Illness In Canada Research Articles

Bringing politics and evidence together: Policy entrepreneurship and the conception of the At Home/Chez Soi Housing First Initiative for addressing homelessness and mental illness in Canada

An interesting question concerns how large-scale (mental) health services policy initiatives come into being, and the role of evidence within the decision-making process behind their origins. This paper illustrates the process by which motivation to address homelessness, in the context of the upcoming 2010 Vancouver Olympics, was leveraged into a pan-Canadian project including sites in Vancouver, Winnipeg, Toronto, Montreal and Moncton, New Brunswick. The aim of the initiative was to implement and evaluate an intervention, Housing First, to provide housing and support to previously homeless people with mental illness. This qualitative case study was conducted between December 2009 and December 2010, employing grounded theory, and drawing on archival documents and interviews with 19 key informants involved in the conception of the project. Overall, the findings affirm that policy-making does not follow a rational, linear process of knowledge translation/exchange (KTE) and implementation, whereby evidence-based “products” are brought forward to address objectively determined needs and then “placed into decision-making events” (Lomas, 2007, p. 130). Instead, evidence-based policy making should be understood within the much more complex context of “policy entrepreneurship” (Kingdon, 2003; Mintrom & Norman, 2009) which entails taking advantage of windows of opportunity, and helping to bring together the “streams” of problems, politics, and policy ideas (Kingdon, 2003).

Ending homelessness among people with mental illness: the At Home/Chez Soi randomized trial of a Housing First intervention in Toronto

BackgroundThe At Home/Chez Soi (AH/CS) Project is a randomized controlled trial of a Housing First intervention to meet the needs of homeless individuals with mental illness in five cities across Canada. The objectives of this paper are to examine the approach to participant recruitment and community engagement at the Toronto site of the AH/CS Project, and to describe the baseline demographics of participants in Toronto.MethodsHomeless individuals (n = 575) with either high needs (n = 197) or moderate needs (n = 378) for mental health support were recruited through service providers in the city of Toronto. Participants were randomized to Housing First interventions or Treatment as Usual (control) groups. Housing First interventions were offered at two different mental health service delivery levels: Assertive Community Treatment for high needs participants and Intensive Case Management for moderate needs participants. Demographic data were collected via quantitative questionnaires at baseline interviews.ResultsThe effectiveness of the recruitment strategy was influenced by a carefully designed referral system, targeted recruitment of specific groups, and an extensive network of pre-existing services. Community members, potential participants, service providers, and other stakeholders were engaged through active outreach and information sessions. Challenges related to the need for different sectors to work together were resolved through team building strategies. Randomization produced similar demographic, mental health, cognitive and functional impairment characteristics in the intervention and control groups for both the high needs and moderate needs groups. The majority of participants were male (69%), aged >40 years (53%), single/never married (69%), without dependent children (71%), born in Canada (54%), and non-white (64%). Many participants had substance dependence (38%), psychotic disorder (37%), major depressive episode (36%), alcohol dependence (29%), post-traumatic stress disorder (PTSD) (23%), and mood disorder with psychotic features (21%). More than two-thirds of the participants (65%) indicated some level of suicidality.ConclusionsRecruitment at the Toronto site of AH/CS project produced a sample of participants that reflects the diverse demographics of the target population. This study will provide much needed data on how to best address the issue of homelessness and mental illness in Canada.

Epidemiology of acute kidney injury in Canadian critical care units: a prospective cohort study

We undertook this study to characterize the epidemiology of acute kidney injury (AKI) in Canadian critical care units. We aimed to identify predictors of mortality for patients diagnosed with AKI. We conducted a prospective cohort study of consecutive patients admitted to critical care units at five Canadian hospitals over a 30-day period. Each patient was followed until hospital discharge or for a maximum of 30 days. The serum creatinine criteria for the Acute Kidney Injury Network (AKIN-SCr) system were used to identify, classify, and characterize patients who developed AKI. We used multivariable logistic regression to predict 30-day mortality among patients with AKI. We identified 603 patients, 161 (26.7%) of whom developed AKI. Compared to patients without AKI, those with AKI were more likely to die (29.2% vs 8.6%, P < 0.001). The risk of death increased with increasing AKIN-SCr stage (P < 0.001). In all, 19 patients (11.8% of those with AKI) commenced dialysis a median of one day (interquartile range, one to two days) after AKI diagnosis. At AKI diagnosis, the blood urea nitrogen (BUN) level (adjusted odds ratio [OR] 1.68, 95% confidence interval [CI] 1.01 to 2.79/10 mmol·L(-1)) and serum bicarbonate (adjusted OR 0.88, 95% CI 0.81 to 0.95/1 mmol·L(-1)) were associated with 30-day mortality and predicted death with an area under the receiver-operating characteristic curve of 0.79 (95% CI 0.71 to 0.86). Acute kidney injury is a common complication of critical illness in Canada. The development of even the mildest stage of AKI is associated with a substantially higher risk of death. At AKI diagnosis, routine clinical data may be helpful for predicting adverse outcomes.

