Healthy Canadian Research Articles

Vallentyne legacy

Jack Vallentyne may be remembered best, especially by citizens and school children in the Burlington area, for carrying the whole weight of the global world on his back. He was a passionate defender of environmental values. But for me, the most vivid memory of Jack is in connection with the great detergent phosphate debates and hearings of the early 1970s.Jack Vallentyne assisted in drafting the phosphorus controls section of the ‘International Joint Commission (IJC) Study Boards’ reports in 1969 on pollution of Lakes Erie and Ontario (IJC, 1969). These rather quickly set the stage for action in Canada and became the phosphorus control Annex of the Canada-U.S. Great Lakes Water Quality Agreement of 1972.A draft of the phosphorus control recommendations was written one evening in 1969 on our dining room table, by Dr. Vallentyne and me. It was the first of the 4-part recommendation, subsequently agreed to by the IJC Boards, which was to provoke a major controversy. It recommended in the Board's version that: “phosphates in detergents be immediately reduced to minimum practical levels, with total replacement by environmentally less harmful compounds by 1972.”Subsequently Canada acted to obtain legal authority to control detergent phosphate levels through a specific section incorporated in the Canada Water Act of 1970, then going through Parliament. Upon receipt of the Boards’ reports on pollution of the lower Great Lakes, the IJC held a series of public hearings. At these, representatives of detergent manufacturers testified vigorously that: Other nutrients were more important than phosphorus (e.g. nitrogen, carbon and micro-nutrients such as iron),Without phosphates, detergents would be useless and epidemics would break out in hospitals,There was no safe substitute for the water softening and chelating properties of the phosphates (actually sodium triphosphate—STP),Most of the phosphorus entering the lakes came from human and animal wastes.This controversy has had disturbing echoes over the years in its similarity to other industry-inspired arguments over the sciences of acid rain and of global warming.Jack Vallentyne led the scientific defence of the detergent phosphate control recommendation in the series of IJC Public hearings in 1971 on both sides of the border. He was armed with photos of a telling laboratory demonstration which proved that adding phosphorus, but not other nutrients, to water from the Lakes promoted algal blooms. This was subsequently demonstrated on a lake-wide scale by David Schindler's studies in the Experimental Lakes Area of Northwestern Ontario. Jack was also able to point out that about one half of the phosphorus entering sewage treatment plants was from detergents, and removal of this burden would substantially reduce the ongoing costs of chemical precipitation of phosphorus and removal of sludge from these plants. Other more complex limnological allegations were similarly refuted by Jack. In sum, he demonstrated to the Commissioners’ satisfaction that phosphorus was by far the most controllable of nutrients which affect algal growth and eutrophication.By this time, work commissioned from Canada Centre for Inland Waters had demonstrated a large range of STP concentrations in commercially available detergents in Canada. One, which had found widespread acceptance by the public, had just 20% phosphate (P2 O5) or 8.7% as phosphorus, although others being widely sold had double or more this concentration.Later in 1970, the Canadian government (Minister Joe Green) adopted this already publicly accepted 20% level as the first step in regulation. Several letters from abroad asked for the limnological scientific basis for this original regulation level–but we had to confess that it was set for quite practical reasons. This regulated level was further reduced by Canada at the end of 1972 to 5% P2 O5 or 2.2% as P by Mr. Jack Davis, then Environment Minister, after the IJC Commissioners had accepted the recommendations of the Study Boards. New York and some other States enacted similar regulations, but the U.S. federal government, under much industry pressure, did not, but rather chose other more expensive methods to reduce phosphorus discharge to the lakes. The Great Lakes Water Quality Agreement based on the IJC Report, was signed by President Richard Nixon and Prime Minister Pierre Trudeau in Ottawa, 1972.Of course, the national regulation of detergent phosphates, effectively defended by Jack, has had far reaching positive effects in slowing eutrophication of Canadian lakes throughout the country. The issues involved are discussed in more detail in Dr. Vallentyne's excellent publication The Algal Bowl (1974). This volume was brought up to date in 2008, through the collaboration of Dr. Schindler (Vallentyne and Schindler, 2008). These volumes are a valuable legacy of Jack Vallentyne's work, but the more lasting and important legacy is the large number of still healthy Canadian lakes, spared the impact of detergent phosphates.

