Socioeconomic gradients in cardiovascular risk in Canadian children and adolescents.

INTRODUCTION: Cardiovascular disease (CVD) and its risk factors show clear socioeconomic gradients in Canadian adults. Whether socioeconomic gradients in cardiovascular risk emerge in childhood remains unclear. The objective of this study was to determine whether there are socioeconomic gradients in physiological markers of CVD risk in Canadian children and adolescents. METHODS: Using combined cross-sectional data from the Canadian Health Measures Survey 2007-2011, we examined the following cardiovascular risk markers: overweight (including obesity), aerobic fitness score (AFS), blood pressure (BP), blood lipids (total as well as HDL and LDL cholesterol and triglycerides), glucose metabolism and C-reactive protein (CRP) by sex in 2149 children (ages 6-11 years) and 2073 adolescents (ages 12-17 years). Multivariate linear and logistic regression analyses were used to identify patterns in cardiovascular risk across strata of household income adequacy and parental educational attainment, adjusting for age and ethnicity, and stratified by age group and sex. RESULTS: Young boys showed markedly higher prevalence of obesity than young girls (prevalence of 18.5%, 95% confidence interval [CI]: 15.6-21.5 vs. 7.7%, 95% CI: 5.2-10.3). However, negative SES gradients in adiposity risk were seen in young and adolescent girls rather than boys. Young and adolescent boys were more physically fit than girls (mean AFS of 541, 95% CI: 534-546 vs. 501, 95% CI: 498-505 in children; 522, 95% CI: 514-529 vs. 460, 95% CI: 454-466 in adolescents; p < 001). Although a positive income gradient in AFS was observed in both boys and girls, statistical significance was reached only in girls (p =.006). A negative gradient of parental education in BP was observed in young children. While we observed substantial sex differences in systolic BP, total and HDL cholesterol, fasting glucose and CRP in adolescents, sex-specific socioeconomic gradients were only observed for systolic BP, HDL and LDL cholesterol. Further studies with large samples are needed to confirm these findings. CONCLUSION: This study identified important sex difference and socioeconomic gradients in adiposity, aerobic fitness and physiological markers of CVD risk in Canadian school-aged children. Population health interventions to reduce socioeconomic gradients in CVD risk should start in childhood, with a particular focus on preventing obesity in young boys of all SES and girls of low SES, promoting physical fitness especially in girls and in all ages of youth in low-SES groups, and increasing parental awareness, especially those with low educational attainment, of early CVD risks in their children.

TITRE: Gradients socioéconomiques du risque cardiovasculaire chez les enfants et les adolescents canadiens. INTRODUCTION: Les maladies cardiovasculaires (MCV) et leurs facteurs de risque présentent des gradients socioéconomiques clairs chez les adultes canadiens, mais présentent des ambiguïtés chez les enfants. L'objectif de cette étude est de vérifier l'existence ou non de gradients socioéconomiques dans les marqueurs physiologiques du risque de MCV chez les enfants et les adolescents canadiens. MÉTHODOLOGIE: À partir des données transversales combinées de l'Enquête canadienne sur les mesures de la santé 2007-2011, nous avons étudié, chez 2 149 enfants (6 à 11 ans) et 2 073 adolescents (12 à 17 ans) et selon le sexe, les marqueurs de risque cardiovasculaire suivants : excès de poids (y compris l'obésité), score de capacité aérobique (SCA), pression artérielle (PA), lipides sanguins (totaux, cholestérol LDL et HDL, triglycérides), métabolisme du glucose et protéine C réactive (CRP). Des analyses de régression logistique et de régression linéaire multidimensionnelles ont permis de dégager les tendances relatives au risque cardiovasculaire en fonction de la suffisance du revenu du ménage et du niveau de scolarité des parents, après ajustement en fonction de l'âge et de l'origine ethnique, et après stratification par groupe d'âge et par sexe. RÉSULTATS: La prévalence de l'obésité était sensiblement plus élevée chez les jeunes garçons que chez les jeunes filles (prévalence de 18,5 %, intervalle de confiance [IC] à 95 % : 15,6 à 21,5 contre 7,7 %, IC à 95 % : 5,2 à 10,3). Toutefois, des gradients socioéconomiques négatifs ont été observés en ce qui concerne le risque d'adiposité chez les jeunes filles et les adolescentes, et non chez les garçons. Parmi les enfants et les adolescents, les garçons étaient en meilleure condition physique que les filles (SCA moyen de 541, IC à 95 % : 534 à 546 contre 501, IC à 95 % : 498 à 505 chez les enfants; 522, IC à 95 % : 514 à 529 contre 460, IC à 95 % : 454 à 466 chez les adolescents; p < 0,001). Bien qu'un gradient positif lié au revenu ait été observé relativement au SCA tant chez les garçons que chez les filles, la signification statistique a été atteinte seulement chez les filles (p = 0,006). Un gradient négatif a été observé en fonction du niveau de scolarité des parents relativement à la PA des jeunes enfants. Bien que nous ayons constaté des différences importantes selon le sexe en ce qui concerne la PA systolique, le cholestérol total, le cholestérol HDL, la glycémie à jeun et la CRP chez les adolescents, des gradients socioéconomiques spécifiques au sexe ont uniquement été observés pour la PA systolique, le cholestérol HDL et le cholestérol LDL. Des études fondées sur de grands échantillons devront être réalisées afin de confirmer ces observations. CONCLUSION : Cette étude a révélé d'importantes différences selon le sexe et des gradients socioéconomiques en ce qui concerne l'adiposité, la capacité aérobique et les marqueurs physiologiques du risque de MCV chez les enfants canadiens d'âge scolaire. Des interventions de santé visant à atténuer les gradients socioéconomiques du risque de MCV devraient être mises en place dès l'enfance dans la population, en particulier en ce qui touche la prévention de l'obésité chez les jeunes garçons de tout statut socioéconomique (SSE) et chez les filles dont le SSE est faible, la promotion d'une bonne condition physique, en particulier auprès des filles et des jeunes de tous âges dans les groupes à faible SSE, et enfin la sensibilisation des parents, spécialement de ceux qui ont un faible niveau de scolarité, à l'égard du risque de MCV précoce chez les enfants.