Obesity and Mental Health—A Complicated and Complex Relation

In 2007, following a comprehensive report by a Senate Committee, the Government of Canada announced funding for the launch of a mental health commission.1 This move was timely and sought to address the considerable burden of mental illness in Canada. A parallel epidemic of obesity, currently affecting 1 in 4 adult Canadians and as many as 1 in 10 Canadian children,2 has yet to receive similar attention. Interestingly enough, however, these 2 major health problems affecting millions of Canadians may be much closer related to each other than is evident at first glance. While obesity is largely regarded as a simple consequence of lifestyle choices, with both public health and individual interventions focusing primarily on measures to promote healthy eating and physical activity, its close link to mental health, as one of its key determinants, is often missed. In this edition of The Canadian Journal of Psychiatry, Dr Valerie H Taylor and colleagues34 present 2 articles discussing the complicated and complex links between mental health and excess weight, and provide a brief summary of current approaches to obesity management. As pointed out in the first article,3 there is considerable overlap between the mental health and obesity co-epidemics. Not only do the vast majority of treatment-seeking obese people present with a wide range of mental health issues, mental illness, in turn, can often promote weight gain and prove a major barrier to obesity management. As Dr Taylor and colleagues3 discuss, the latter is not simply a matter of obesogenic psychiatric medications promoting weight gain - the links between obesity and mood disorders, anxiety disorders, attention disorders, addiction disorders, psychotic disorders, personality disorders, and trauma (to name a few) invoke societal, cognitive, behavioural, and biological factors that interact in complex and complicated ways. Thus I have previously proposed that even a cursory assessment of mental health should be an integral part of every assessment for obesity.5 In addition, mental illness must be considered as a possible etiological factor in anyone presenting with weight gain attributable to overeating and undermoving.6 Not surprisingly, as outlined in the second article,4 current treatments for obesity borrow freely from the behavioural and pharmacological arsenal of mental health interventions. Cognitive-behavioural therapy, interpersonal therapy, motivational interviewing, and other techniques, well established in the treatment of mental health and addictions, are increasingly recognized for their role in obesity management. In addition, current pipelines for the pharmacological treatment of obesity include drugs targeting the serotonergic, dopaminergic, endocannabinoid, opiate, and other systems within the peripheral and central nervous systems. Given the importance of the central nervous system as a prime determinant of ingestive and activity behaviour, it is also not surprising that current obesity research uses a wide range of psychological assessments and neuroimaging techniques to better define the obesity phenotype. …

Informing source attribution of enteric disease: An analysis of public health inspectors’ opinions on the “most likely source of infection”

Enteric illness continues to place a significant burden on the health of Canadians. To reduce this burden and establish effective prevention and intervention practices, the sources of these infections need to be understood. Multiple methods have been used to examine source attribution. This study presents a unique method for examining source attribution and enteric disease risk factors within a Canadian community. Open text data from 2006 to 2010 were analyzed on the “most likely source of infection” (MLSI) identified by public health inspectors (PHIs), investigating sporadic endemic cases of enteric illness in the Region of Waterloo, Ontario. The MLSI data were classified under nine categories and analyzed using five disease groups consisting of overall enteric disease, campylobacteriosis, salmonellosis, verotoxigenic Escherichia coli (VTEC) infection, and parasitic disease. Food was the most frequently reported MLSI for overall enteric disease (26.1%), salmonellosis (41.1%), and VTEC infection (31.3%). Animal and water exposure were the most frequently reported MLSI for campylobacteriosis (26.2%) and parasitic disease (45.8%), respectively. Food safety practices were more frequently implicated as the source of infection for salmonellosis (17.7%) and campylobacteriosis (12.6%), compared with verotoxigenic Escherichia coli (VTEC) infection (6.3%) and parasitic disease (1.0%). The category unpasteurized was the third most frequent MLSI for campylobacteriosis (12.6%), along with food safety practices (12.6%). The analysis of PHIs’ opinions on the MLSI of enteric disease is a valuable method to inform source attribution. The enhanced Canada's National Integrated Enteric Pathogen Surveillance Program (C-EnterNet) standardized questionnaires provided an important source of data to complete this analysis. The results from this study can be used to generate hypotheses for future studies and inform public health policy and practice at the local, provincial, and national levels to reduce the burden of enteric illness in Canada.