Healthy midlife Canadian women: how bone health is considered in their food choice systems

The incidence of osteoporosis is predicted to increase as Western populations age. Diet is considered to be an important modifiable factor in bone health, yet the diets of many women are insufficient in calcium and vitamin D, which comprise two key nutrients for bone health. This focus group study explored ways in which midlife women consider bone health in their personal food choice systems. Data were obtained in six audio-recorded focus groups from a total of 36 women from upper, middle and lower income neighbourhoods. Open and axial coding and thematic analysis revealed shared and unique themes across and within the income groups. Use of member checks, peer debriefing, and independent and team data analysis enhanced rigour in the findings. All participants were aware of osteoporosis. Most women idealised making simple food decisions and eating for 'holistic' health, but not specifically for bone health. Most midlife women were not motivated to change their diets, few had deliberately increased their intake of calcium and vitamin D through foods and supplements, and few others had simplified their food decisions. Midlife women in the present study did not make eating for bone health a priority in their food choice systems. Instead, women wanted to eat for 'holistic' health, and only by implication bone health.

Fungal arthritis of the knee caused by Mycoleptodiscus indicus

Mycoleptodiscus indicus is a recognized plant pathogen which has very rarely been reported as a cause of human infection. It is a tropical or subtropical fungus which is difficult to culture and identify from clinical specimens. This is the first report of septic arthritis with this fungus in a healthy Canadian male. The fungal infection was contracted on a vacation in Costa Rica, probably through direct inoculation through injured skin. The fungus was isolated from synovial fluid and identification was confirmed by DNA sequencing. There has only been one previous case of septic arthritis of the knee and one skin infection reported with this fungus; both cases involved immunocompromised hosts. Both septic arthritis patients required joint surgery and lavage to eradicate the fungus, however, only the immunocompromised patient required antifungal medications. In the future, it is very likely that the number of patients identified with M. indicus infection will rise due to increasing awareness of this pathogen as well as increasing exposure. Many immunocompromised patients on anti-retroviral or biologic therapy are healthy enough to travel, thereby exposing themselves to exotic and infected plants which increase the risk of unusual fungal infections.

Vitamin D Status in Healthy Free-Living Elderly Men and Women Living in Québec, Canada

Objective: To assess vitamin D status in relation to age, sex, season, adiposity, physical activity level, and supplement use in healthy elderly Canadians living in Québec.Design: Cross-sectional survey.Setting: Data for 405 healthy free-living elderly Quebécers aged between 68 and 82 years with no major health problems were examined.Subjects: Men and women in age groups of 68–72, 73–77, and 78–82 years, in 2 seasons, participating in the NuAge cohort. Measurements: serum 25(OH)D assessed by radioimmunoassay (RIA), weight, height, smoking status, disease status, education, perception of income, Physical Activity Scale for the Elderly (PASE) questionnaire, and vitamin D supplement consumption.Results: The prevalence of vitamin D deficiency (25(OH)D <37.5 nmol/L) was 12.6% and 5.7% for men in winter and summer, and 8.7% and 1.9% for women, respectively. Over 50% of the participants had 25(OH)D concentrations <75 nmol/L. Correlates of vitamin D status by multiple regression analysis indicated that the vitamin D level in summer was 13.8 nmol/L higher for participants measured in winter and 17.2 nmol/L higher for those using supplements. Age, sex, body mass index, and physical activity were not associated with 25(OH)D concentration.Conclusion: Prevalence of vitamin D deficiency is low in healthy elderly men and women, especially in summer, but over 50% of the participants had suboptimal vitamin D concentrations. Vitamin D supplement consumption increased 25(OH)D concentrations substantially, particularly in the winter months, and should be encouraged.

