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Background: Statistics Canada routinely collects information on functional health and related concepts. Recently, the Washington Group on Disability Statistics (WG) measure of disability has been introduced to the Canadian Community Health Survey (CCHS). The WG measure is used as a tool for developing internationally comparable data on disability. In alternate cycles of the CCHS, it replaces the Health Utilities Index Mark 3 (HUI3), a generic preference-based measure of health-related quality of life. The HUI3 is used to derive evaluative health measures common in population health and economic evaluations. Since the WG measure is not preference-based, it is unable to derive these measures. To address resulting data gaps, this study empirically maps the health state utility values of the HUI3 score from the WG measure., Data and Methods: Empirical mapping used a "head-to-head" subsample of the 2017 CCHS where WG and HUI3 measures were collected from the same respondents aged 40 and over. Empirical mapping used regression models to estimate the statistical relationship between WG and HUI3 measures in addition to health and demographic variables. Out-of-sample predictive performance was assessed through descriptive statistics, mean absolute error, and other measures of predictive accuracy., Results: The preferred estimation strategy resulted in reasonably precise estimates of the HUI3 score corresponding to trends across health and demographic characteristics and reflecting distributional properties of the HUI3 score. Inclusion of different components of the WG measure influenced predictive accuracy., Interpretation: Empirical mapping offers a potential method to estimate health state utility scores from the WG measure and addresses data gaps in health-related quality of life measures in the CCHS when HUI3 is not collected.

Background: Data on fasting during Ramadan and the risk of preterm birth and child mortality are conflicting, but the association with stillbirth is unknown., Objective: We studied the relationship between Ramadan and the risk of stillbirth for Arab women in Quebec, Canada., Methods: We conducted a retrospective cohort study using birth certificates for Arab women in Quebec, Canada, between 1981 and 2017. The exposure was Ramadan in the first and second trimester (1-27 weeks of gestation), and the outcome was early (<28 weeks) or late (≥28 weeks) stillbirth. We used log-binomial regression models to estimate risk ratios (RR) and 95% confidence intervals (CI) for the association between Ramadan and risk of stillbirth. We adjusted models for maternal characteristics and assessed associations by cause of death., Results: The study included 78,349 live births and 274 stillbirths. There were 3.5 stillbirths per 1,000 pregnancies for women exposed to Ramadan between weeks 1-27 of gestation (95% CI 3.0, 4.0), and 3.4 per 1,000 for unexposed women (95% CI 2.8, 4.1). Compared with no exposure, Ramadan between weeks 1-27 was not associated with the risk of early (RR 1.32, 95% CI 0.76, 2.28) or late stillbirth (RR 0.93, 95% CI 0.70, 1.23) in adjusted models. RRs for early stillbirth were 1.40 for Ramadan between weeks 15-21 (95% CI 0.70, 2.80) and 1.38 for Ramadan between weeks 22-27 (95% CI 0.67, 2.84). Relative to no exposure, Ramadan between weeks 15-21 was associated with early stillbirth due to congenital anomaly (RR 3.96; 95% CI 1.35, 11.57) in unadjusted models. There was no association with other causes of stillbirth., Conclusions: There is no evidence that Ramadan is associated with the risk of early or late stillbirth overall. Further research is needed to confirm an association with stillbirth due to congenital anomalies., (© 2021 John Wiley & Sons Ltd.)

Introduction&#160;: Cardiovascular disease is on the rise and is the second leading cause of death among Canadians. Background&#160;: The care pathway followed by myocardial infarction patients in remote areas has an impact on their continuity of care.Objective&#160;: To describe the care pathway of myocardial infarction patients living in a remote area.Methods&#160;: A qualitative formative research design was used. Two samples were created, the first comprising sixteen people who had undergone a percutaneous transluminal coronary angioplasty, and the second made up of four health professionals working in Family Medicine Groups (FMGs).Results&#160;: Eight steps were identified and three priority needs were raised, namely&#160;: 1) understanding the pathway of care and services&#160;; 2) effectively communicating health information to the various establishments&#160;; and 3) setting up follow-up by FMG health professionals when the patient returns home.Discussion&#160;: Nurses play a key role in all steps of the pathway and in meeting patients&#8217; needs.Conclusion&#160;: The care and service pathway are suboptimal but the same for participants from this remote area.

