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This paper describes the reported distribution of AIDS cases in each country reporting 25 cases or more by November 20, 1997, by age and sex, as well as by assumed mode of transmission. These data come from surveillance systems of varying quality and must be interpreted with care when used for international comparisons, for the proportion of AIDS cases reported ranges from 10% in some countries to more than 90% in others. Moreover, AIDS develops rather late in the natural history of the disease and most people currently living with HIV infection have not yet developed AIDS. People who have developed AIDS are largely those who were initially infected with HIV up to a decade ago. The AIDS data presented in this paper therefore represent HIV transmission which occurred years ago. There is also considerable variation in the speed of progression from HIV to AIDS between children and adults, between those receiving treatment and those without treatment, and between different regions of the world. Finally, there is considerable variation in the way in which the data have been reported by countries.

Introduction Several regions in Canada have recently experienced sharp increases in opioid overdoses and related hospitalizations and deaths. This paper describes opioid-related mortality and disability from opioid use disorder in Canada from 1990 to 2014 using data from the Global Burden of Disease (GBD) study. Methods We used data from the GBD study to describe temporal trends (1990–2014) in opioid-related mortality and disability from opioid use disorder using common metrics: disability-adjusted life years (DALY), deaths, years of life lost (YLL) and years lived with disability (YLD). We also compared age-standardized YLL and DALY rates per 100 000 population between Canada, the USA and other regions. Results The age-standardized opioid-related DALY rate in Canada was 355.5 per 100 000 population in 2014, which was higher than the global rate of 193.2, but lower than the rate of 767.9 in the United States. Between 1990 and 2014, the age-standardized opioid-related YLL rate in Canada increased by 142.2%, while globally this rate decreased by 10.1%. In comparison with YLL, YLD accounted for a larger proportion of the overall opioid-related burden across all age groups. Health loss was greater for males than females, and highest among those aged 25 to 29 years. Conclusion The health burden associated with opioid-related mortality and disability from opioid use disorder in Canada is significant and has increased dramatically from 1990 to 2014. These data point to a need for public health action including enhanced monitoring of a range of opioid-related harms.

First Nations/Métis populations develop diabetes earlier and at higher rates than other Canadians. The Canadian diabetes risk questionnaire (CANRISK) was developed as a diabetes screening tool for Canadians aged 40 years or over. The primary aim of this paper is to assess the effectiveness of the existing CANRISK tool and risk scores in detecting dysglycemia in First Nations/Métis participants, including among those under the age of 40. A secondary aim was to determine whether alternative waist circumference (WC) and body mass index (BMI) cut-off points improved the predictive ability of logistic regression models using CANRISK variables to predict dysglycemia.Information from a self-administered CANRISK questionnaire, anthropometric measurements, and results of a standard oral glucose tolerance test (OGTT) were collected from First Nations and Métis participants (n = 1479). Sensitivity and specificity of CANRISK scores using published risk score cut-off points were calculated. Logistic regression was conducted with alternative ethnicity-specific BMI and WC cut-off points to predict dysglycemia using CANRISK variables.Compared with OGTT results, using a CANRISK score cut-off point of 33, the sensitivity and specificity of CANRISK was 68% and 63% among individuals aged 40 or over; it was 27% and 87%, respectively among those under 40. Using a lower cut-off point of 21, the sensitivity for individuals under 40 improved to 77% with a specificity of 44%. Though specificity at this threshold was low, the higher level of sensitivity reflects the importance of the identification of high risk individuals in this population. Despite altered cut-off points of BMI and WC, logistic regression models demonstrated similar predictive ability.CANRISK functioned well as a preliminary step for diabetes screening in a broad age range of First Nations and Métis in Canada, with an adjusted CANRISK cutoff point for individuals under 40, and with no incremental improvement from using alternative BMI/WC cut-off points.Le diabète touche en plus grande proportion et à un plus jeune âge la population des Premières Nations et des Métis que le reste de la population canadienne. Cet article vise principalement à évaluer l’efficacité et les scores de risque de CANRISK (Questionnaire canadien sur le risque de diabète, un outil de dépistage du diabète destiné aux Canadiens de 40 ans et plus) pour détecter la dysglycémie chez les participants issus des Premières Nations et d’origine métisse en incluant les moins de 40 ans. L’objectif secondaire de cette étude est de déterminer si une modification des seuils relatifs au tour de taille (TT) et à l’indice de masse corporelle (IMC) améliore la valeur prédictive de modèles de régression logistique lorsque les variables du questionnaire CANRISK sont utilisées pour prédire la dysglycémie.Nous avons recueilli auprès de 1479 participants métis et des Premières Nations des données provenant d’un questionnaire CANRISK autoadministré, de mesures anthropométriques et de résultats d’épreuve standard d’hyperglycémie provoquée par voie orale (HGPO). Nous avons calculé la sensibilité et la spécificité des scores CANRISK en appliquant les seuils usuels de classification des risques. Une régression logistique a été effectuée en utilisant des seuils tenant compte de l’origine ethnique pour l’IMC et le TT pour prédire la dysglycémie à l’aide des variables CANRISK.Appliqué aux résultats de l’épreuve d’HGPO, le score seuil CANRISK à 33 points a conduit à une sensibilité et une spécificité de l’outil CANRISK de respectivement 68 % et 63 % chez les 40 ans et plus, et de respectivement 27 % et 87 % chez les moins de 40 ans. L’utilisation d’un seuil inférieur, à 21 points, a fait monter à 77 % la sensibilité chez les moins de 40 ans, avec une spécificité de 44 %. Malgré la faible spécificité correspondant à ce seuil, l’augmentation de la sensibilité montre son importance à identifier les personnes à risque au sein de cette population. Après modification des seuils d’IMC et de TT, les modèles de régression logistique ont présenté une valeur prédictive comparable.L’utilisation du questionnaire CANRISK s’est révélée efficace comme première étape de dépistage du diabète chez les membres des Premières Nations et les Métis d’un large éventail d’âge au Canada, dans la mesure où le seuil CANRISK a été adapté aux moins de 40 ans, et sans que l’on constate d’amélioration différentielle en modifiant les seuils d’IMC et de TT.

