Physical activity (MVPA) levels during home-based cardiac rehabilitation (CR) remain problematic. Consequently, the present study examined the association between MVPA and urban vs. rural residential status and the perceived environment in patients attending home-based CR. A total of 280 patients completed a questionnaire assessing demographic, clinical, MVPA, and perceived environmental variables measured at baseline and 3 months later. Patient addresses were geocoded and linked to the 2006 Canadian census to establish the urban/rural distinction. Results showed that urban and rural patients had similar baseline MVPA and improvements in MVPA by 3 months. Several perceived environmental variables were significantly related to MVPA throughout home-based CR that were common and urban/rural-specific. Therefore, although there does not appear to be an urban vs. rural advantage in MVPA levels during home-based CR, there does appear to be environmental/MVPA-specific relationships specific to urban and rural patients that may warrant attention.
While many societies have made remarkable progress in population health improvements, health inequalities remain as a central concern to health policy. There is substantial evidence to show that differences in health achievements and access to health care are increasing both within and among societies. Socio-economic and environmental health determinants are strongly associated to population health status regardless of what risk factor or technological advance is in vogue. Understanding the fundamental causes underlying the existence of health inequalities is useful for guiding health policy as it provides a direction to guide resource allocation and the targeting of policy interventions. The purpose of this paper is to review current perspectives and methods in the assessment of health inequalities with particular relevance to public health policymakers and practitioners.
To examine the relationship between density of fast food restaurants and measures of social and material deprivation at the community level in Nova Scotia, Canada.
Census information on population and key variables required for the calculation of deprivation indices were obtained for 266 communities in Nova Scotia. The density of fast food restaurants per 1000 individuals for each community was calculated and communities were divided into quintiles of material and psychosocial deprivation. One-way analysis of variance was used to investigate associations between fast food outlet densities and deprivation scores at the community level.
A statistically significant inverse association was found between community-level material deprivation and the mean number of fast food restaurants per 1000 people for Nova Scotia (p
Research suggests that Canadian francophones living in minority contexts have little access to health services in French and are more likely to receive poorer health services. We examined whether francophones in one Nova Scotia (NS) community showed different patterns of health service use from anglophones in similar rural communities, or the NS population overall.
We used administrative data to calculate 10-year cumulative incidence rate ratios for the period 1996-2005 for treated cancers, circulatory diseases, diabetes and psychiatric disorders in Clare (population 8,815, predominantly francophone) and compared these with six predominantly Anglophone communities (total population 38,147) using data for the province overall as the reference standard. We also compared 10-year treated incidence rate ratios for visits to family physicians and specialists and for admissions to hospital.
Treatment incidence rates for all four disease groups in all rural areas were dominated by family physician visits and hospital visits; visits to specialists for some disease outcomes were often lower in rural communities. Visits to psychiatric specialists were especially low in rural communities, irrespective of language status, being 30% less than for the province overall. No significant differences in treated disease incidence were detected between Clare and the comparison anglophone communities. Treated incidence rate ratios for diabetes and circulatory diseases were significantly higher in Clare and the rural anglophone communities relative to the province overall.
The patterns of health care use and treated disease incidence seen in Clare and the comparison areas are more likely a function of rurality than they are of language.
Earth is a finite system with a limited supply of resources. As the human population grows, so does the appropriation of Earth's natural capital, thereby exacerbating environmental concerns such as biodiversity loss, increased pollution, deforestation and global warming. Such concerns will negatively impact human health although it is widely believed that improving socio-economic circumstances will help to ameliorate environmental impacts and improve health outcomes. However, this belief does not explicitly acknowledge the fact that improvements in socio-economic position are reliant on increased inputs from nature. Gains in population health, particularly through economic means, are disconnected from the appropriation of nature to create wealth so that health gains become unsustainable. The current study investigated the sustainability of human population health in Canada with regard to resource consumption or "ecological footprints" (i.e., the resources required to sustain a given population). Ecological footprints of the 20 largest Canadian cities, along with several important determinants of health such as income and education, were statistically compared with corresponding indicators of human population health outcomes. A significant positive relationship was found between ecological footprints and life expectancy, as well as a significant negative relationship between ecological footprints and the prevalence of high blood pressure. Results suggest that increased appropriation of nature is linked to improved health outcomes. To prevent environmental degradation from excessive appropriation of natural resources will require the development of health promotion strategies that are de-coupled from ever-increasing and unsustainable resource use. Efforts to promote population health should focus on health benefits achieved from a lifestyle based on significantly reduced consumption of natural resources.
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Physical activity and nutrition are essential to healthy living and particularly important during youth, when growth and development are key. This study examined rates of physical activity (PA) and diet quality (DQ) among youth in grades 7 to 9 in Halifax, Nova Scotia, during the 2008/09 school year and tested differences among students in rural, urban and suburban neighbourhood types of high and low socio-economic status (SES).
Youth in grades 7 through 9 (aged 12-16; 53% male) from six schools (N=380), stratified by neighbourhood type (urban, suburban, rural) and SES, wore accelerometers for up to 7 days (mean=4.14, standard deviation=1.49) and completed a nutritional survey.