Linoleic acid is associated with lower long-chain n–6 and n–3 fatty acids in red blood cell lipids of Canadian pregnant women

Arachidonic (ARA), eicosapentaenoic (EPA), and docosahexaenoic (DHA) acids are important in membrane glycerophospholipids. Higher maternal blood ARA, EPA, and DHA concentrations in gestation are associated with higher maternal-to-fetal transfer of ARA, EPA, and DHA, respectively, which emphasizes the importance of maternal fatty acid status in gestation. As in the brain, red blood cell (RBC) ethanolamine phosphoglycerides (EPGs) are high in plasmalogen, ARA, and DHA. We determined the relation between dietary n-6 (omega-6) and n-3 (omega-3) fatty acid intakes and n-6 and n-3 fatty acids in RBC EPGs and phosphatidylcholine in near-term pregnant women. The subjects were 105 healthy Canadian pregnant (36 wk gestation) women. Fatty acid intakes were estimated by food-frequency questionnaire, and fasting venous blood samples were collected. DHA and EPA intakes were positively associated with RBC EPG and phosphatidylcholine concentrations of DHA (rho = 0.309 and 0.369, respectively; P < 0.001) and EPA (rho = 0.391 and 0.228, respectively; P < 0.001) and inversely associated with RBC EPG 22:4n-6 and 22:5n-6 (P < 0.001). In RBCs, concentrations of linoleic acid (LA, 18:2n-6) were inversely associated with DHA, EPA, and ARA, respectively, in EPGs (r = -0.432, P < 0.01; r = -0.201, P < 0.04; and r = -0.303, P < 0.01) and phosphatidylcholine (r = -0.460, -0.490, and -0.604; P < 0.01 for all). Membrane fatty acids are influenced by the amount and balance of fatty acid substrates. Our results suggest the competitive interaction of LA with ARA, EPA, and DHA, with no evidence that higher LA increases ARA. Biochemical indicators to suggest that DHA is limiting are present in our population. This trial was registered at clinicaltrials.gov as NCT00620672.

Re: "Vitamin C Deficiency in a Population of Young Canadian Adults"

In their report that nearly 50% of healthy young Canadian adults have subnormal serum vitamin C concentrations, Cahill et al. (1) cite our observation that 60% of the acute-care patients in a tertiary care Montreal hospital had subnormal plasma vitamin C concentrations (2). More pertinently, we also observed that only 13% of people concurrently attending the hospital's outpatient test center had a subnormal plasma vitamin C concentration (2). The method used by Cahill et al. (1) for handling, storing, and analyzing serum vitamin C is questionable. To prevent vitamin C degradation, whole blood samples must be kept cold at all times, and as soon as the plasma is obtained it must immediately be stabilized by ice-cold deproteinization or flash frozen with ethanol-dry ice with prompt storage at −70°C to −80°C (3, 4). If not stored at −70°C to −80°C, vitamin C will disappear even from deproteinized plasma samples. The serum samples in the reported study were neither deproteinized nor flash frozen prior to storage, and they were stored at only −20°C. The high performance liquid chromatography detection method is not identified or described, precluding an assessment of its reliability.

Dietary Arachidonic Acid to EPA and DHA Balance Is Increased among Canadian Pregnant Women with Low Fish Intake1–3

