Projection of future cancer incidence and new cancer cases in Manitoba, 2006–2025

Introduction Projecting the burden of cancer is important for evaluating prevention strategies and for administrative planning at cancer facilities. Methods We projected cancer incidence and counts for the population of Manitoba using population projections from the Manitoba Bureau of Statistics for the years 2006 to 2025 and cancer incidence data from the Manitoba Cancer Registry for the years 1976 to 2005. Data were analyzed using a version of the age-period-cohort model with recommended modifications that was developed and tested in the Nordic countries. Results The overall incidence of cancer in Manitoba is not projected to change substantially from 2006 to 2025. However, the age-standardized incidence for lung cancer is expected to decrease, particularly for males, highlighting the importance of tobacco prevention. The total number of new cancer cases per year is expected to increase 36% over the projection period, attributable primarily to demographic changes. Conclusion As the population of Manitoba increases, resource and infrastructure planning will need to account for the expected increase in cancer cases.

The development of community health indicators: a district-wide approach

Introduction In response to high rates of chronic disease, the Capital District Health Authority in Nova Scotia recognized a need to move from a focus on acute care in decision making to one that also values a population health approach guided by community health indicators. Methods Stakeholders were surveyed on the choice, knowledge and utility of selected indicators. Results Respondents reported high scores for changes in their knowledge and attitude regarding community health indicators, and identified priority indicators for action.Decision makers’ use of community health indicators was increased by stakeholder involvement, supporting evidence in plain language, and wide dissemination.

The effectiveness of implementing a reminder system into routine clinical practice: does it increase postpartum screening in women with gestational diabetes?

Introduction During regular care, women with previous gestational diabetes mellitus (GDM) rarely receive the recommended screening test for type 2 diabetes, a 2-hour oral glucose tolerance test ( OGTT), in the postpartum period. The current study examined whether the implementation of a reminder system improved screening rates. Methods Based on our previous randomized control trial, we implemented a postpartum reminder (letter or phone call) protocol into routine care at two of three clinical sites. We verified postpartum testing by searching hospital laboratory databases and by linking to the provincial physician service claims database. The primary outcome was the proportion of patients who underwent an OGTT within 6 months of delivery. Results Women who received care in a setting using a reminder system were more likely to receive an OGTT within 6 months postpartum (28%) compared with usual care (14%). The OGTT rates for both reminder groups were lower than that found in our randomized control trial (28% vs. 60%). Conclusion Although the screening rates remain low, postpartum reminders doubled screening rates using the recommended test, the OGTT.

A profile of older community-dwelling home care clients with heart failure in Ontario

Introduction The aging of the Canadian population is associated with a rising burden of heart failure (HF), a condition associated with significant morbidity, mortality and health service use. Methods We used data from the Ontario Resident Assessment Instrument-Home Care database for all long-stay home care clients aged 65 years or older to (1) describe the demographic and clinical characteristics of home care clients with HF and (2) examine service use among home care clients with HF to promote management at home with appropriate services. Results Compared with other home care clients, HF clients exhibit more health instability, take more medications, experience more comorbid conditions and receive significantly more nursing, homemaking and meal services. They are hospitalized more frequently, have significantly more emergency department visits and use more emergent care. Discussion HF clients are a more complex group than home care clients in general. Patient self-care must be tailored to the clinical characteristics, patterns of service use and barriers to self-care of the client. This is particularly true for older, frail and medically complex HF patients, many of whom require home care services. This work provides a background upon which to base initiatives to help these higher-needs clients manage their HF at home with appropriate support and services.

Dietary sodium intake among Canadian adults with and without hypertension

Introduction Almost 30% of hypertension among Canadians may be attributed to excess dietary sodium. Methods We examined the average sodium intake of Canadians aged 30 years and over, with and without hypertension, by age, sex and diabetes status using 24-hour recall data from the 2004 Canadian Community Health Survey, Cycle 2.2, Nutrition. We compared absolute (crude) average sodium intake levels of those with and without hypertension to the 2009 Canadian Hypertension Education Program (CHEP) guidelines and adjusted average sodium intake between those with and without hypertension. Results Both those with and without diagnosed hypertension display average sodium intakes well above the 1500 mg/day recommended by the 2009 CHEP guidelines (2950 mg/day and 3175 mg/day, respectively). After confounding adjustment, those with hypertension have significantly higher average sodium intake (p = .0124). Stratified subgroup analyses found the average sodium intake among those with hypertension was higher for men between 30 and 49 years old (p = .0265), women between 50 and 69 years old (p = .0083) and those without diabetes (p = .0071) when compared to their counterparts without hypertension. Conclusion Better approaches are needed to reduce sodium intake in hypertension patients, as well as the general population.

