A qualitative review of population health assessment models used throughout the United States and Canada indicate both individual and community-level domains of health. Individual-level domains of health include health habits, education, public safety, environment, social, government, culture, and mobility. Community-level domains include the same general health domains but aggregated to the community level Aggregate Health Status (AHS). In the development of the AHS portion of our model, the dependent variable was the general health question from the Medical Outcomes Study. The remainder of the survey was partitioned into mutually exclusive individual measure subsets. A linear combination of these global variables then produces a single estimate relating the multiple domains of the broader determinants of health to health status. This global variable uniquely discriminates between the five categories of general health. This model serves as a framework and benchmark indicator that (1) provides a summary indicator of the overall health status of the population, (2) is broadly representative of populations rather than individuals, (3) is a population perspective rather than a provider perspective, and (4) emphasizes outcomes versus inputs and processes.
Analysis of prevalence, triggers, risk factors and the related socio-economic effects of childhood asthma in the Student Lung Health Survey (SLHS) database, Canada 1996.
Centre for Chronic Disease Prevention and Control, Population and Public Health Branch, Health Canada, 120 Colonnade Road, Ottawa, Ontario, Canada K1A 0K9. Frank_Mo@hc-sc.gc.ca
Source
Int J Adolesc Med Health. 2003 Oct-Dec;15(4):349-58
The purpose of this study was to provide information to improve the management of childhood asthma in Canada. The Student Lung Health Survey (SLHS) was conducted as a stratified and multi-staged cluster survey across Canada in 1996. It included a total of 136 public, private and separate schools in nine health units. The target study population was schoolchildren aged 5 to 19 years. Among all 5-19 years old students, the prevalence of asthma was 13.0%, with the prevalence for males being higher than for females, the adjusted Odds Ratio (OR) was 1.17, (95% CI 1.14-1.19) for males, in comparison with females. The prevalence in the 15-19 age group was higher than that in the 5-9 and 10-14 age group in females, but it was higher in the 5-9 and 10-14 age group than in the 15-19 age group in males. The mean delay from the onset of symptoms to time of first diagnosis was 1, 0.4 and 0.3 years for the 1-4, 5-9 and 10-14 age group respectively. However, there was no delay in the 15-19 group. The prevalence of asthma in Prince Edward Island (17.9%), Halifax (17.1%), and Kingston (16.1%) was higher than that in Saskatoon (10.0%). Sherbrooke (9.7%) and Kelowna (11.9%). The proportion of asthma for students who smoked more than 11 cigarettes per day (OR = 1.41), were exposed to passive smoke in home (OR = 7.29), in car (OR = 4.71), and in school (OR = 4.24) or had a family income less than CAN$40,000 (OR = 1.19), was significantly higher than groups without those factors. Risk factors and socio-economic status such as living conditions and environment, pets or plants in the home, parental education levels also affected the morbidity of asthma. The results of the SLHS study demonstrated the serious burden of childhood asthma, and asthma triggers, living and environmental conditions and lifestyle influence the prevalence and the effects of childhood asthma diagnosis, treatment, and education in Canada. Asthma is still a serious chronic condition for students and it influences their academic performance and their quality of life. The diagnostic methods and the practice guidelines for asthma control are useful for preventing and controlling asthma. These findings provide indications of interventions are being used for the control of asthma in Canada.
An open source web application for the surveillance and prevention of the impacts on public health of extreme meteorological events: the SUPREME system.
Every year, many deaths or health problems are directly linked to heat waves. Consequently, numerous jurisdictions around the world have developed intervention plans that are employed during extreme heat events; beyond their emergency sections, these plans generally include preventive measures to be implemented each year. Over the last five years, local and regional information systems have been implemented in a few Canadian cities for surveillance purposes. However, until recently, no such systems existed at the provincial level. In the context of the Government of Quebec's 2006-2012 Action Plan on Climate Change, a real-time integrated system for the surveillance and monitoring of extreme heat events has been implemented on a provincial level. The system is a component of a broader approach that would also monitor the public health impacts of all types of extreme meteorological events.