Arachidonic [ARA, 20:4(n-6)], eicosapentaenoic [EPA, 20:5(n-3)], and docosahexaenoic acids [DHA, 22:6(n-3)] occur in the diet in animal tissue lipids, play important roles in human development and health, but have interactive and opposing functions. Meat and poultry have higher ARA and fish are richer in EPA and DHA. National databases were recently revised to include complete data on ARA in foods. We used a validated FFQ and the revised nutrient databases to quantify the distribution of ARA, EPA, and DHA intakes and balance for 204 healthy Canadian pregnant women. We focused on intake distributions because risk of adverse health effects increases at lower nutrient intakes. RBC fatty acids were analyzed concurrenly with dietary assessment. The distribution of ARA, EPA, and DHA intakes were skewed (P < 0.001), with a median (5–95th percentile) of 107 (41–225), 65 (10–228), and 105 (10–430) mg/d ARA, EPA, and DHA, respectively. Fish provided 66 and 76% of EPA and DHA, respectively, whereas eggs, poultry, and meats provided 81% of ARA. Women consuming <101 g fish/wk consumed less EPA and DHA and had markedly elevated median dietary ARA:EPA and ARA:DHA ratios and RBC lipid ARA:EPA + DHA ratios compared with women consuming ≥101 g fish/wk (P < 0.001). Relatively small increases in fish intake of 1–2 servings (25–50 g)/wk corrected the distorted dietary (n-6):(n-3) fatty acid balance among women consuming meats, but not fish. Median fish and DHA intakes below the recommended 1–2 servings/wk fish for pregnant women suggest major changes in the availability, cost, or acceptance of fish are needed.

The development and evaluation of a food frequency questionnaire used in assessing vitamin D intake in a sample of healthy young Canadian adults of diverse ancestry

Little data exist on vitamin D deficiency related with intake, especially for the Canadian population. The purpose of this study was to develop and evaluate a food frequency questionnaire (FFQ) with 37 items for rapid assessment of vitamin D intake in healthy young adults of diverse ancestry. We recruited 107 subjects in Southern Ontario during the late winter of 2007 who completed an FFQ twice (FFQ-1 and FFQ-2, repeated for reproducibility assessment) and a 7-day food diary (for validation). Serum 25-hydroxyvitamin D (25(OH)D), the major biomarker of vitamin D nutritional status, and skin melanin were determined. The FFQ results were highly correlated with 7-day diary results and with serum 25(OH)D concentrations (r = 0.529, P < .001; r = 0.481, P < .001, respectively). Modifications to the FFQ, by redefining the large serving size and excluding the fortified orange juice category, improved the validity of the FFQ (r = 0.602, P < .001; r = 0.520, P < .001, respectively). The FFQ results were highly correlated (r = 0.663, P < .001), but the mean intakes were different (P < .05). Using results from a modified version of FFQ-1, we examined dietary intakes in 3 predominant groups: East Asian (n = 27), European (n = 31), and South Asian (n = 32). The European group had higher total vitamin D intake (P < .05) and the highest serum 25(OH)D concentrations (P < .05), with a trend for dairy products being responsible for this (P < .10). Because Canadians are reliant on dietary intakes of vitamin D in the wintertime, especially those with higher skin melanin, our FFQ can monitor and provide information on intake and food group consumption.

Entwicklung des Zahnalters bei Juveniler Idiopathischer Arthritis

Bei Patienten mit Juveniler Idiopathischer Arthritis (JIA) wurde in früheren Studien eine beschleunigte Zahnentwicklung beschrieben. Das Zahnalter bei JIA kann sowohl durch die Grundkrankheit selbst als auch durch Medikamente wie z. B. Glukokortikoide beeinflusst werden. In den letzten zehn Jahren haben sich die Behandlungsansätze aller Subgruppen der JIA deutlich verändert mit einem verminderten Einsatz von Glukokortikoiden zugunsten von Methotrexat und biologischen Therapien (z. B. TNF-Blocker). In der vorliegenden Studie wurde deshalb untersucht, ob es bei nach aktuellen Therapiestandards behandelten JIA-Patienten zu Abweichungen des Zahnalters kommt. Dazu wurden 64 Orthopantomogramme von betroffenen Kindern und Jugendlichen im Alter von 7,8 bis 17,6 Jahren aus der rheumatologischen Kiefergelenksprechstunde untersucht. Zum Vergleich wurden die Normwerte von Zahnalterstudien aus Deutschland, Kanada und den Niederlanden herangezogen. Die Zahnentwicklung der hier untersuchten Patientengruppe entsprach den Normwerten, die Mittelwerte der JIA-Patienten lagen zwischen den Zahnreifungskurven der oben genannten Untersuchungen. Im Gegensatz zu früheren Studien konnte in der vorliegenden Untersuchung keine Beschleunigung der Zahnentwicklung bei Patienten mit JIA festgestellt werden.

