This paper examines access to and use of the physician resources for ambulatory care by residents of Winnipeg and rural areas in Manitoba. Analyses were conducted on physician claims submitted to Manitoba Health in the fiscal years 1986-87 and 1991-92. The percentage of people who made contact with physicians, the number of visits per 100 residents, and the number of visits per user were used to asses changes between 1986 and 1991. There were important variations between residents of Winnipeg and the rural regions in access to and use of physicians' services across the years, and by physician specially. These variations accompanied a decrease in physician supply in the province.
BACKGROUND: The importance of early life conditions and current conditions for mortality in later life was assessed using historical data from four rural parishes in southern Sweden. Both demographic and economic data are valid. METHODS: Longitudinal demographic and socioeconomic data for individuals and household socioeconomic data from parish registers were combined with local area data on food costs and disease load using a Cox regression framework to analyse the 55-80 year age group mortality (number of deaths = 1398). RESULTS: In a previous paper, the disease load experienced during the birth year, measured as the infant mortality rate, was strongly associated with old-age mortality, particularly the outcome of airborne infectious diseases. In the present paper, this impact persisted after controlling for variations in food prices during pregnancy and the birth year, and the disease load on mothers during pregnancy. The impact on mortality in later life stems from both the short-term cycles and the long-term decline in infant mortality. An asymmetrical effect and strong threshold effects were found for the cycles. Years with very high infant mortality, dominated by smallpox and whooping cough, had a strong impact, while modest changes had almost no impact at all. The effects of the disease load during the year of birth were particularly strong for children born during the winter and summer. Children severely exposed to airborne infectious diseases during their birth year had a much higher risk of dying of airborne infectious diseases in their old age. CONCLUSIONS: This study suggests that exposure to airborne infectious diseases during the first year of life increases mortality at ages 55-80.
Comment In: Int J Epidemiol. 2003 Apr;32(2):294-512714552
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.
The epidemiological aim was to draw a general picture of spatial patterns of diseases, socio-demographics, and land use in Finland to detect possible under-recognized associations between the patterns. The methodological purpose was to compare and combine two statistical techniques to approach the data from different viewpoints.
Two different statistical methods, the self-organizing map and principal coordinates of neighbor matrices with variation partitioning, were used to search for spatial patterns of 15 non-infectious diseases and 17 direct or indirect risk factors. The dataset was gathered from five Finnish registries and pooled over the years 1991-2010. The statistical unit in the analyses was a municipality (n=303).
Variables referring to urban living were related to low incidences of all other diseases but cancer, whereas variables referring to rural living were related to low incidences of cancer and high incidences of other diseases, especially coronary heart disease (CHD), hypertension, diabetes, asthma/chronic obstructive pulmonary disease, and serious mental illnesses at the municipal level. The relationships between diseases other than cancer and risk factors related to socio-demographics and land use variables were stronger than those between cancer and risk factors.
The structuration of spatial patterns was dominated by CHD together with land use features and unemployment rate. The relationship between unemployment and spatial health inequalities was emphasized. On the basis of the present study, it is suggested that large heterogeneous datasets are clustered and analyzed simultaneously with more than one statistical method to recognize the most significant and generalizable results.
Molar-Incisor Hypomineralization (MIH) is a common developmental enamel defect characterized by demarcated opacities in permanent molars and incisors. Its etiology still remains unclear. The aim of this retrospective cohort study was to assess if the socioeconomic environment of the child is associated with MIH.
The study was located in two rural towns and three urban cities in Finland. A total of 818 children, between 7-13 years old, were examined for MIH using the evaluation criteria in line with those of the European Academy of Paediatric Dentistry, but excluding opacities smaller than 2 mm in diameter. The mothers filled in a questionnaire which included questions related to the family's way of living (e.g. area of residency, farming, day care attendance) and socioeconomic status (family income, number of mother's school years, level of maternal education).
The prevalence of MIH in the study population was 17.1%. Family income, urban residency and day care attendance were associated with MIH in the univariate analysis. In the multivariate analysis using binary logistic regression, only urban residency during a child's first 2 years of life remained associated with MIH. The prevalence of MIH in urban areas was 21.3% and in rural areas 11.5% (OR = 2.18, CI = 1.35-3.53, p = 0.001).
The prevalence of MIH was related to urban residency and could not be explained by any other factor included in the study.