Introduction: The objective of our study was to present model-based estimates and projections on current and future health and economic impacts of cerebral palsy in Canada over a 20-year time horizon (2011-2031)., Methods: We used Statistics Canada's Population Health Model (POHEM)-Neurological to simulate individuals' disease states, risk factors and health determinants and to describe and project health outcomes, including disease incidence, prevalence, life expectancy, health-adjusted life expectancy, health-related quality of life and health care costs over the life cycle of Canadians. Cerebral palsy cases were identified from British Columbia's health administrative data sources. A population-based cohort was then used to generate the incidence and mortality rates, enabling the projection of future incidence and mortality rates. A utility-based measure (Health Utilities Index Mark 3) was also included in the model to reflect various states of functional health to allow projections of health-related quality of life. Finally, we estimated caregiving parameters and health care costs from Canadian national surveys and health administrative data and included them as model parameters to assess the health and economic impact of cerebral palsy., Results: Although the overall crude incidence rate of cerebral palsy is projected to remain stable, newly diagnosed cases of cerebral palsy will rise from approximately 1800 in 2011 to nearly 2200 in 2031. In addition, the number of people with the condition is expected to increase from more than 75 000 in 2011 to more than 94 000 in 2031. Direct health care costs in constant 2010 Canadian dollars were about $11 700 for children with cerebral palsy aged 1-4 years versus about $600 for those without the condition. In addition, people with cerebral palsy tend to have longer periods in poorer health-related quality of life., Conclusion: Individuals with cerebral palsy will continue to face challenges related to an ongoing need for specialized medical care and a rising need for supportive services. Our study offers important insights into future costs and impacts associated with cerebral palsy and provides valuable information that could be used to develop targeted health programs and strategies for Canadians living with this condition., Competing Interests: MO is a site investigator for clinical trials in spinal muscular atrophy by Roche, Biogen and Cytokinetics, and a past member of the data safety monitoring board for Avexis.

Changes in health behaviours (smoking, physical activity, alcohol consumption, and fruit and vegetable consumption) after diagnosis of chronic health conditions (heart disease, cancer, stroke, respiratory disease, and diabetes) were examined among Canadians aged 50 or older. Results from 12 years of longitudinal data from the Canadian National Population Health Survey indicated relatively modest changes in behaviour. Although significant decreases in smoking were observed among all groups except those with respiratory disease, at least 75% of smokers did not quit. No significant changes emerged in the percentage meeting physical activity recommendations, except those with diabetes, or in excessive alcohol consumption, except those with diabetes and respiratory disease. The percentage reporting the recommended minimum fruit and vegetable intake did not increase significantly among any group.

Background: Mortality and morbidity have been shown to follow a 'social gradient' in Canada and many other countries around the world. Comparatively little, however, is known about whether ageing amplifies, diminishes or sustains socio-economic inequalities in health., Methods: Growth curve analysis of seven cycles of the Canadian National Population Health Survey (n=13,682) for adults aged 20 and older at baseline (1994/95). The outcome of interest is the Health Utilities Index Mark 3, a measure of health-related quality of life (HRQL). Models include the deceased so as not to present overly optimistic HRQL values. Socio-economic position is measured separately by household-size-adjusted income and highest level of education attained., Results: HRQL is consistently highest for the most affluent and the most highly educated men and women, and is lower, in turn, for middle and lower income and education groups. HRQL declines with age for both men and women. The rate of the decline in HRQL, however, was related neither to income nor to education for men, suggesting stability in the social gradient in HRQL over time for men. There was a sharper decline in HRQL for upper-middle and highest-income groups for women than for the poorest women., Conclusion: HRQL is graded by both income and education in Canadian men and women. The grading of HRQL by social position appears to be 'set' in early adulthood and is stable through mid- and later life.

Objective: A 14-year multiwave panel design was used to examine relationships between longitudinal alcohol-consumption patterns, especially persistent moderate use, and change in health-related quality of life among middle-aged and older adults., Method: A nationally representative sample of 5,404 community-dwelling Canadians ages 50 and older at baseline (1994/1995) was obtained from the longitudinal National Population Health Survey. Alcohol-consumption patterns were developed based on the quantity and frequency of use in the 12 months before the interview. Health-related quality of life was assessed with the Health Utilities Index Mark 3 (HUI3). Latent growth curve modeling was used to estimate the change in HUI3 for each alcohol pattern after adjusting for covariates measured at baseline., Results: Most participants showed stable alcohol-consumption patterns over 6 years. Persistent non-users, persistent former users, those decreasing their consumption levels, and those with unstable patterns (i.e., U shaped and inverted U shaped) had lower HUI3 scores at baseline compared with persistent moderate drinkers. A more rapid decline in HUI3 scores than that observed for persistent moderate users was seen only in those with decreasing consumption (p < .001). In a subgroup identified as consistently healthy before follow-up, longitudinal drinking patterns were associated with initial HUI3 scores but not rates of change., Conclusions: Persistent moderate drinkers had higher initial levels of health-related quality of life than persistent nonusers, persistent former users, decreasing users, U-shaped users, and inverted U-shaped users. However, rates of decline over time were similar for all groups except those decreasing their consumption, who had a greater decline in their level of health-related quality of life than persistent moderate users.