A comparison of five transition programmes for youth with chronic illness in Canada

Adolescents with chronic illnesses who are transferred from the paediatric healthcare setting to adult care often get lost in the system, resulting in poorer long-term health outcomes. The Canadian Pediatric Society and the Society of Adolescent Health and Medicine have position papers on the key elements recommended for transition programmes. A comparison of five transition programmes for youth with chronic illness in Canada is presented with a discussion of how they reflect these guidelines. The process used to review the content and effectiveness can provide others with a framework for learning about existing transition programmes to assist them in developing their own.

P1-S3.02 The economic burden of chlamydia and gonorrhoea in Canada

BackgroundThe latest estimate of the economic burden of chlamydia and gonorrhoea in Canada was modelled with data from 1990 and was published in 1992 by Ron Goeree and Paul Gully. Given the changes that have occurred since in diagnostic testing technology, the availability of new data sources and increasing rates of the two infections, a new model using updated data from 2000 is called for.MethodsDiagnostic test costs were estimated using provincial laboratory data on the number of diagnostic tests performed forChlamydia trachomatis(CT) andNeisseria gonorrhoeae(GC) for the year 2000. Direct costs of CT and GC from drugs, hospitals, and physician billings were estimated using the Economic Burden of Illness in Canada (EBIC) data. Direct costs of associated sequelae of each infectious disease were also included in the model. Indirect costs estimated in the model included production losses from both infectious diseases and their associated sequelae. Sensitivity analyses were conducted to provide upper, base and lower-bound estimates of the total cost.ResultsThe preliminary combined estimate for both direct and indirect costs of CT and GC (in 2000 dollars) ranges from approximately $31.5 to $178.4 million (CAD).ConclusionsFurther work is required to improve data access and estimates of the burden of infection in Canada. A top priority should be to improve the data infrastructure by expanding data linkages within and among provinces around laboratory tests. The majority of costs related to CT and GC are attributable to drug, hospital and physician costs, suggesting that much of the burden of these two infections can be reduced through implementation of effective prevention programs. The number of CT infections has increased exponentially since 2000, warranting further modelling considering current incidence rates and inflation costs.

Food-Specific Attribution of Selected Gastrointestinal Illnesses: Estimates from a Canadian Expert Elicitation Survey

The study used a structured expert elicitation survey to derive estimates of food-specific attribution for nine illnesses caused by enteric pathogens in Canada. It was based on a similar survey conducted in the United States and focused on Campylobacter spp., Escherichia coli O157:H7, Listeria monocytogenes, nontyphoidal Salmonella enterica, Shigella spp., Vibrio spp., Yersinia enterocolitica, Cryptosporidium parvum, and Norwalk-like virus. A snowball approach was used to identify food safety experts within Canada. Survey respondents provided background information as well as self-assessments of their expertise for each pathogen and the 12 food categories. Depending on the pathogen, food source attribution estimates were based on responses from between 10 and 35 experts. For each pathogen, experts divided their estimates of total foodborne illness across 12 food categories and they provided a best estimate for each category as well as 5th and 95th percentile limits for foods considered to be vehicles. Their responses were treated as triangular probability distributions, and linear aggregation was used to combine the opinions of each group of experts for each pathogen-food source group. Across the 108 pathogen-food groups, a majority of experts agreed on 30 sources and 48 nonsources for illness. The number of food groups considered to be pathogen sources by a majority of experts varied by pathogen from a low of one food source for Vibrio spp. (seafood) and C. parvum (produce) to a high of seven food sources for Salmonella spp. Beta distributions were fitted to the aggregated opinions and were reasonable representations for most of the pathogen-food group attributions. These results will be used to quantitatively assess the burden of foodborne illness in Canada as well as to analyze the uncertainty in our estimates.