Fracture of the neck of the femur (or hip fracture) is an important cause of mortality and morbidity among the elderly, and contributes significantly to health care costs. This paper examines recent Canadian trends in mortality and hospital morbidity attributable to this condition. Age-standardized rates for deaths, hospital admissions and hospital days at ages 55 and over are presented, and average annual percentage changes are estimated for each of these statistics using logarithmic regression. Changing trends in surgical procedures used to treat femoral fractures are also examined and linked with mean lengths of hospital stays. Between 1972 and 1990, deaths due to femoral fractures declined an average 2.3% annually for women and 1.2% for men. Hospital admissions dropped 0.1% for women and remained stable for men, while hospital days fell by 2.9% and 1.9% respectively. Beginning in 1977 there was a marked reduction in the proportion of admissions due to femoral fractures for which no surgical intervention was recorded and a corresponding increase in the proportion of fractures treated surgically by open reduction. Changes over the past two decades in the surgical treatment of patients with fracture of the neck of the femur may have reduced the hospital care burden. It is not possible from the available data to determine whether changes in treatment have also contributed to the observed reduction in mortality due to hip fracture. Neither can this downward trend be attributed to a fall in the condition's incidence, given observed hospital admission rates. Programs to prevent osteoporosis, falls, and injuries from falls are needed to complement improvements in surgical procedures.

This paper tries to reconstruct the demographic evolution of China during the past 30 years, in the light of new data recently published by Chinese sources. At the end of 1979 China had a population of 1970 million, a birth rate of 18/1000, a mortality rate of 6/1000, and a growth rate of 12/1000; the Chinese population which was 540 million in 1949, the year of the Liberation, was already 642 million by the end of 1957. The demographic evolution of the past 30 years can be summed up in 5 phases: 1) 1950-57, marked by a natural growth rate of 10-24/1000, due mainly to a significant decrease in mortality; fecundity was about 5 children/woman; 2) 1958-61; very little is known about those years, the period of the "great leap forward"; there was undoubtedly a marked decrease in birth rate due to starvation-caused amenorrhea, and a marked decrease in mortality rate, resulting in a natural growth rate of only 5/1000; 3) 1963-64, with a natural growth rate of 33.5/1000, and mortality decreases again; 4) 1965-70, with a birth rate of 35/1000 and a mortality rate down to 7-8/1000; these are the years of the Cultural Revolution and the demographic problem is underrated in comparison to the political situation; 5) 1970-on; fertility rate is at its lowest, 2.3, and the slogan is "2 children/couple". The characteristics of China's population in 1979 are not very different from those of 1953; 38.5% of the population is in the age group 0-15, and there are 410 million dependent young people as compared to 60 million dependent old people; survival rate is 65.7% and infant mortality has fallen to the level of that in developed countries. The Communist Party made public its directives in 1979: 1 child/couple, reduction of natural growth rate to 5/1000 by 1985 and zero population growth by the year 2000; should these directives become real, China will have a population of 1050 million inhabitants by the year 2000. The level of education in China is still low despite the doubling and tripling of the number of schools at every level; the current reduction in birth rate will show in the classrooms only in about 12 years' time. The active population includes almost the totality of the population over 17, with the majority employed in the agricultural section; the internal gross product has increased 60 times in the past 26 years; still, unemployment exists and it becoming a serious problem. Demographic aging is still much below the level of developed countries. The real problem will become apparent in 1982-93, when the mass of the people born between 1962-73, about 300 million people, will become adults and will be looking for jobs.