Purpose: The objective of the paper is to describe trajectories of health-related quality of life (HRQL) associated with categories of body mass index (BMI): underweight, normal weight, overweight, obese class I, and obese classes II and III., Methods: Data come from the longitudinal Canadian National Population Health Survey. Analyses are based on data for 3,864 men and 4,745 women who were 40+ in 1998/1999 and followed through 2006/2007. HRQL was measured with the Health Utilities Index Mark 3. Multi-level growth modeling was used., Results: HRQL declined with age. For men, there was a large HRQL decrement for being underweight; trajectories for all other BMI categories were very similar. For women being underweight was associated with higher HRQL at younger ages but lower at older ages. Otherwise, for women, HRQL was ordered from highest to lowest: normal, overweight, obese class I, and obese classes II and III., Conclusions: Given that excess weight is a risk factor for mortality and the development of chronic conditions, the HRQL results for men are surprising. The HRQL results for women may reflect both the importance of body image on mental health and the health effects of excess weight.

Background: A better understanding of factors associated with adopting leisure-time physical activity among people with chronic vascular conditions can help policy-makers and health care professionals develop strategies to promote secondary prevention among older Canadians., Data and Methods: Cross-sectional data from the 1994/1995 National Population Health Survey (NPHS), household component, and the 2007/2008 Canadian Community Health Survey were used to estimate the prevalence of inactivity. Longitudinal data from eight cycles (1994/1995 through 2008/2009) of the NPHS, household component, were used to examine the adoption of leisure-time physical activity, intentions to change health risk behaviours, and barriers to change., Results: Over half (54%) of the population aged 40 or older were inactive during their leisure time in 2007/2008. A new vascular diagnosis was not associated with initiating leisure-time physical activity. Among the newly diagnosed, those with no disability or a mild disability had higher odds of undertaking leisure-time physical activity., Interpretation: The majority of Canadians in mid- to late life are inactive. They tend to remain so when diagnosed with a vascular condition.

Background: With longitudinal data, lifetime health statusŏ dynamics can be estimated by modeling trajectories. Health status trajectories measured by the Health Utilities Index Mark 3 (HUI3) modeled as a function of age alone and also of age and socio-economic covariates revealed non-normal residuals and variance estimation problems. The possibility of transforming the HUI3 distribution to obtain residuals that approximate a normal distribution was investigated., Data and Methods: The analysis is based on longitudinal data from the first six cycles of the National Population Health Survey (NPHS). The data pertain to 7,784 individuals, who, in 1994/1995, were aged 40 to 99, were living in private households, and had complete information on HUI3. A multilevel growth model was used to examine the hierarchical structure of NPHS data (repeated measurements nesting within respondents). The transformation of arcsine [2 x (HUI + 0.36) / (1 + 0.36)-1] was used to improve the distribution of the residuals at both levels and limit the conditional mean to the -0.36 to 1.00 interval. A model was estimated using socio-economic determinants. Analyses were performed with SAS and MLwiN., Results: After the transformation of HUI3, the model was satisfactory and allowed for inclusion of new socio-demographic and health variables in order to estimate their impact on the health-related quality of life of aging populations. Because of the complex transformation of the arcsine model, the regression coefficients were not interpreted. Instead, the estimation results were summarized graphically.

Objective: To assess the challenges faced by caregivers of children with impairments of psychological functions (IPFs)., Method: Data came from the 2001 Participation and Activity Limitation Survey, a post-census national survey of people with disabilities residing in the 10 Canadian provinces. Interviews of caregivers of children aged 5 to 14 years with a disability (n = 3908) were conducted between September 2001 and January 2002., Results: Caregivers of children with IPFs who are severely limited in their everyday activities were more likely to: need respite care; be refused a child care program or service; not receive health services for their children when needed; and not take a job, quit work, and work fewer hours to care for their children., Conclusions: This highlights the importance of both removing barriers and obstacles to the full participation of children with IPFs in everyday activities and improving their caregivers' access to health and child care services. It also argues in favour of family-centred care that explicitly considers caregivers' concerns, identifies their needs and problems, and supports families in their caregiving roles.