This qualitative research aims to understand, from the standpoint of the family physician, the barriers to treating depression in the office setting. Three primary barriers to treating depression in the family physician's office were identified: systemic, physician-related, and patient-related. The systemic barriers involved the shortage of qualified, publicly-funded counsellors, lack of locally available counselling, and the cost of medication. Physician-related barriers included lack of time and expertise, and inadequacies of the reimbursement system. Patient-related barriers were rooted in the stigma attached to depression and failure to comply with treatment.
Bromoxynil (3,5-dibromo-4-hydroxybenzonitrile), a phenolic herbicide, is widely used in production of cereals and other crops. Little is known, however, about bromoxynil exposure in humans. Results of previous research suggest a longer residence time in the body for bromoxynil compared to phenoxy herbicides [e.g., (2,4-dichlorophenoxy)acetic acid (2,4-D), 4-chloro-2-methylphenoxyacetic acid (MCPA)] and that bromoxynil would tend to partition into fatty tissue more so than 2,4-D. In previous research, body mass index (BMI) was found to be an independent predictor of plasma concentrations of 1,1-dichloro-2,2-bis(p-chlorophenyl)ethylene (DDE), the persistent lipophilic metabolite of the chlorinated pesticide bis(4-chlorophenyl)-1,1,1-trichloroethane (DDT). As part of the Prairie Ecosystem Study, gas chromatography/mass spectrometry analysis was used to measure concentrations of bromoxynil and seven other herbicides (2,4-D, dicamba, fenoxaprop, MCPA, ethalfluralin, triallate, and trifluralin) in plasma from residents (104 men, 88 women, 24 youths age 12-17 yr) of a cereal-producing region in Saskatchewan, Canada, during spring herbicide application, 1996. Multiple logistic regression analysis was used to explore whether BMI predicted detection of bromoxynil in plasma from the adults. The prevalence of detection (detection limits: 2-50 microg/L) was markedly higher for bromoxynil (men, 44.2%; women, 14.8%; youths, 20.8%) compared to each of the other herbicides including 2,4-D (men, 16.5%; women, 3.4%; youths, 12.5%) and MCPA (men, 6.8%; women, 1.1%; youths, 4.2%), although bromoxynil is commonly formulated or tank mixed with these herbicides. In the multiple logistic regression analysis, the variables BMI, exposure group [bromoxynil applicators, non-applicator family members of bromoxynil applicators, all others (reference group)], and days elapsed since the last use of bromoxynil were found to be independent predictors of detection of bromoxynil, while age, gender, and farm residency were not statistically significant. With adjustment for exposure group [bromoxynil applicators: odds ratio (OR = 24.30, 95% confidence interval (CI) = 9.59-61.58; nonapplicator family members of bromoxynil applicators: OR = 3.53, 95% CI = 1.19-10.44; all others (reference group)], the OR for detection of bromoxynil was 2.35 (95% CI = 0.87-6.33) for participants in the middle (25.53-29.00 kg/m2) tertile (men: OR = 2.85, 95% CI = 0.75-10.82; women: OR = 1.63, 95% CI = 0.36-7.40) of BMI and 4.01 (95% CI = 1.46-11.03) for participants in the highest (> 29.00 kg/m2) tertile (men: OR = 4.67, 95% CI = 1.17-18.58; women: OR = 2.20, 95% CI = 0.44-10.99) with participants in the lowest (
This study was undertaken with the objective of assessing current sources of information for anaesthesia Physician Resource Planning (PRP). Four major data bases, the annual reports of Health and Welfare Canada (H&W), the education statistics from the Canadian Post-M.D. Education Registry (CAPER), the Royal College of Physicians and Surgeons of Canada (RCPSC) and the Physician Resource Data System of the Canadian Medical Association (PRDS), were examined for the period 1982 to 1991. The ratio of the number of surgical (S) to anaesthesia (A) clinicians decreased over this period despite an increase in the S:A ratios for trainees and certificants. The number of female anaesthetists has progressively increased. A steady decline in the number of rural anaesthetists has occurred. Age distribution of active certified anaesthetists revealed marked inter-regional differences. Little change was noted in the total mean hours worked per week. Each database provided valuable, but limited, data. The PRDS data is useful in assessing trends (age, sex and practice activity). Information provided by H&W tends to underestimate anaesthesia resource information by at least 10%. While information obtained from RCPSC and CAPER is accurate, the current mode of presentation of data limits their usefulness. Integrating data from all the databases appears to provide a meaningful assessment for PRP rather than assessing each database in isolation. Interpretation of the information and its value must take into account the limitations of the data being provided. Assessing present and planning future needs based on the current information structure will prove extremely difficult.