Cardiovascular risk according to plasma apolipoprotein and lipid profiles in a Canadian First Nation

Introduction Despite high diabetes rates among Canadian First Nations people, little is known about their cardiovascular disease risk. Our aim was to describe the apolipoprotein profile with respect to cardiovascular risk in a Canadian First Nation community. Methods In 2003, a representative sample of adult members of a Manitoba First Nation (N = 483) participated in a screening study for diabetes and diabetes complications. We assessed their cardiovascular risk factors. Results Sixty percent of women were at increased cardiovascular risk because of low apolipoprotein A1 (apoA1) levels, compared with 35% of men. The proportion of women with low apoA1 levels decreased with age, but the proportion with low high-density lipoprotein levels remained stable across age groups. Both apoB and apoA1 were significantly associated with obesity when age, sex, diastolic blood pressure, homocysteine, diabetes, and insulin resistance were controlled for. Conclusion Apolipoprotein and lipid profiles in this First Nation population suggest high cardiovascular risk. Future research should characterize the lipoprotein particle size in this population.

Arthritis in the Canadian Aboriginal population: north-south differences in prevalence and correlates

Background Information on arthritis and other musculoskeletal disorders among Aboriginal people is sparse. Survey data show that arthritis and rheumatism are among the most commonly reported chronic conditions and their prevalence is higher than among non-Aboriginal people. Objective To describe the burden of arthritis among Aboriginal people in northern Canada and demonstrate the public health significance and social impact of the disease. Methods Using cross-sectional data from more than 29 000 Aboriginal people aged 15 years and over who participated in the Aboriginal Peoples Survey 2006, we assessed regional differences in the prevalence of arthritis and its association with other risk factors, co-morbidity and health care use. Results The prevalence of arthritis in the three northern territories ("North") is 12.7% compared to 20.1% in the provinces ("South") and is higher among females than males in both the North and South. The prevalence among Inuit is lower than among other Aboriginal groups. Individuals with arthritis are more likely to smoke, be obese, have concurrent chronic diseases, and are less likely to be employed. Aboriginal people with arthritis utilized the health care system more often than those without the disease. Conclusion Aboriginal-specific findings on arthritis and other chronic diseases as well as recognition of regional differences between North and South will enhance program planning and help identify new priorities in health promotion.

Obesity and obesity-related comorbidities in a Canadian First Nation population

Introduction Rates of obesity are higher among Canada's Aboriginal First Nations populations than among non-First Nations populations. We studied obesity and obesity-related illness in a Manitoba First Nation community. Methods We conducted a screening study of diabetes and diabetes complications in 2003, from which we drew a representative sample of Manitoba First Nation adults (N = 483). We assessed chronic disease and chronic disease risk factors. Results Prevalence of obesity and associated comorbidities was higher among women than men. By using multivariate analysis, we found that factors significantly associated with obesity among women were diastolic blood pressure, insulin resistance, and employment status. Among men, factors were age, apolipoprotein A1 level, apolipoprotein B level, and insulin resistance. Seventy-five percent of study participants had at least 1 of the following conditions: obesity, dyslipidemia, hypertension, or diabetes. Comorbidity was high even among the youngest age groups; 22% of men and 43% of women aged 18 to 29 had 2 or more chronic conditions. Twenty-two percent of participants had undiagnosed hypertension. Participants with undiagnosed hypertension had significantly more chronic conditions and were more likely to have microalbuminuria than were those without hypertension. The number of chronic conditions was not significantly different for participants with newly diagnosed hypertension than for those with previously diagnosed hypertension. Conclusion The prevalence of obesity and other chronic conditions in the study community is high, especially considering the number of young people. Community-based interventions are being undertaken to reduce the excessive rate of illness.