Background: The objective of this study was to validate categories of cognitive functioning using data from the 2009 Canadian Community Health Survey (CCHS)--Healthy Aging Cognition Module., Data and Methods: Four measures of cognitive functioning--immediate and delayed recall (memory), and animal-naming and the Mental Alternation Test (executive functioning)--were coded into five categories for the Canadian household population aged 45 or older. The scores for each measure were standardized to t-scores that controlled for age, sex and education. Respondents were classified into five cognitive functioning categories. Cross-tabulations, stratum-specific likelihood ratios and multinomial logit regression were used to assess associations between levels of cognitive functioning and various health outcomes: self-reported general and mental health status, memory and problem-solving ability, activities of daily living, life satisfaction, loneliness, depression, and chronic conditions., Results: Results supported the use of five levels of cognitive functioning for all four outcomes on the CCHS--Healthy Aging sample overall and by age group (45 to 64, 65 or older) and language group (English, French)., Interpretation: These categories can be used in future work on cognitive functioning based on the CCHS--Healthy Aging.

Background: Recent clinical trials have demonstrated benefit with early revascularization following acute myocardial infarction (AMI). Trends in and the association between early revascularization after (ie, 30 days or fewer) AMI and early death were determined., Methods and Results: The Statistics Canada Health Person-Oriented Information Database, consisting of hospital discharge records for seven provinces from the Canadian Institute for Health Information Hospital Morbidity Database, was used. If there was no AMI in the preceding year, the first AMI visit within a fiscal year for a patient 20 years of age or older was included. Times to death in hospital and to revascularization procedures were counted from the admission date of the first AMI visit. Mixed model regression analyses with random slopes were used to assess the relationship between early revascularization and mortality. The overall rate of revascularization within 30 days of AMI increased significantly from 12.5% in 1995 to 37.4% in 2003, while the 30-day mortality rate decreased significantly from 13.5% to 10.6%. There was a linearly decreasing relationship - higher regional use of revascularization was associated with lower mortality in both men and women., Conclusions: These population-based utilization and outcome findings are consistent with clinical trial evidence of improved 30-day in-hospital mortality with increased early revascularization after AMI.

The immense burden of health conditions in children that is associated with mental disorders worldwide is increasingly being recognized. In comparison, the burden of disability associated with children's impairments of psychological functions (IPFs) is not well documented. The goal of this population-based study was to derive a measure of the burden of disability in children associated with IPFs that takes into account the highly variable impact such impairments might have on children's everyday activities. Data came from the 2001 Participation and Activity Limitation Survey, a national survey of individuals with disabilities living in Canada. Latent class analysis was used to obtain a maximum likelihood estimate of the proportion of children with IPFs living in Canada who were severely limited in their everyday activities, by age and sex. As expected, the burden of disability was not evenly shared among children with IPFs. In fact, only a minority of children with IPFs were severely limited in their everyday activities. This represents approximately 15% of 5-14year-old boys with a disability and 10% of their female counterparts living in Canada. These estimates provide a better appraisal of the burden of disability in children associated with IPFs than previous estimates, which only considered the presence or absence of IPFs., (Copyright 2010 Elsevier Ireland Ltd. All rights reserved.)

This article examines geographical variations in 30-day revascularization rates and 30-day in-hospital mortality rates for Canadian heart attack (acute myocardial infarction) patients. The data are from the Health Person-Oriented Information Database and pertain to health regions with at least 100,000 population in seven provinces for the years 1995/1996 and 2003/2004. Revascularization rates rose in all health regions between these years, and mortality rates dropped in most, but not all, regions. Generally, health regions with high revascularization rates had lower mortality rates. However, some regions with high revascularization rates had relatively high mortality rates, and some with relatively low revascularization rates achieved relatively low mortality rates. These results raise important questions about the overall efficiency of health care in Canada, and suggest that better data are needed to support research on explaining the wide geographical variations in treatment and survival rates for heart attack patients.

