Under-treatment of pain is frequently reported, especially among seniors, with chronic non-cancer pain most likely to be under-treated. Legislation regarding the prescribing/dispensing of opioid analgesics (including multiple prescription programs [MPP]) may impede access to needed analgesics.
To describe access and intensity of use of analgesics among older Manitobans by health region.
A cross-sectional study of non-Aboriginal non-institutionalized Manitoba residents over 65 years of age during April 1, 2002 to March 31, 2003 was conducted using the Pharmaceutical Claims data and the Cancer Registry from the province of Manitoba. Access to analgesics (users/1000/Yr) and intensity of use (using defined daily dose [DDD] methodology) were calculated for non-opioid analgesics, opioids, and multiple-prescription-program opioids [MPP-opioids]. Usage was categorized by age, gender, and stratified by cancer diagnosis. Age-sex standardized rates of prevalence and intensity are reported for the eleven health regions of Manitoba.
Thirty-four percent of older Manitobans accessed analgesics during the study period. Female gender, increasing age, and a cancer diagnosis were associated with greater access and intensity of use of all classes of analgesics. Age-sex standardized access and intensity measures revealed the highest overall analgesic use in the most rural / remote regions of the province. However, these same regions had the lowest use of opioids, and MPP-opioids among residents lacking a cancer diagnosis.
This population-based study of analgesic use suggests that there may be variations in use of opioids and other analgesics depending on an urban or rural residence. The impact of programs such as the MPP program requires further study to describe its impact on analgesic use.
To determine reproductive services offered to lesbian patients by Canadian fertility clinics, policies of practice, ease of access to these services, and sensitivity of clinics to this population of patients.
Survey sent to assisted reproductive technology (ART) clinic directors.
Academic medical center, university-based ethics institute.
The percentage of Canadian fertility clinics that will provide reproductive services to lesbian patients; services offered; the presence of clinic policies on lesbian care; and the presence on web sites of heteronormative material.
Completed surveys were received from 71% (24/34) of clinics. All clinics surveyed provided reproductive services to lesbian patients, with the exception of one clinic. Five of 24 (21%) clinics have a written policy on care for lesbian patients; 29% (7/24) will provide services to lesbian patients without prior investigations. All clinics will offer IUI and cycle monitoring to lesbian patients. Twenty-three of 24 clinics (96%) will offer IVF services when required. Fourteen of 32 clinic web sites (44%) make mention of lesbian patients and 27% (8/30) have heteronormative information only.
Lesbians encounter several barriers to accessing reproductive services in Canada. Addressing these issues could improve experiences of lesbian women and couples seeking care at fertility clinics.
AIM: This paper is a report of a study to determine the demographic, personal, interpersonal and illness factors associated with asthma quality of life (QOL), as self-reported by adolescents from the United States of America (USA) and Iceland. BACKGROUND: Asthma affects 12% of children in the USA and an estimated 9% in Iceland. Limited research has addressed asthma QOL for adolescents. METHODS: This cross-sectional exploratory study included adolescents with asthma (n = 15 from the USA; n = 15 from Iceland), aged 13-17 years, primarily recruited from paediatric practices in central Kentucky, USA and Reykjavik, Iceland. Data were collected in 2006. Adolescents in the USA (47% male) had a mean age of 14.1 years (sd = 1.5); Icelandic adolescents (73% male) had a mean age of 15.1 years (sd = 1.4). Participants completed questionnaires measuring sociodemographic and asthma characteristics, degree of limitations due to asthma, self-rated health, depressive symptoms and asthma QOL. Multiple regression was used to determine predictors of asthma QOL. RESULTS: Gender was statistically significantly associated with QOL. The difference in QOL between adolescents in the USA and Iceland was not statistically significant. Statistically significant predictors of higher asthma QOL were a better rating of overall health (P
To reveal the specific features of marital status and educational level in people who have died of leading circulatory diseases (CDs) in Arkhangelsk in relation to the place of death, alcohol anamnesis, and demographic characteristics (gender, life span). Materials and methods. Data on the diagnosed underlying cause of death, marital status, educational level, and place of death were copied from 4137 medical death certificates (form 106/y-08) of all those who had died in Arkhangelsk in 1 July to 30 June 2012. Data on patients registered at a psychoneurology dispensary as having a diagnosis of alcohol-induced mental and behavioral disorders (F10) were copied. The data were statistically processed using the procedures of binary and multinomial logistic regression analysis.