Increasing Access to Cognitive-Behavioural Therapy (CBT) for the Treatment of Mental Illness in Canada: A Research Framework and Call for Action

International studies suggest that cognitive-behavioural therapy (CBT) for the treatment of mental disorders results in improved clinical and economic outcomes. In Canada, however, publicly funded CBT is scarce, representing an inequity in service delivery. A research framework to evaluate the Canadian health economic impact of increasing access to CBT is proposed. Canadian data related to the epidemiology of mental disorders, patterns of usual care, CBT effectiveness, resource allocation and costs of care will be required and methodologies should be transparent and outcomes meaningful to Canadian decision-makers. Findings should be delivered by multidisciplinary teams of researchers and health professionals. Barriers to funding reform must be identified and knowledge translation strategies delineated and implemented. Canadian clinical and economic outcomes data are essential for those seeking to provide decision-makers with the evidence they need to evaluate whether CBT represents value for mental health dollars spent.

Obesity and overweight in Canada: an updated cost‐of‐illness study

This study is to update the estimates of the economic burden of illness because of overweight and obesity in Canada by incorporating the increase in prevalence of overweight and obesity, findings of new related comorbidities and rise in the national healthcare expenditure. The burden was estimated from a societal perspective using the prevalence-based cost-of-illness methodology. Results from a literature review of the risks of 18 related comorbidities were combined with prevalence of overweight and obesity in Canada to estimate the extent to which each comorbidity is attributable to overweight and obesity. The direct costs were extracted from the National Health Expenditure Database and allocated to each comorbidity using weights principally from the Economic Burden of Illness in Canada. The study showed that the total direct costs attributable to overweight and obesity in Canada were $6.0 billion in 2006, with 66% attributable to obesity. This corresponds to 4.1% of the total health expenditures in Canada in 2006. The inclusion of newly identified comorbidities increased the direct cost estimates of obesity by 25%, while the rise in national healthcare expenditure accounted for a 19% increase. Policies to reduce being overweight and obese could potentially save the Canadian healthcare system millions of dollars.

Canadian Network for Mood and Anxiety Treatments (CANMAT) Clinical Guidelines for the Management of Major Depressive Disorder in Adults. I. Classification, Burden and Principles of Management

Background Major depressive disorder (MDD) is one of the most burdensome illnesses in Canada. The purpose of this introductory section of the 2009 revised CANMAT guidelines is to provide definitions of the depressive disorders (with an emphasis on MDD), summarize Canadian data concerning their epidemiology and describe overarching principles of managing these conditions. This section on “Classification, Burden and Principles of Management” is one of 5 guideline articles in the 2009 CANMAT guidelines. Methods The CANMAT guidelines are based on a question–answer format to enhance accessibility to clinicians. An evidence-based format was used with updated systematic reviews of the literature and recommendations were graded according to the Level of Evidence using pre-defined criteria. Lines of Treatment were identified based on criteria that included evidence and expert clinical support. Results Epidemiologic data indicate that MDD afflicts 11% of Canadians at some time in their lives, and approximately 4% during any given year. MDD has a detrimental impact on overall health, role functioning and quality of life. Detection of MDD, accurate diagnosis and provision of evidence-based treatment are challenging tasks for both clinicians and for the health systems in which they work. Limitations Epidemiologic and clinical data cannot be seamlessly linked due to heterogeneity of syndromes within the population. Conclusions In the eight years since the last CANMAT Guidelines for Treatment of Depressive Disorders were published, progress has been made in understanding the epidemiology and treatment of these disorders. Evidence supporting specific therapeutic interventions is summarized and evaluated in subsequent sections.