The findings suggest important differences in PA and DQ across SES and neighbourhood type. Specifically, rates of moderate to vigorous physical activity among youth from schools in lower socio-economic areas were higher in urban than in suburban or rural settings. Furthermore, DQ was better among youth in higher than in lower socio-economic urban settings.
Understanding these differences in PA and DQ across rural, urban and suburban environments of high and low SES may highlight subgroups and targeted geographic areas for the design of interventions to improve rates of PA and health nutrition.
The town of Sydney, located on the north coast of Nova Scotia, is Canada's most contaminated community. The local tidal estuary, called the tar ponds, was used as a receptacle for industrial waste from a century of coke production and steel making and is estimated to contain more than 700,000 metric tons of polycyclic aromatic hydrocarbons, 50,000 metric tons of polychlorinated biphenyls, and many other residuals including arsenic, naphthalene, and toluene. Many residents have expressed consternation over the potential for exposure and subsequent health effects from the ponds. Recent epidemiological studies estimate a 30 to 40 percent increased incidence in several types of cancer within the community. This paper examines the claims and responses made by a variety of interested parties about the chemical contamination in Sydney. It also considers how those claims, in addition to a number of other mediating factors, may have influenced the local community in the mobilization of a response to the contamination.
Most arctic communities use primary wastewater treatment systems that are capable of only low levels of pathogen removal. Effluent potentially containing fecally derived microorganisms is released into wetlands and marine waters that may simultaneously serve as recreation or food harvesting locations for local populations. The purpose of this study is to provide the first estimates of acute gastrointestinal illness (AGI) attributable to wastewater treatment systems in Arctic Canada. A screening-level, point estimate quantitative microbial risk assessment model was developed to evaluate worst-case scenarios across an array of exposure pathways in five case study locations. A high annual AGI incidence rate of 5.0 cases per person is estimated in Pangnirtung, where a mechanical treatment plant discharges directly to marine waters, with all cases occurring during low tide conditions. The probability of AGI per person per single exposure during this period ranges between 1.0?×?10-1 (shore recreation) and 6.0?×?10-1 (shellfish consumption). A moderate incidence rate of 1.2 episodes of AGI per person is estimated in Naujaat, where a treatment system consisting of a pond and tundra wetland is used, with the majority of cases occurring during spring. The pathway with the highest individual probability of AGI per single exposure event is wetland travel at 6.0?×?10-1. All other risk probabilities per single exposure are
Personal exposure studies of air pollution generally use self-reported diaries to capture individuals' time-activity data. Enhancements in the accuracy, size, memory and battery life of personal Global Positioning Systems (GPS) units have allowed for higher resolution tracking of study participants' locations. Improved time-activity classifications combined with personal continuous air pollution sampling can improve assessments of location-related air pollution exposures for health studies.
Data was collected using a GPS and personal temperature from 54 children with asthma living in Montreal, Canada, who participated in a 10-day personal air pollution exposure study. A method was developed that incorporated personal temperature data and then matched a participant's position against available spatial data (i.e., road networks) to generate time-activity categories. The diary-based and GPS-generated time-activity categories were compared and combined with continuous personal PM2.5 data to assess the impact of exposure misclassification when using diary-based methods.
There was good agreement between the automated method and the diary method; however, the automated method (means: outdoors?=?5.1%, indoors other =9.8%) estimated less time spent in some locations compared to the diary method (outdoors?=?6.7%, indoors other?=?14.4%). Agreement statistics (AC1?=?0.778) suggest 'good' agreement between methods over all location categories. However, location categories (Outdoors and Transit) where less time is spent show greater disagreement: e.g., mean time "Indoors Other" using the time-activity diary was 14.4% compared to 9.8% using the automated method. While mean daily time "In Transit" was relatively consistent between the methods, the mean daily exposure to PM2.5 while "In Transit" was 15.9 µg/m3 using the automated method compared to 6.8 µg/m3 using the daily diary.
Mean times spent in different locations as categorized by a GPS-based method were comparable to those from a time-activity diary, but there were differences in estimates of exposure to PM2.5 from the two methods. An automated GPS-based time-activity method will reduce participant burden, potentially providing more accurate and unbiased assessments of location. Combined with continuous air measurements, the higher resolution GPS data could present a different and more accurate picture of personal exposures to air pollution.
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Wastewater management in Canadian Arctic communities is influenced by several geographical factors including climate, remoteness, population size, and local food-harvesting practices. Most communities use trucked collection services and basic treatment systems, which are capable of only low-level pathogen removal. These systems are typically reliant solely on natural environmental processes for treatment and make use of existing lagoons, wetlands, and bays. They are operated in a manner such that partially treated wastewater still containing potentially hazardous microorganisms is released into the terrestrial and aquatic environment at random times. Northern communities rely heavily on their local surroundings as a source of food, drinking water, and recreation, thus creating the possibility of human exposure to wastewater effluent. Human exposure to microbial hazards present in municipal wastewater can lead to acute gastrointestinal illness or more severe disease. Although estimating the actual disease burdens associated with wastewater exposures in Arctic communities is challenging, waterborne- and sanitation-related illness is believed to be comparatively higher than in other parts of Canada. This review offers a conceptual framework and evaluation of current knowledge to enable the first microbial risk assessment of exposure scenarios associated with food-harvesting and recreational activities in Arctic communities, where simplified wastewater systems are being operated.