated. Although high-risk immigrant populations in Ontario have been identified, further knowledge is required before a program of GC prevention that is targeted to them can be planned. [ABSTRACT FROM AUTHOR]

Background:A 15-country study of nuclear workers reported significantly increased radiation-related risks of all cancers excluding leukaemia, with Canadian data a major factor behind the pooled results. We analysed mortality (1956-1994) in the updated Canadian cohort and provided revised risk estimates.Methods:Employment records were searched to verify and revise exposure data and to restore missing socioeconomic status. Excess relative risks per sievert (ERR/Sv) of recorded radiation dose and 95% confidence intervals (CIs) were estimated using Poisson regression.Results:A significant heterogeneity of the dose-response for solid cancer was identified (P=0.02), with 3088 early (1956-1964) Atomic Energy of Canada Limited (AECL) workers having a significant increase (ERR/Sv=7.87, 95% CI: 1.88, 19.5), and no evidence of radiation risk for 42 228 workers employed by three nuclear power plant companies and post-1964 AECL (ERR/Sv=−1.20, 95% CI: <−1.47, 2.39). Radiation risks of leukaemia were negative in early AECL workers and non-significantly increased in other workers. In analyses with separate terms for tritium and gamma doses, there was no evidence of increased risk from tritium exposure. All workers had mortality lower than the general population.Conclusion:Significantly increased risks for early AECL workers are most likely due to incomplete transfer of AECL dose records to the National Dose Registry. Analyses of the remainder of the Canadian nuclear workers (93.2%) provided no evidence of increased risk, but the risk estimate was compatible with estimates that form the basis of radiation protection standards. Study findings suggest that the revised Canadian cohort, with the exclusion of early AECL workers, would likely have an important effect on the 15-country pooled risk estimate of radiation-related risks of all cancer excluding leukaemia by substantially reducing the size of the point estimate and its significance. [ABSTRACT FROM AUTHOR]

The Centers for Disease Control and Prevention provides biomonitoring data in the United States as part of the National Health and Nutrition Examination Survey (NHANES). Recently, Statistics Canada initiated a similar survey - the Canadian Health Measures Survey (CHMS). Comparison of US and Canadian biomonitoring data can generate hypotheses regarding human exposures from environmental media and consumer products. To ensure that such comparisons are scientifically meaningful, it is essential to first evaluate aspects of the surveys' methods that can impact comparability of data. We examined CHMS and NHANES methodologies, using bisphenol A (BPA) as a case study, to evaluate whether survey differences exist that would hinder our ability to compare chemical concentrations between countries. We explored methods associated with participant selection, urine sampling, and analytical methods. BPA intakes were also estimated to address body weight differences between countries. Differences in survey methods were identified but are unlikely to have substantial impacts on inter-survey comparisons of BPA intakes. BPA intakes for both countries are below health-based guidance values set by the US, Canada and the European Food Safety Authority. We recommend that before comparing biomonitoring data between surveys, a thorough review of methodologic aspects that might impact biomonitoring results be conducted. [ABSTRACT FROM AUTHOR]

Previous studies have detected an effect of earlier temperatures on the incidence of campylobacteriosis in humans, but without adjustment for earlier numbers of cases of the disease. We estimated the effect of temperature on the number of cases notified by week in Montreal, Canada, from 1 January 1990 to 26 March 2006, simultaneously with the effect of the numbers of cases notified in the preceding weeks. The current campylobacteriosis count (week 0) was modelled by negative binomial regression, with earlier weekly average temperatures and earlier counts as predictors. Secular trends were accounted for by cubic spline functions and seasonal variations by sine-cosine functions. Indicator variables identified weeks with fewer than 5 working days. In the final statistical model, a 1°C increase in temperature above 10°C during any of weeks −1 to −6 was associated with a 0.8% (95% CI: 0.3% to 1.3%) increase in the current count. For each additional notified case during any of weeks −1 to −5 or −9 to −12, the increase in the current count was approximately 0.5% (95% CI: 0.2% to 1.0%). Thus, earlier temperatures and earlier counts have independent effects, that of temperatures being the larger one. The temperature effect is too small to require short term public health planning. However, in Montreal, an increase in average temperature of the order of 4.5°C, forecast by some for 2055, could produce a 23% increase in incidence, resulting in about 4,000 excess cases per year. [ABSTRACT FROM AUTHOR]