After conducting a detailed needs analysis, the Quebec National Institute for Public Health developed and implemented an integrated web application leveraging open source software for the real-time Surveillance and Prevention of the impacts of Extreme Meteorological Events on public health, called the SUPREME system. Its first field use involved heat waves. This decision-support system is based on open source software and is composed of four modules: (1) data acquisition and integration, (2) risk analysis and alerts, (3), cartographic application, and (4) information dissemination - climate change and health portal. The system is available to health specialists through a secure web information portal and provides access to weather forecasts, historic and real-time indicators (including deaths and hospital admissions), alerts and various cartographic data used for conducting prevention activities and launching emergency measures.
The SUPREME system was implemented and used during the summer of 2010. It served as an important decision-making tool during the July 2010 heat wave in the province of Quebec, Canada. Planned improvements for 2011 include the integration of data related to other risk factors for other extreme events to the system. The next steps will be to provide access to the application to other groups of specialists that are involved in the prevention, monitoring, or analysis of extreme meteorological events and their effects on community health and well-being.
Application of Bayesian techniques to model the burden of human salmonellosis attributable to U.S. food commodities at the point of processing: adaptation of a Danish model.
Mathematical models that estimate the proportion of foodborne illnesses attributable to food commodities at specific points in the food chain may be useful to risk managers and policy makers to formulate public health goals, prioritize interventions, and document the effectiveness of mitigations aimed at reducing illness. Using human surveillance data on laboratory-confirmed Salmonella infections from the Centers for Disease Control and Prevention and Salmonella testing data from U.S. Department of Agriculture Food Safety and Inspection Service's regulatory programs, we developed a point-of-processing foodborne illness attribution model by adapting the Hald Salmonella Bayesian source attribution model. Key model outputs include estimates of the relative proportions of domestically acquired sporadic human Salmonella infections resulting from contamination of raw meat, poultry, and egg products processed in the United States from 1998 through 2003. The current model estimates the relative contribution of chicken (48%), ground beef (28%), turkey (17%), egg products (6%), intact beef (1%), and pork (
BACKGROUND: Numerous child health status measures have been developed, ranging from assessments of physical and mental health to activity continuums. Our objective was to report the regional distribution of physical morbidity among children in Manitoba. METHODS: Using Manitoba's population-based prescription and health care data for 1998/99, the prevalence of children with lower respiratory tract infections, four chronic conditions (asthma, cardiovascular disease, Type 1 diabetes mellitus and seizure disorders) and physical disabilities, including spina bifida and cerebral palsy, was determined for 12 Regional Health Authorities and 12 Winnipeg Community Areas, ranked by a measure of population healthiness, the premature mortality rate (PMR). Prescription rates were also reported by neighbourhood income quintile, derived from census data. RESULTS: Hospitalization for lower respiratory tract infection was highest in infants (6%) and increased with successive decreases in neighbourhood income or in the population healthiness of a region. On the basis of a physician diagnosis or prescription drug for asthma, 10% of school-age children had asthma. Asthma treatment rates in northern Manitoba were substantially lower than in Winnipeg. Treatment rates for cardiovascular conditions, Type I diabetes and seizure disorders approached 1% in adolescents and there were no regional differences in the distribution of these conditions. The prevalence of physical disability was highest in northern Manitoba. CONCLUSION: A minority of Manitoba children suffer from chronic and serious acute health problems in childhood, but the burden of illness is not evenly distributed among children.
To assess the ability of an Adjusted Clinical Group (ACG)-based morbidity measure to assess the overall health service needs of populations. Data Sources/Study Setting. Three population-based secondary data sources: registration and health service utilization data from fiscal year 1995-1996; mortality data from vital statistics reports from 1996-1999; and Canadian census data. The study included all continuously enrolled residents in the universal health care plan in Manitoba.