The effect of age and gender on arterial stiffness in healthy Caucasian Canadians

We aimed to investigate age and gender differences in arterial stiffness, and whether this cardiovascular risk factor was detectable in healthy Caucasians before established disease was manifest. A growing number of risk factors including diabetes, obesity, hypertension, hyperlipidaemia, smoking and age have been linked to the adverse cardiovascular end-points of myocardial infarction, stroke and heart failure. These risk factors lead to an increase in arterial stiffness. Measuring this stiffness at an early age may identify candidates for primary preventative intervention strategies by nurses. Caucasian Canadians (n = 176) were recruited. Peripheral and central blood pressure, pulse pressure, augmentation pressure, arterial compliance (augmentation index and pulse wave velocity) and sub-endocardial viability ratio (SEVR), were assessed using applanation tonometry (SphygmoCor system). Blood was drawn for fasting lipid and glucose profiling. Women participants had significantly stiffer arteries than men (augmentation index: 28 SEM = 1% vs. 18 SEM = 2% respectively; p < 0.001). Pulse wave velocity, however, was not different (7.7 SEM = 0.2 m/s vs. 8.3 SEM = 0.1 m/s respectively; p < 0.001). Age was a strong predictor of arterial stiffening in both genders, but the effect was greater in women. Women having stiffer arteries than men, thus at greater cardiovascular risk, may require earlier screening. The effect might be postmenopausal, and mechanisms require further investigation. However, both middle-aged men and women considering themselves 'healthy' may benefit from more proactive primary prevention. Applanation tonometry, used extensively by nurses, provides early detection of central haemodynamic changes and vascular compliance at all ages. Knowledge of arterial stiffness could guide the management of primary prevention in the nursing cardiovascular risk reduction clinic.

Interactions between hepatic lipase and apolipoprotein E gene polymorphisms affect serum lipid profiles of healthy Canadian adults

The purpose of this study was to assess the individual and interactive effects between hepatic lipase (LIPC; C-514T, G-250A) and apolipoprotein E (APOE) (E2, E3, E4) gene polymorphisms on levels of plasma lipoprotein cholesterol and triglyceride among healthy, young, Canadian adults (n = 440). All subjects with at least one APOE2 allele had significantly lower low-density lipoprotein cholesterol, total cholesterol, and total cholesterol - high-density lipoprotein cholesterol ratio when compared with those with the APOE3 or APOE4 allele. There were significant differences in the LIPC allele and genotype frequencies between Caucasian (n = 207) and Asian (n = 211) individuals, but ethnicity did not contribute to the variations in circulating lipids. In addition, the lowest triglyceride levels (0.87 +/- 0.27 mmol.mL(-1)) were found in all APOE2 individuals carrying LIPC-514-CC and LIPC-250-GG genotypes, whereas the highest triglyceride levels (1.29 +/- 0.34 -1.32 +/- 0.32 mmol.mL(-1)) were found in APOE2 individuals carrying the opposite genotypes, LIPC-514TT and LIPC-250AA. These observations, distinct from the anti-atherogenic effects of APOE2 through the lowering of low-density lipoprotein cholesterol and LIPC on high-density lipoprotein cholesterol, suggest that there is an interactive effect between APOE and LIPC genotypes on plasma triglyceride levels. These results provide the basis for further studies on establishing which genotype combinations would be the most protective against hypertriglyceridemia.

La place de l’éducation à la citoyenneté et des droits de la personne dans l’enseignement au Canada et en Ontario

The article explores Canadian and Ontarian perspectives on citizenship education and shows how citizenship education contributes to student awareness of the various dimensions of citizenship and the rights of individuals. First, we trace the origin of citizenship education and its importance to a healthy Canadian society. Second, we review the literature on citizenship education in the context of Manitoban, Quebec, and Ontarian ministry guidelines for secondary citizenship education curricula. The article ends with recommendations for future research in the area.