Use of Administrative Data for the Surveillance of Mental Disorders in 5 Provinces

To evaluate the usefulness of administrative data for the surveillance of mental illness in Canada using databases in the following 5 provinces: British Columbia, Ontario, Quebec, Nova Scotia, and Alberta. We used a population-based record-linkage analysis with data from physician billings, hospital discharge abstracts, and community-based clinics. The following diagnostic codes from the International Classification of Diseases, Ninth Edition, were used to define cases: 290 to 319, inclusive. The prevalence of treated psychiatric disorder was similar in Nova Scotia, British Columbia, Alberta, and Ontario at about 15%. The prevalence for Quebec was slightly lower at 12%. Findings from the provinces showed remarkable consistency across age and sex, despite variations in data coding. Women tended to show a higher prevalence overall of treated mental disorders than men. Prevalence increased steadily to middle age, declining in the 50s and 60s, and then increasing again after age 70 years. Provincial and territorial administrative data can provide a useful, reliable, and economical source of information for the surveillance of treated mental disorders. Such a surveillance system can provide longitudinal data at little cost to support health service provision and planning.

Food safety knowledge retention study.

Foodborne illness in Canada is an ongoing burden for public health and the economy. Many foodborne illnesses result from improper food handling practices. If food handlers had a greater knowledge of what causes foodborne illness, perhaps these illnesses would have less of an impact on society. This study gave researchers the opportunity to examine the current food safety knowledge of food handlers by using a standardized questionnaire. Questionnaires were distributed by environmental health officers to food handlers working in the food service industry during on-site inspections, and responses were used to evaluate immediate knowledge of key food safety issues. Both certified and noncertified food handlers were evaluated. Information also was collected on the number of years since food safety certification was achieved and the number of years experience noncertified food handlers had in the food service industry. Results indicated that certified food handlers had a greater knowledge of food safety information than did noncertified food handlers. The highest failure rates were observed among noncertified food handlers with more than 10 years of experience and less than 1 year of experience. The results support the need for mandatory food safety certification for workers in the food service industry and for recertification at least every 10 years. Although the study was not sufficiently rigorous to evaluate existing food safety courses, data collected provided valuable insight into what issues should be emphasized in existing food safety courses and which should be targeted by future food safety initiatives.

Differences in access to wage replacement benefits for absences due to work‐related injury or illness in Canada

The objective of this article is to examine the factors associated with differences in access to income replacement benefits for workers experiencing a work-related injury or illness of 1-week or longer in the Canadian labor force. This study utilized data from the Survey of Labour and Income Dynamics, a representative longitudinal survey conducted by Statistics Canada. A total of 3,352 work-related absences were identified. Logistic regression models examined factors at the individual, occupational, and geographic level that were associated with the probability of receiving compensation. The probability of not receiving employer or workers' compensation benefits was higher among women, immigrants in their first 10 years in Canada, younger workers, respondents who were in their first year of a job, those who were not members of a union or collective bargaining agreement, and part-time workers. More research is required to understand why almost 50% of respondents with 1-week or longer work-related absences did not report receiving workers' compensation payments following their absence. More importantly, research is required to understand why particular groups of workers are more likely to be excluded from any type of compensation for lost earnings after a work-related injury and illness in Canada.

A descriptive analysis of hospitalization due to acute gastrointestinal illness in Canada, 1995-2004.

Gastrointestinal illness (GI) remains a leading cause of morbidity and mortality worldwide. In Canada, research has already demonstrated a rate in excess of one episode per person-year. National passive surveillance programs may be enhanced by information from hospitalizations for acute gastrointestinal disease. The objective of this report is to explore the incidence of acute GI in hospital administrative data collected by the Canadian Institute for Health Information (CIHI)--specifically the hospital morbidity database (HMDB). Data from acute care facilities and select chronic care and rehabilitation facilities across Canada were analyzed using standardized rates, and age- and sex-adjusted rates for the years 1995-2004. The results indicate that GI causes at least 92,765 hospital admissions per year in Canada. In the majority (78.3%) of gastrointestinal hospitalizations, no specific etiology was recorded. Of the remaining diagnoses, 11.6% were due to viruses, 9.7% to bacteria and 0.3% to parasites. Age-standardized rates of hospitalizations for acute GI appear to have declined over the 10-year period. Gastrointestinal illness is still present in the Canadian population and presents a significant burden to the health care system. Whereas the HMDB likely underestimates the true rate of GI, it does capture cases that are serious enough to require hospitalization. This is a unique source of data and highlights other pathogen-specific disease data not currently collected through national surveillance tools (e.g., viruses).