Objectives: To establish empirical evidence for the validity of the following disability categories derived from Health Utilities Index Mark III (HUI3) global utility scores: none (1.00), mild (0.89 to 0.99), moderate (0.70 to 0.88), and severe (less than 0.70)., Data and Methods: Data from the 2005 Canadian Community Health Survey (cycle 3.1) were analyzed. Frequency distributions, stratum-specific likelihood ratios, and multinomial regression were used to examine the relationship between health indicators and the HUI3 disability categories., Results: People reporting chronic conditions, activity restrictions, and fair/poor self-rated health (general and mental) were more likely to be in the moderate and severe disability categories. Those having more positive outcomes on the health indicators tended to fall into the mild and no disability groups. The stratum-specific likelihood ratios increased monotonically with the severity of disability level. Compared to those with positive health status characteristics, those with negative health status characteristics had the highest odds of falling in the severe rather than the non-disabled category., Interpretation: This study makes an initial contribution to the evidence base for the validity of the proposed HUI3 disability categories. The categories were well-supported empirically and are likely to be useful for assessing disability levels.

Background: Taking account of the impacts of institutionalization and death, this study describes the normative trajectories of health-related quality of life (HRQL) in Canada as individuals age from mid-to late life., Methods: A nationally representative sample of 7,915 community-dwelling adults aged 40 and older in 1994/1995 was studied using 10 years of data from the longitudinal National Population Health Survey. Growth curve models of HRQL over age were fitted to describe the evolution of HRQL. Successive models were tested, first including only those living in a household throughout the entire period, then adding those who moved to an institution, and finally, including those who had died., Results: HRQL remained generally stable until approximately age 70, when it began to decline. Excluding individuals when they were institutionalized, or ignoring the impact of death resulted in overly optimistic trajectories of HRQL in later years., Interpretation: These results demonstrate the importance of following individuals into institutions and accounting for death in the production of realistic health estimates in aging populations.

A major objective of the Population Health Impact of Disease in Canada (PHI) research program was to obtain Canadian-specific preferences for health states associated with various diseases, in order to estimate the morbidity component of summary measures of population health embodying the Canadian experience of disease. In this study, preferences for health states were elicited from lay panels (N=146) in nine Canadian communities (Vancouver, Edmonton, Saskatoon, Toronto, Ottawa, Montréal, Québec, Moncton and Halifax); the study was conducted from January to June of 2003. Information on health states was presented to raters using the CLAssification and MEasurement System of Functional Health (CLAMES), which assesses functional capacity using 11 health status attributes, each with four to five levels ranging from normal to severely limited functioning. Preferences for 238 health states classified by CLAMES were elicited using the standard gamble (SG) technique in both individual and group exercises. Mean preferences for these health states were then used to estimate the parameters of a log-linear scoring function for CLAMES. The function provides a convenient method of computing preference scores for any health state classified by CLAMES, without the need for direct measurement in surveys. Further, the SG appears feasible in group settings.

Michel Joseph Ahern began the historical study of the medical profession in Quebec in 1910, with the publication of a series of biographies entitled Notes pour servir à l'histoire de la médecine dans le Bas-Canada depuis la fondation de Québec jusqu'au commencement du XIXe siècle in the Bulletin médical de Québec. After his death, his son George used his extant notes to continue the publication of these texts and a subsequent one-volume compilation with the same title. Despite several weaknesses, this work remains an indispensable source for researchers interested in the medical history of Quebec. Prepared in the context of several commemorations at the beginning of the 20th Century such as the 300th anniversary of the founding of Quebec City, Ahern's texts were tributes to the founders of medicine in Quebec, irrespective of their status; consequently, this work is not a pantheon of great names in medicine in the period. Doctor Ahern strove for historical integrity, and consulted archives, historians, and the learned men o f his time.

Heavy metals including mercury, lead, and cadmium are present throughout the ecosystem and are detectable in small amounts in the Great Lakes water and fish. The main route of exposure of humans to these metals is via the ingestion of contaminated food, especially fish. Extensive experimental investigations indicated that heavy metals alter a number of parameters of the host's immune system and lead to increased susceptibility to infections, autoimmune diseases, and allergic manifestations. The existing limited epidemiologic data and data derived from in vitro systems in which human peripheral blood leukocytes were used suggested that the human immune system may also be at increased risk following exposure to these metals. The magnitude of the risk that the presence of such metals in the Great Lakes may pose to the human immune system, and consequently to their health, is not known. In this review, the available data with respect to potential adverse effects of heavy metals on the immune system of humans and experimental animals are discussed, and additional data requirements are suggested.