[Access to the early diagnosis of dementia in New Brunswick: perceptions of potential users of services depending on the language and the middle of life].
The early diagnosis of dementia (EDD) enables the identification of reversible causes of dementia and allows the timely implementation of secondary preventive and therapeutic interventions. This study explores New Brunswick seniors' perceptions of the accessibility and availability of EDD services as well as their satisfaction with them while taking into account their language of use and place of residence (urban or rural).
Self-administered survey exploring perceptions of EDD services in Francophone and Anglophone seniors from rural and urban areas of New Brunswick. Univariate and bivariate analyses were carried out.
Of the 157 participants aged 65 years and over who filled out the survey and whose data were analyzed, 84 identified as Francophone, 72 of whom lived in rural areas. Bivariate analyses showed that linguistic groups were comparable with regard to their perceptions of the availability, access to, and satisfaction with EDD services. However, when taking the geographic dimension into account, linguistic intergroup and intragroup disparities were observed, notably in the areas pertaining to the type of services available in the area.
These results suggest that seniors who live in rural areas of New Brunswick are a particularly vulnerable group with perceived limited access to EDD services in their area.
Walking or cycling to school represents an opportunity for children to engage in physical activity. The study objectives were to: 1) describe active transportation policies, programs, and built environments of Canadian schools and their surrounding neighbourhoods, and 2) document variations based on urban-rural location and school type (primary vs. secondary vs. mixed primary/secondary schools).
397 schools from across Canada were studied. A school administrator completed a questionnaire and responses were used to assess schools' policies and programs related to active transportation and the safety and aesthetics of their respective neighbourhoods. Built environment features in a 1 km-radius circular buffer around each school were measured using geographic information systems.
Greater than 70% of schools had passive policies (e.g., skateboards permitted on school grounds) and facilities (e.g., bicycle racks in secure area to avoid theft) to encourage bicycle and small-wheeled vehicle use. Less than 40% of schools had active programs designed to encourage active transportation, such as organized 'walk to school' days. Garbage in the streets, crime and substance abuse were barriers in most school neighbourhoods. Approximately 42% of schools were located on high-speed roads not amenable to active transportation and 14% did not have a sidewalk leading to the school. Secondary schools had less favourable active transportation policies/programs and neighbourhood safety/aesthetics compared to primary schools. Rural schools had less favourable built environments than urban schools.
Canadian children, particularly those from rural areas, face a number of impediments to active transportation as a method of travelling to school.
Nursing home residents are prone to acute illness due to their high age, underlying illnesses and immobility. We examined the incidence of acute hospital admissions among nursing home residents versus the age-matched community dwelling population in a geographically defined area during a two years period. The hospital stays of the nursing home population are described according to diagnosis, length of stay and mortality. Similar studies have previously not been reported in Scandinavia.
The acute hospitalisations of the nursing home residents were identified through ambulance records. These were linked to hospital patient records for inclusion of demographics, diagnosis at discharge, length of stay and mortality. Incidence of hospitalisation was calculated based on patient-time at risk.
The annual hospital admission incidence was 0.62 admissions per person-year among the nursing home residents and 0.26 among the community dwellers. In the nursing home population we found that dominant diagnoses were respiratory diseases, falls-related and circulatory diseases, accounting for 55% of the cases. The median length of stay was 3 days (interquartile range = 4). The in-hospital mortality rate was 16% and 30 day mortality after discharge 30%.
Acute hospital admission rate among nursing home residents was high in this Scandinavian setting. The pattern of diagnoses causing the admissions appears to be consistent with previous research. The in-hospital and 30 day mortality rates are high.
Using the POPULIS framework, this project estimated health care expenditures across the entire population of Manitoba for inpatient and outpatient hospital utilization, physician visits, mental health inpatient, and nursing home utilization.
This estimated expenditure information was then used to compare per capita expenditures relative to premature mortality rates across the various areas of Manitoba.
Considerable variation in health care expenditures was found, with those areas having high premature mortality rates also having higher health care expenditures.
Despite very little confirming evidence, one of the most pervasive beliefs about dying is that terminally ill people receive a great deal of health care in the last few days, weeks, or months of life. A secondary analysis of 1992/93 through 1996/97 Alberta inpatient hospital abstracts data was undertaken to explore and describe hospital use over the five years before death by all Albertans who died in acute care hospital beds during the 1996/97 year (n = 7,429). There were four key findings: (1) hospital use varied, but was most often low, (2) the last hospital stay was infrequently resource intensive, (3) age, gender, and illness did not distinguish use, and (4) most ultra-high users were rural residents, with the majority of care episodes taking place in small, rural hospitals.
Though high discontinuation rates for antipsychotics (APs) by patients with schizophrenia are frequently reported, the percentage of patients receiving pharmaceutical treatment for schizophrenia in routine practice in accordance with international clinical guidelines is unknown. Further, it is unknown if these rates are influenced by levels of neighbourhood deprivation or by a patient's age or sex. Our study aims to investigate if inequalities in AP treatment could be observed between patients living in neighbourhoods with the highest levels of material and social deprivation and those with the lowest deprivation levels, between patients from different age groups, or between men and women.