A Descriptive Analysis of Hospitalization Due to Acute Gastrointestinal Illness in Canada, 1995–2004

A Descriptive Analysis of Hospitalization Due to Acute Gastrointestinal Illness in Canada, 1995–2004

Perceived Unmet Need for Mental Health Care for Canadians With Co-occurring Mental and Substance Use Disorders

Previous analyses demonstrated an elevated occurrence of perceived unmet need for mental health care among persons with co-occurring mental and substance use disorders in comparison with those with either disorder. This study built on previous work to examine these associations and underlying reasons in more detail. Secondary data analyses were performed on a subset of respondents to the 2002 Canadian Community Health Survey (unweighted N=4,052). Diagnostic algorithms classified respondents by past-year substance dependence and selected mood and anxiety disorders. Logistic regressions examined the associations between diagnoses and unmet need in the previous year, accounting for recent service use and potential predisposing, enabling, and need factors often associated with help seeking. Self-reported reasons underlying unmet need were also tabulated across diagnostic groups. Of persons with a disorder, 22% reported a 12-month unmet need for care. With controls for service use and other potential confounders, the odds of unmet need were significantly elevated among persons with co-occurring disorders (adjusted odds ratio=3.25; 95% confidence interval=1.96-5.37). Most commonly, the underlying reason involved a preference to self-manage symptoms or not getting around to seeking care, with some variation by diagnosis. The findings highlight potential problems for individuals with mental and substance use disorders in accessing services. The elevated occurrence of perceived unmet need appeared to be relatively less affected by contact with the health care system than by generalized distress and problem severity. Issues such as stigma, motivation, and satisfaction with past services may influence help-seeking patterns and perceptions of unmet need and should be examined in future work.

A new population-based measure of the economic burden of mental illness in Canada

This paper presents a comprehensive measure of the incremental economic burden of mental illness in Canada which incorporates the use of medical resources and productivity losses due to long-term and short-term disability, as well as reductions in health-related quality of life (HRQOL), for the diagnosed and undiagnosed population with mental illness. The analysis was based on the population-based Canadian Community Health Survey Cycle 2.1 (2003). For all persons, we measured all health services utilization, longterm and short-term work loss, and health-related quality of life and their dollar valuations, with the economic burden being the difference in dollar measures between the populations with and without mental health problems. In total, the economic burden was $51 billion in 2003. Over one-half was due to reductions in HRQOL. The current accepted practice in economic assessments is to include changes in medical resource use, work loss, and reductions in HRQOL.

Canadian Thoracic Society Recommendations for Management of Chronic Obstructive Pulmonary Disease - 2008 Update - Highlights for Primary Care

Chronic obstructive pulmonary disease (COPD) is a major respiratory illness in Canada that is preventable and treatable but unfortunately remains underdiagnosed. The purpose of the present article from the Canadian Thoracic Society is to provide up-to-date information so that patients with this condition receive optimal care that is firmly based on scientific evidence. Important summary messages for clinicians are derived from the more detailed Update publication and are highlighted throughout the document. Three key messages contained in the update are: use targeted screening spirometry to establish a diagnosis and initiate prompt management (including smoking cessation) of mild COPD; improve dyspnea and activity limitation in stable COPD using new evidence-based treatment algorithms; and understand the importance of preventing and managing acute exacerbations, particularly in moderate to severe disease.

Canadian Thoracic Society Recommendations for Management of Chronic Obstructive Pulmonary Disease – 2008 Update – Highlights for Primary Care

Chronic obstructive pulmonary disease (COPD) is a major respiratory illness in Canada that is preventable and treatable but unfortunately remains underdiagnosed. The purpose of the present article from the Canadian Thoracic Society is to provide up-to-date information so that patients with this condition receive optimal care that is firmly based on scientific evidence. Important summary messages for clinicians are derived from the more detailed Update publication and are highlighted throughout the document. Three key messages contained in the update are: use targeted screening spirometry to establish a diagnosis and initiate prompt management (including smoking cessation) of mild COPD; improve dyspnea and activity limitation in stable COPD using new evidence-based treatment algorithms; and understand the importance of preventing and managing acute exacerbations, particularly in moderate to severe disease.