Evidence Brief--Trends and projections of obesity among Canadians.

The prevalence of obesity, defined as body mass index (BMI) of 30 kg/m2 or higher for adults and as 2 standard deviations above the World Health Organization growth standard mean for children, has increased in many parts of the world. Obese adults are at an increased risk of certain chronic conditions, including hypertension, type 2 diabetes, cardiovascular diseases and some cancers, and of premature death. Obese children have increased cardiometabolic risk, including dyslipidemia, insulin resistance and elevated blood pressure. Excess childhood body weight that continues into adulthood can affect quality of life, educational attainment and earnings over the lifecourse. The Public Health Agency of Canada has projected an annual direct health care cost (including physician, hospitalization and medication costs) of those categorized as obese in Canada in constant 2001 Canadian dollars. Calculated as $7.0 billion in 2011, this annual direct health care cost is projected to rise to $8.8 billion by 2021, based on simulated average direct health care costs, which are higher among the obese ($2,283) than the overweight ($1,726), the underweight ($1,298) and those at normal weight ($1,284). Canadian estimates from 2006 and 2008 that used different methodologies place the annual economic burden (direct and indirect costs) of obesity between $4.6 billion and $7.1 billion. The purpose of this evidence brief is to show current Canadian obesity prevalence rates and estimates for the future using objectively measured height and weight to calculate BMI. The use of objectively measured height and weight to derive BMI is strongly recommended, especially for children and adolescents, as self- or proxy-reported height and weight tend to underestimate actual weight and consequently BMI and obesity prevalence.

TITRE: Synthèse portant sur les données probantes - Tendances et projections relatives à l'obésité chez les Canadiens. INTRODUCTION: La prévalence de l'obésité ­ soit un indice de masse corporelle (IMC) supérieur ou égal à 30 kg/m2 chez les adultes ou deux écarts-types au-dessus de la médiane de la norme de croissance de l'Organisation mondiale de la santé chez les enfants ­ a augmenté dans de nombreuses régions du monde. Les adultes obèses sont plus susceptibles d'être atteints de certaines affections chroniques, notamment d'hypertension, de diabète de type 2, de cardiopathies et de certains cancers, ainsi que de mourir prématurément. Les enfants obèses présentent aussi un risque cardiométabolique accru (dyslipidémie, résistance à l'insuline et hypertension artérielle). Un excès pondéral pendant l'enfance qui se poursuit à l'âge adulte peut nuire à la qualité de vie, au rendement scolaire et au revenu tout au long de la vie. L'Agence de la santé publique du Canada a estimé les coûts annuels directs, en dollars canadiens constants de 2001, des soins de santé (coûts liés aux médecins, aux hospitalisations et aux médicaments) pour les personnes classées comme obèses au Canada. Évalués à 7,0 milliards de dollars en 2011, ils devraient atteindre 8,8 milliards de dollars d'ici 2021, d'après un calcul à partir des moyennes actuelles qui font qu'ils sont plus élevés chez les obèses (2 283 $) que chez les personnes en surpoids (1 726 $), les personnes en insuffisance pondérale (1 298 $) et les personnes de poids normal (1 284 $). Des estimations canadiennes antérieures, de 2006 et 2008 et obtenues par des méthodologies différentes, ont évalué le fardeau économique annuel (coûts directs et indirects) de l'obésité dans une fourchette allant de 4,6 à 7,1 milliards de dollars. Cette synthèse fondée sur des données probantes vise à présenter les taux de prévalence de l'obésité au Canada à la fois actuels et projetés, à partir d'un calcul de l'IMC reposant sur des mesures objectives de la taille et du poids. L'utilisation de mesures objectives de la taille et du poids pour calculer l'IMC est fortement recommandée, particulièrement chez les enfants et les adolescents, car lorsque la taille et le poids sont autodéclarés ou obtenus par procuration, le poids réel est généralement sous-estimé, ce qui fait que l'IMC et la prévalence de l'obésité le sont également.