The fiscal sustainability of government health expenditures is defined as the gap between growth rates of spending and measures of the resource base. The results show that over the period 1965-2008, real per capita Canadian provincial government health spending has grown at rates that exceed growth in basic measures of the resource base such as per capita gross domestic product (GDP), per capita federal transfers and per capita provincial government revenues. Forecasts of future spending to 2035 using determinant regression and growth rate extrapolation techniques show that Canadian provincial government health spending is projected to continue rising in the future and its share of provincial GDP will rise. While the amount spent on health is ultimately a public policy choice, provincial government health spending also cannot continue growing faster than the resource base indefinitely. [ABSTRACT FROM AUTHOR]

The relationship between time, money, and regular participation in physical activities, especially at the intensities and durations required to improve one's health, is an important public health and social policy issue. The objective of this research is to develop a better understanding of the extent to which income poverty and time poverty act as barriers to regular participation in moderate or higher intensity physical activities. This study uses Canadian time use data collected in 2005 in order to measure income poverty, time poverty, and active living. Objective measures of physical activity engagement (participation rates, daily occurrences, and daily time budgets) are used to explore differences between the rich and poor categories of both income and time wealth. The income and time wealth categories are corroborated using subjective assessments of stress and perceived barriers to regular participation in sports. The results illustrate the multidimensional nature of poverty, but from a public health and social policy perspective, time poverty may be more important than income poverty as a barrier to regular physical activity engagement. [ABSTRACT FROM AUTHOR]

The article reports that on March 18, 2005, the World Health Organization launched the Global Commission on Social Determinants of Health. In recognition of the many determinants of health, the Federal Government has begun work on the development of Public Health Goals for Canada. A discussion paper, workbook and survey are available on the Public Health Goals website at www.healthycanadians.ca. The goals must facilitate reinvestment in public health and focus on populations so that widespread improvements will take place.

The UNEP GEMS/Water Programme is the leading international agency responsible for the development of water quality indicators and maintains the only global database of water quality for inland waters (GEMStat). The protection of source water quality for domestic use (drinking water, abstraction etc) was identified by GEMS/Water as a priority for assessment. A composite index was developed to assess source water quality across a range of inland water types, globally, and over time. The approach for development was three-fold: (1) Select guidelines from the World Health Organisation that are appropriate in assessing global water quality for human health, (2) Select variables from GEMStat that have an appropriate guideline and reasonable global coverage, and (3) determine, on an annual basis, an overall index rating for each station using the water quality index equation endorsed by the Canadian Council of Ministers of the Environment. The index allowed measurements of the frequency and extent to which variables exceeded their respective WHO guidelines, at each individual monitoring station included within GEMStat, allowing both spatial and temporal assessment of global water quality. Development of the index was followed by preliminary sensitivity analysis and verification of the index against real water quality data. [ABSTRACT FROM AUTHOR]

Compared to other industrialized countries, the U.S. spends most of all on health care. Nonetheless, the U.S. ranks relatively low on health care indicators. This paradox has been already known for decades. For example, the turning point comparing the U.S. and Canada was in 1972. Health expenditure as a percentage of GDP was higher in Canada than in the USA from 1960 until 1972. Since 1972 expenditure on health care has been higher in the U.S. than in Canada (OECD 2005a, Health data 2005, fourteenth OECD electronic database on health systems, date of release June 2005, last update 04/26/2005). The present study integrates the dispersed literature on spending and health care rankings and adds some statistical analysis to these studies. The evaluation of different factors influencing health care expenditure in the U.S. relative to other countries is restricted to a comparison with Canada. The U.S. and Canada are two countries that are sufficiently similar to make comparisons useful. The comparison of factors influencing health care expenditure in the U.S. and Canada in 2002 reveals that health care expenditure in the U.S. is higher than in Canada mainly due to administration costs, Baumol’s cost disease and pharmaceutical prices. It is not primarily inefficiency in health care production but the dominant prevalence for free choice and own responsibility that explains the paradox of high expenditure on health care and low ranking on health care indicators. [ABSTRACT FROM AUTHOR]

Introduces articles based on paper presented during the National Symposium on Immigrant Health in Canada, published in the May-June 2004 issue of the "Canadian Journal of Public Health."