Influenza Vaccine Programs and Pregnancy: New Canadian Evidence for Immunization

Among healthy pregnant women, excess deaths due to influenza were documented during pandemics, but the impact of influenza on pregnant women in non-pandemic years is not clear. In Canada, influenza immunization is recommended for pregnant women only if they have comorbidities known to place them at increased risk of complications or if they deliver during influenza season, therefore becoming a contact of a high-risk infant. The National Advisory Committee on Immunization has indicated that additional evidence, relevant to healthy pregnant Canadian women, is needed to support a recommendation for influenza immunization for all pregnant women. In this commentary we summarize new Canadian data supporting universal influenza immunization for pregnant women and discuss ways in which the Society of Obstetricians and Gynaecologists of Canada might take a leadership role in making influenza vaccination in pregnancy a priority to decrease influenza morbidity in pregnant Canadian women.

Mutation analysis and characterization of ATR sequence variants in breast cancer cases from high-risk French Canadian breast/ovarian cancer families

BackgroundAtaxia telangiectasia-mutated and Rad3-related (ATR) is a member of the PIK-related family which plays, along with ATM, a central role in cell-cycle regulation. ATR has been shown to phosphorylate several tumor suppressors like BRCA1, CHEK1 and TP53. ATR appears as a good candidate breast cancer susceptibility gene and the current study was designed to screen for ATR germline mutations potentially involved in breast cancer predisposition.MethodsATR direct sequencing was performed using a fluorescent method while widely available programs were used for linkage disequilibrium (LD), haplotype analyses, and tagging SNP (tSNP) identification. Expression analyses were carried out using real-time PCR.ResultsThe complete sequence of all exons and flanking intronic sequences were analyzed in DNA samples from 54 individuals affected with breast cancer from non-BRCA1/2 high-risk French Canadian breast/ovarian families. Although no germline mutation has been identified in the coding region, we identified 41 sequence variants, including 16 coding variants, 3 of which are not reported in public databases. SNP haplotypes were established and tSNPs were identified in 73 healthy unrelated French Canadians, providing a valuable tool for further association studies involving the ATR gene, using large cohorts. Our analyses led to the identification of two novel alternative splice transcripts. In contrast to the transcript generated by an alternative splicing site in the intron 41, the one resulting from a deletion of 121 nucleotides in exon 33 is widely expressed, at significant but relatively low levels, in both normal and tumoral cells including normal breast and ovarian tissue.ConclusionAlthough no deleterious mutations were identified in the ATR gene, the current study provides an haplotype analysis of the ATR gene polymorphisms, which allowed the identification of a set of SNPs that could be used as tSNPs for large-scale association studies. In addition, our study led to the characterization of a novel Δ33 splice form, which could generate a putative truncated protein lacking several functional domains. Additional studies in large cohorts and other populations will be needed to further evaluate if common and/or rare ATR sequence variants can be associated with a modest or intermediate breast cancer risk.

6S]-5-Methyltetrahydrofolate is at least as effective as folic acid in preventing a decline in blood folate concentrations during lactation

Studies in nonpregnant, nonlactating women suggest that folate supplementation in the form of 5-methyltetrahydrofolate ([6S]-5-methylTHF) is at least as effective as folic acid in increasing blood folate indexes. No data, however, are available on the effect of supplemental [6S]-5-methylTHF on blood folate concentrations during lactation. We assessed the relative effectiveness of [6S]-5-methylTHF, a placebo, and folic acid in maintaining blood folate indexes during lactation in a sample of healthy Canadian women consuming folic acid-fortified foods. This study was designed as a 16-wk, randomized, placebo-controlled intervention. Pregnant women (n = 72) advised to consume a folic acid-containing prenatal supplement (1000 microg/d) during pregnancy were enrolled at 36 wk gestation. After delivery, the women were randomly assigned to receive [6S]-5-methylTHF (416 microg/d, 906 nmol/d) or a placebo or were assigned to a folic acid (400 microg/d, 906 nmol/d) reference group. At 16 wk of lactation, the mean red blood cell (RBC) folate concentration in women in the [6S]-5-methylTHF group (2178; 95% CI: 1854, 2559 nmol/L) was greater than that in the folic acid (1967; 1628, 2377 nmol/L; P < 0.05) and placebo (1390; 1198, 1613 nmol/L; P < 0.002) groups after adjustment for baseline concentrations (36 wk gestation). The distribution of folate forms in RBCs did not differ significantly between the [6S]-5-methylTHF and placebo groups. However, the folic acid group had greater amounts of 5-formylTHF (P < 0.03). [6S]-5-MethylTHF appeared to be as effective as, and perhaps more effective than, folic acid in preserving RBC folate concentrations during lactation.