Using 60 small geographic areas as the units of analysis, we compared a population-based "ACG morbidity index," derived from individual ACG assignments in fiscal year 1995-1996, with the standardized mortality ratio (ages
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We assessed the linkage and correct linkage rate using deterministic record linkage among three commonly used Canadian databases, namely, the population registry, hospital discharge data and Vital Statistics registry.
Three combinations of four personal identifiers (surname, first name, sex and date of birth) were used to determine the optimal combination. The correct linkage rate was assessed using a unique personal health number available in all three databases.
Among the three combinations, the combination of surname, sex, and date of birth had the highest linkage rate of 88.0% and 93.1%, and the second highest correct linkage rate of 96.9% and 98.9% between the population registry and Vital Statistics registry, and between the hospital discharge data and Vital Statistics registry in 2001, respectively. Adding the first name to the combination of the three identifiers above increased correct linkage by less than 1%, but at the cost of lowering the linkage rate almost by 10%.
Our findings suggest that the combination of surname, sex and date of birth appears to be optimal using deterministic linkage. The linkage and correct linkage rates appear to vary by age and the type of database, but not by sex.
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The recent Canadian experience with pandemic H1N1 (pH1N1) influenza in 2009 highlighted the need for enhanced surveillance at local and regional levels to support evidence-based decision making by physicians and public health. We describe the rationale, methodology, and provide preliminary findings from the implementation of an automated Mortality Surveillance System (MSS) in the Kingston, Frontenac and Lennox & Addington (KFL&A) health unit.
The MSS utilized an automated web-based framework with secure data transfer. A data sharing agreement between the local Medical Officer of Health and the City of Kingston facilitated weekly updates of mortality data. Deaths due to influenza were classified using keywords in the cause of death and a phonetic algorithm to capture alternate spellings. Anomaly detection was modeled on the modified cumulative sum algorithm implemented in the Early Aberration Reporting System.
Retrospective analysis of municipal mortality data over a 10-year period established baseline mortality rates in the region. MSS data monitored during the pH1N1 influenza season showed no significant impact on the burden or timing of mortality in the KFL&A health unit.
Municipal data enabled surveillance of mortality in the KFL&A region with weekly updates. Other municipalities may participate in this surveillance project using the Kingston model without significant ongoing investment. Efforts to improve data quality at the physician and transcription level are ongoing. Integration of mortality data and other real-time data streams into an integrated electronic public health dashboard could provide decision-makers with timely information during public health emergencies.
Healthcare workers are exposed to a variety of work-related hazards including biological, chemical, physical, ergonomic, psychological hazards; and workplace violence. The Occupational Health and Safety Agency for Healthcare in British Columbia (OHSAH), in conjunction with British Columbia (BC) health regions, developed and implemented a comprehensive surveillance system that tracks occupational exposures and stressors as well as injuries and illnesses among a defined population of healthcare workers.
Workplace Health Indicator Tracking and Evaluation (WHITE) is a secure operational database, used for data entry and transaction reporting. It has five modules: Incident Investigation, Case Management, Employee Health, Health and Safety, and Early Intervention/Return to Work.
Since the WHITE database was first introduced into BC in 2004, it has tracked the health of 84,318 healthcare workers (120,244 jobs), representing 35,927 recorded incidents, resulting in 18,322 workers' compensation claims. Currently, four of BC's six healthcare regions are tracking and analyzing incidents and the health of healthcare workers using WHITE, providing OHSAH and healthcare stakeholders with comparative performance indicators on workplace health and safety. A number of scientific manuscripts have also been published in peer-reviewed journals.
The WHITE database has been very useful for descriptive epidemiological studies, monitoring health risk factors, benchmarking, and evaluating interventions.
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Comment In: Can J Public Health. 2009 Mar-Apr;100(2):157; author reply 157-819839296
Erratum In: Can J Public Health. 2009 Sep-Oct;100(5):397