A total of 2101 people (50.8% of the total number of deaths) died of CDs (ICD-10 Class IX) in the study period. Male sex and a compromised alcohol anamnesis were associated with untimely death (less than 60 years of age) from acute conditions in ICD-10 Class IX. Male sex, a compromised alcohol anamnesis, and negative characteristics of marital and educational statuses were related to untimely death from chronic conditions in ICD-10 Class IX. Single people having a lower educational level and a compromised alcohol anamnesis statistically more frequently died of CDs outside a health care facility.
The results of the investigation suggest that there is inequality in the excess risk of death from leading CDs among the representatives of different social population groups in Arkhangelsk, as well as nonequivalence in their interaction with the public health system.
Objectives. The objective of this study was to identify individual and environmental correlates of fear of falling among community-dwelling seniors. Method. The study sample involved 288 community-dwelling adults aged 65 years or older going through the normal aging process. Fear of falling and a series of individual and environmental characteristics were measured with a questionnaire during home interviews. Results. Multivariate logistic regression procedures showed that the strongest correlates of fear of falling are gender, support from a spouse or partner, and residential area. Being a female as well as living in a smaller city or rural area were shown to be risk factors for fear of falling, whereas the availability of support from a spouse or partner was a protective factor. Discussion. Findings from this study suggest that researchers should adopt an ecological perspective to understanding the phenomenon of fear of falling among seniors and collect data on a broader range of individual and environmental factors.
The Saskatchewan Population Health and Evaluation Research Unit (SPHERU) is a new interdisciplinary research institute established by the Universities of Saskatchewan and Regina. SPHERU developed four of its research programs using a hierarchic model of health determining conditions and contexts. In descending order these programs include: Economic and Environmental Globalization, Governance and Health Community/Environment as a Health Determinant Multiple Roles, Gender and Health Determinants of Healthy Childhood Development A fifth program researching the determinants of health of indigenous peoples spans all four levels. Two research projects, one on power, control and health, and another on community capacity building approaches to human service programs, assist SPHERU in developing the theoretical linkages between its programs. This article describes SPHERU's research model and the Unit's approach to research and summarizes each of its current research programs and projects.
To describe gender differences in starting and response to treatment regimens and long-term clinical outcome in a well-characterized regional population from the Southern Alberta HIV Clinic (SAC) of 1403 patients, where all medical care for HIV, including physician fees, laboratory tests, and antiretroviral drug costs is provided free of charge.
Observational cohort study.
Cox proportional hazards models were used to examine the relative risk of starting treatment regimens and disease progression (new AIDS-defining illness or death).
There are 126 women in the SAC (9.0%). The median CD4 lymphocyte count at first visit among all patients was 350 cells/mm3, and was significantly higher among women than men (428 cells/mm3 versus 345 cells/mm3, respectively; p = 0.0024). Participating women were less well educated than participating men; 29% of women did not proceed beyond a tenth grade education compared with 13% of men; only 28% of women went to college or received a degree in contrast to 40% of men (p
To examine predictors of participation and to describe the methodological considerations of conducting a two-stage population-based oral health survey.
An observational, cross-sectional survey (telephone interview and clinical oral examination) of community-dwelling adults aged 45-64 and =65 living in Nova Scotia, Canada was conducted.
The survey response rate was 21% for the interview and 13.5% for the examination. A total of 1141 participants completed one or both components of the survey. Both age groups had higher levels of education than the target population; the age 45-64 sample also had a higher proportion of females and lower levels of employment than the target population. Completers (participants who completed interview and examination) were compared with partial completers (who completed only the interview), and stepwise logistic regression was performed to examine predictors of completion. Identified predictors were as follows: not working, post-secondary education and frequent dental visits.
Recruitment, communications and logistics present challenges in conducting a province-wide survey. Identification of employment, education and dental visit frequency as predictors of survey participation provide insight into possible non-response bias and suggest potential for underestimation of oral disease prevalence in this and similar surveys. This potential must be considered in analysis and in future recruitment strategies.
To determine the: (1) national prevalence of epilepsy and depression; (2) prevalence of depression among those with epilepsy; (3) odds ratio of depression among those with epilepsy compared to those without, controlling for demographic characteristics; (4) demographic correlates of depression among those with epilepsy and those without; and, (5) health services utilization of those with epilepsy and depression.
The full sample of the nationally representative 2000/2001 Canadian Community Health Survey (n = 130,880) was used to determine prevalence of epilepsy and depression. A subsample of 781 individuals reporting an epilepsy diagnosis and with complete depression data was used to determine prevalence and correlates of depression, and health service utilization patterns. Correlates of depression among those without epilepsy (n = 126,104) were also determined. Chi-square analyses, t-tests, prevalence ratios, and a logistic regression were conducted.
Thirteen percent of those with epilepsy were depressed, in comparison to 7% of those without (p