End Paper: Healthy Provinces, Healthy Canadians: A Provincial Benchmarking Report

End Paper: Healthy Provinces, Healthy Canadians: A Provincial Benchmarking Report

Reliability and Validity of the Past Year Total Physical Activity Questionnaire

The authors determined the validity and reliability of their Past Year Total Physical Activity Questionnaire (PYTPAQ), which assesses the frequency, duration, and intensity of occupational, household, and recreational activities performed over the past year. The PYTPAQ was completed twice at baseline, 9 weeks apart (on average), by 154 healthy Canadian men and women aged 35-65 years for assessment of reliability. The PYTPAQ was completed again 1 year later as a self-administered questionnaire. Four times during the year, participants wore an accelerometer for 7 days and completed 7-day physical activity logs. The authors assessed validity by comparing PYTPAQ summary values with 1-year averages of the physical activity logs and accelerometer data and with physical fitness and anthropometric data measured at baseline and 1 year. Spearman correlations for reliability (metabolic equivalent-hours/week) were 0.64 for total activity, 0.70 for occupational activity, 0.73 for recreational activity, and 0.65 for household activity. For total activity, the intraclass correlation coefficient for correlation between the PYTPAQ and the 7-day physical activity logs was 0.42 (95% confidence interval: 0.28, 0.54), and for the accelerometer data it was 0.18 (95% confidence interval: 0.03, 0.32). Spearman correlations between PYTPAQ hours/week of vigorous activity and maximal oxygen uptake were 0.37 and 0.32 at baseline and follow-up, respectively. In general, the PYTPAQ has acceptable reliability and validity for measurement of past-year physical activity that is comparable to that of similar questionnaires.

Introduction to Dietary Reference Intakes

Dietary Reference Intakes (DRIs) are nutrient reference standards used for planning and assessing the diets of apparently healthy Canadians and Americans. The development of DRIs reflects a joint initiative by the United States and Canada to update, expand on, and replace the former Recommended Nutrient Intakes for Canadians and Recommended Dietary Allowances for Americans. DRIs include the Estimated Average Requirement (EAR), Recommended Dietary Allowance (RDA), Adequate Intake (AI), and Tolerable Upper Intake Level (UL). The EAR is the average daily intake level that meets the requirement of 50% of healthy individuals in a life stage and gender group, whereas the RDA is set at a level that will meet the requirements of almost all (97%-98%) individuals in that life stage and gender group. An AI is a recommended intake level that is thought to meet the needs of almost all healthy individuals, and is set when there are insufficient data to establish an EAR (and therefore an RDA). The UL represents a threshold above which adverse effects of excessive intake may increase. In addition to these DRIs, macro nutrients have an Acceptable Macro nutrient Distribution Range (AMDR) and, for energy, an Estimated Energy Requirement (EER) is described.

Psychology's pursuit of prescriptive authority: Would it meet the goals of Canadian health care reform?