We conducted a secondary analysis of medical-administrative data of a cohort of adult patients in the province of Quebec with a medical contact for schizophrenia in a 2-year period (2004-2005). We assessed the proportion of patients that filled at least 1 prescription for an AP and received adequate pharmaceutical treatment, defined as being in possession of APs at least 80% of the time as outpatients during a 2-year follow-up period.
Among the 30 544 study patients, 88.5% filled at least 1 prescription for an AP, and 67.5% of the treated patients received adequate treatment. Though no clinically significant differences were observed by deprivation or sex, younger age was associated with lower proportions of patients receiving adequate treatment (46% of treated patients aged between 18 and 29 years, compared with 72% aged between 30 and 64 years, and 77% aged 65 years and over).
In Quebec's routine practice, over 70% of treated patients aged 30 and over received adequate pharmacological treatment, regardless of sex or neighbourhood socioeconomic status. In contrast, in patients aged between 18 and 29 years this percentage was 47%. This is a discouraging finding, especially because optimal treatment in the early phase of disease is reported to result in the best long-term outcomes.
To estimate the level of alcohol consumption and problems among adolescents in city districts in Oslo, Norway with different socio-economic composition; to test whether differences in alcohol consumption are related to district differences in socio-demographic characteristics; and to analyse whether such associations remain significant after controlling for individual-level variables.
Cross-sectional survey using multi-level linear regression analyses with individual responses at the lowest level and city-district data at the highest level.
Oslo, Norway.
A total of 6635 secondary school students, in 62 schools, living in 15 different city districts.
Frequency of alcohol consumption and alcohol intoxication; alcohol problems; and individual characteristics such as immigrant status, religious involvement and parental norms with regard to alcohol. Socio-economic indicators in city districts, such as education, income and unemployment, were combined into a district-level socio-economic index (DLSI).
DLSI scores were related positively to alcohol use (r?=?0.31, P?
The suicide rate in Alberta is consistently above the Canadian average. Health care use profiles of those who die by suicide in Alberta are currently unknown.
Death records were selected for people aged 25 to 64 with suicide coded as the underlying cause of death from April 1, 2003 to March 31, 2006. The death records were linked to administrative records pertaining to physician visits, emergency department visits, inpatient hospital separations, and community mental health visits. The control group was the Alberta population aged 25 to 64 who did not die by suicide. Frequency estimates were produced to determine the characteristics of the study population. Odds ratios relating to demographics, exposure to health care services, and case-control status were estimated with logistic regression.
Almost 90% of suicides had a health service in the year before their death. Suicides averaged 16.6 visits per person, compared with 7.7 visits for non-suicides. Much of the health service use among people who died by suicide appears to have been driven by mental disorders.
Information about health service delivery to those who die by suicide can guide prevention and intervention efforts.
Department of Psychology and Research Unit on Children's Psychosocial Maladjustment (GRIP), Université de Montréal, Montréal, QC, Canada. veronique.dupere@umontreal.ca
Because youth gangs tend to cluster in disadvantaged neighborhoods, adolescents living in such neighborhoods are more likely to encounter opportunities to join youth gangs. However, in the face of these opportunities, not all adolescents respond in the same manner. Those with preexisting psychopathic tendencies might be especially likely to join. In this study, we tested whether a combination of individual propensity and facilitating neighborhood conditions amplifies the probabilities of youth gang affiliation. A subset of 3,522 adolescents was selected from a nationally representative, prospective sample of Canadian youth. Psychopathic tendencies (i.e., a combination of high hyperactivity, low anxiety, and low prosociality as compared to national norms) were assessed through parent reports, while neighborhood characteristics (i.e., concentrated economic disadvantage and residential instability) were derived from the 2001 Census of Canada. Our results indicated that neighborhood residential instability, but not neighborhood concentrated economic disadvantage, interacted with individual propensity to predict youth gang membership. Adolescents with preexisting psychopathic tendencies appeared especially vulnerable mainly if they were raised in residentially unstable neighborhoods.
Alcohol misuse in seniors has been studied in clinical samples and in small communities, but relatively few studies are population-based. Objectives are: (1) to describe the characteristics of seniors who score 1 or more on the CAGE (Cut down; Annoyed; Guilty; Eye-opener) questionnaire of alcohol problems; (2) to determine if depressive symptoms are associated with alcohol misuse after accounting for other factors.
Cross-sectional study of community-dwelling older people (65+ years) sampled from a representative population registry in Manitoba, Canada. Participants were initially interviewed in 1991-1992 and reinterviewed in 1996-1997. Data from Time 2 were used; 1,028 persons were included in the analyses. Sociodemographic characteristics, the CAGE questionnaire, Activities of Daily Living (ADLs) and instrumental ADLs (IADLs), the Center for Epidemiologic Studies-Depression (CES-D) scale and the Mini-Mental State Examination (MMSE) were assessed by trained interviewers.
Males were more likely to score positive on the CAGE questionnaire. After adjusting for gender, age, and education, there was a strong association between depressive symptoms and alcohol misuse. Poor self-rated health and impairments in IADLs were also associated with alcohol misuse.
Male gender, depressive symptoms, and poor functional status were associated with alcohol misuse in this population-based study. Attention to depressive symptoms and functional status may be important in the care of seniors with alcohol misuse. Alternatively, physicians should enquire about alcohol use in seniors with functional impairment or depressive symptoms.