Cohort studies represent an important epidemiological tool for exploring the potential adverse health effects of low-dose exposure to ionizing radiation in the workplace. Analyses of data from the National Dose Registry of Canada have suggested that occupational radiation exposure leads to increased risk of several specific types of cancer, as well as increased overall risk of cancer. An important aspect of such studies is the censoring in recorded exposures induced by dosimetry detection limits. Such a censoring effect can lead to significant underestimation of cumulative doses which, in turn, can result in overestimation of the excess cancer risk associated with occupational radiation exposure. In this article, we present analytic results, supported by a simulation study, on the magnitude of overestimation of risk based on the additive relative risk model used in the analysis of the NDR data that can occur due to censoring. Our results indicate that overestimation of risk is modest, being less than 20% in all situations considered here. Because censoring also results in ovestimation of the precision of the risk estimates, the significance levels of Wald-type statistical tests for increased risk based on the ratio of the estimate to its standard error are virtually unaffected by censoring. These results suggest that although the application of the additive excess relative risk model in the presence of censoring may lead to some overestimation of risk, the model does not lead to invalid conclusions regarding the association between occupational radiation exposure and cancer risk based on data from the NDR.Journal of Exposure Analysis and Environmental Epidemiology (2005) 15, 398–406. doi:10.1038/sj.jea.7500416; published online 8 December 2004 [ABSTRACT FROM AUTHOR]

This Canadian hepatitis C model estimates economic burden of disease using Markov modeling to predict progression over 11 health states annually from 2001 to 2040. Incidence-based estimates help demonstrate the capability to determine cost-effectiveness of programs to prevent different proportions of incident cases. Benefits of prevention increase linearly with the number of incident cases prevented. The model forecasts annual health care costs for the treatment of HCV-related disease ranging from $103 to $158 million over time. Health care costs attributable to 2001 incidence cohort are forecast at $14.6 million for prevention. The increasing cost of HCV provides a framework for further analysis and implementation of long-term policies aimed at appropriate allocation of resources for health in Canada. [ABSTRACT FROM AUTHOR]

OBJECTIVE:: To measure the independent correlates of excess body weight and obesity in Quebec in 1993 and 1997. DESIGN:: A population-based, cross-sectional survey in three settings in the province of Quebec. SUBJECTS:: A total of 10014 individuals aged 18-64?y. MEASUREMENTS:: Excess body weight was defined as a body mass index (BMI) (self-reported weight and height) greater than or equal to 25?kg/m2 and obesity as BMI greater than or equal to 30?kg/m2. Data were collected by a questionnaire completed at home by the participants. Diet was assessed by a food frequency questionnaire. RESULTS:: The correlates varied according to gender. While university achievement, smoking habit and physical activity level reduced the risk of excess body weight in both genders, increased dietary fat intake was positively associated with overweight and obesity in men only. In women, greater family income lowered the risk of having a BMI over 25. Increasing age, speaking a language other than French and living in a rural environment elevated the risk. CONCLUSION:: Future interventions for the control of obesity should be gender-specific. Target groups should include individuals with low education, those living in rural environments and non-caucasian women. Dietary interventions should target men in particular.International Journal of Obesity (2004) 28, 766-774. doi:10.1038/sj.ijo.0802633 Published online 13 April 2004 [ABSTRACT FROM AUTHOR]

In the current American debate over national health insurance an examination of the Canadian governmental experience is very instructive. Canada is enough like the United Slates to make the effects of Canadian health insurance policies rather like a large natural experiment. The Canadian experience-universal government health insurance administered by the ten provinces with some fiscal and policy variations-can be used to predict the impact in the United Stales of proposed national health insurance plans on the medical care system, and the reaction of mass publics and national policymakers to these effects. The central purpose of the Canadian national health insurance was to reduce and hopefully eliminate financial barriers to medical care. In this it succeeded. But il also produced results ' which Canadian policymakers never anticipated: essentially unexpected side-effects on cost, quality, organization, and manpower distribution of the particular national health insurance program adopted. It should be cause for concern, the article concludes, that most of the prominent American national health insurance proposals resemble the Canadian program in failing to provide a single level of government with both the means and incentives to curb the inflationary effects of national health insurance. The lesson from Canada is that unless the system has very strong anti-inflationary mechanisms and incentives built into it. national health insurance will feed the fires of medical inflation despite great formal governmental authority to control it. [ABSTRACT FROM AUTHOR]