Abstract We seek to facilitate reflection on the important issue of prescriptive authority for Canadian psychologists. The present paper contextualizes the discussion of prescriptive authority in the broader context of health care reform in Canada. More specifically, we review pharmacotherapy and psychological services in view of how effectively each of these currently meets three major challenges in health care reform: reducing costs, increasing treatment efficacy, and improving access to treatment. Should Prescriptive Authority be in the Future of Canadian Clinical Psychology? Whether to pursue prescriptive authority is a critically important and controversial issue currently facing psychology. It has the potential to fundamentally change the way the public, other providers, and psychologists themselves view psychological services. Having prescriptive authority would have implications for the very identity of psychology (Dozois & Dobson, 1995) and every aspect of the science and practice of psychology from research (Antonuccio, Danton, & McClanahan, 2003), to training (Dozois & Dobson, 2001), to practice (Hayes, Walser, & Bach, 2002). Passionate arguments for (Deleon, Sammons, & Morgan, 1995; Nussbaum, 2001) and against (Albee, 2002; Bush, 2002) prescriptive authority have been advanced. An issue with such potential to change psychology cannot be taken lightly and must be approached with careful consideration. The intent of this paper is to facilitate such reflection among psychologists in the Canadian context. We argue that to fully reflect on the issue of prescriptive authority, one has to understand the larger current health care context. Further, we assume that in order to remain viable in the long term, any changes within psychology would need to accommodate to the current realities of the Canadian health care system. The Commission on the Future of Health Care in Canada (CFHCC) led by Roy Romanow was spurred by a number of specific problems in Canada's health care system. These include escalating costs, suboptimal quality of care, and lack of timely access to service (see Romanow & Marchildon, 2003 for a discussion of the implications of this review for Canadian psychologists specifically). In the report, Healthy Canadians (Health Canada, 2002), First Ministers developed a framework of indicators of health status, health outcomes, and quality of service. Importantly, these indicators will be used to monitor our health care system's evolution. Quality of service, patient satisfaction with care, and access to service are among the key indicators by which future health care delivery will be judged. Finally, the movement toward EvidenceBased Practice in medicine, emphasizing research evidence, clinical expertise, and patient preferences and values (Dobrow, Goel, & Upshur, 2004; Sackett, Straus, Richardson, Rosenberg, & Haynes, 2000), has been suggested as an important model for evaluating and ensuring the influence of psychology (Barlow, 2004; Levant, 2005). As a result of these evolutions in how health care is delivered and evaluated, any change to the practice of psychology, such as obtaining prescriptive authority, will ultimately be judged based on how effectively it addresses key priorities in health care reform such as containing and reducing costs, enhancing treatment efficacy, and increasing treatment access and patient satisfaction with care. Goals of the Present Paper and an Invitation for Reflection The aim of this paper is to stimulate reflection on the question: Would prescriptive authority for psychologists address key priorities in Canadian health care reform? There are undoubtedly other criteria that could be used to explore the broader issue of whether or not psychologists should seek prescriptive authority such as the competence of psychologists to do so, the impact on various professions etc. (see Table 1 for a summary of arguments advanced in this debate to date). …

Freedom or Folly? Canadians and the Consumption of Online Health Information

The concept of e-health has come to assume a key place within a larger Canadian governmental discourse that lauds the benefits of supplying Internet-based services to as wide an audience as possible. In order to fulfil its vision of a connected public accessing services cheaply and easily through electronic media, the federal government has assumed that the potential exists for all Canadians to use the Internet and has done its best to achieve this result through programmes aimed at ameliorating accessibility issues. There is particular enthusiasm over the possibility of moving some health services online, thus reducing costs incurred through personal patient-practitioner meetings while ostensibly creating more informed, proactive and healthy Canadians. This paper discusses whether or not the enthusiasm of the government, and of individual users, regarding e-health practices is merited, focussing particularly on the consumption of online health information by patients. Numerous consequences and conflicts can accompany such practices, but this paper specifically addresses the negative aspects of promoting informed health choices through a medium inaccessible to all members of Canadian society, such as the aged, the poor, rural dwellers and some ethnic minorities. The paper also assesses the potential risks of acting upon incorrect information provided online and addresses the possibility that health professionals' workloads will increase rather than decrease. However, as this paper also notes, e-health does contain potential for improving the delivery of medical services in Canada if contained within clearly defined parameters, and if alternatives still exist for those who cannot or will not benefit from such technology.