Methodology of the 2009 Survey on Living with Chronic Diseases in Canada--hypertension component.

INTRODUCTION: The Survey on Living with Chronic Diseases in Canada--hypertension component (SLCDC-H) is a 20-minute cross-sectional telephone survey on hypertension diagnosis and management. Sampled from the 2008 Canadian Community Health Survey (CCHS), the SLCDC-H includes Canadians (aged ≥ 20 years) with self-reported hypertension from the ten provinces. METHODS: The questionnaire was developed by Delphi technique, externally reviewed and qualitatively tested. Statistics Canada performed sampling strategies, recruitment, data collection and processing. Proportions were weighted to represent the Canadian population, and 95% confidence intervals (CIs) were derived by bootstrap method. RESULTS: Compared with the CCHS population reporting hypertension, the SLCDC-H sample (n = 6142) is slightly younger (SLCDC-H mean age: 61.2 years, 95% CI: 60.8-61.6; CCHS mean age: 62.2 years, 95% CI: 61.8-62.5), has more post-secondary school graduates (SLCDC-H: 52.0%, 95% CI: 49.7%-54.2%; CCHS: 47.5%, 95% CI: 46.1%-48.9%) and has fewer respondents on hypertension medication (SLCDC-H: 82.5%, 95% CI: 80.9%-84.1%; CCHS: 88.6%, 95% CI: 87.7%-89.6%). CONCLUSION: Overall, the 2009 SLCDC-H represents its source population and provides novel, comprehensive data on the diagnosis and management of hypertension. The survey has been adapted to other chronic conditions--diabetes, asthma/chronic obstructive pulmonary disease and neurological conditions. The questionnaire is available on the Statistics Canada website; descriptive results have been disseminated by the Public Health Agency of Canada.

TITRE: Méthodologie de l'Enquête sur les personnes ayant une maladie chronique au Canada ­ composante de l'hypertension de 2009. INTRODUCTION: L'Enquête sur les personnes ayant une maladie chronique au Canada ­ composante de l'hypertension (EPMCC-H) est une enquête téléphonique transversale de 20 minutes sur le diagnostic et la prise en charge de l'hypertension. L'échantillon de l'EPMCC-H, sélectionné à partir des répondants à l'Enquête sur la santé dans les collectivités canadiennes (ESCC) de 2008, était composé de Canadiens (de 20 ans et plus) des dix provinces ayant déclaré avoir reçu un diagnostic d'hypertension. MÉTHODOLOGIE: Le questionnaire a été élaboré au moyen de la technique Delphi et a fait l'objet d'un examen externe ainsi que de tests qualitatifs. Statistique Canada s'est chargé des stratégies d'échantillonnage, du recrutement, de la collecte et du traitement des données. Les proportions ont été pondérées afin de représenter la population canadienne et les intervalles de confiance (IC) à 95 % ont été calculés au moyen de la méthode de rééchantillonnage bootstrap. RÉSULTATS: Si on le compare à la population de l'ESCC ayant déclaré souffrir d'hypertension, l'échantillon de l'EPMCC-H (n = 6 142) est légèrement plus jeune (âge moyen des répondants à l'EPMCC-H : 61,2 ans, IC à 95 % : 60,8 à 61,6; âge moyen des répondants à l'ESCC : 62,2 ans, IC à 95 % : 61,8 à 62,5), comporte plus de détenteurs d'un diplôme d'études postsecondaires (EPMCC-H : 52,0 %, IC à 95 %: 49,7 % à 54,2 %; ESCC : 47,5 %, IC à 95 % : 46,1 % à 48,9 %) et moins de répondants prenant un médicament pour l'hypertension (EPMCC-H : 82,5 %, IC à 95 % : 80,9 % à 84,1 %; ESCC : 88,6 %, IC à 95 % : 87,7 % à 89,6 %). CONCLUSION: Dans l'ensemble, l'EPMCC-H de 2009 est représentatif de sa population source et fournit des données nouvelles et exhaustives sur le diagnostic et la prise en charge de l'hypertension. L'enquête a été adaptée à d'autres maladies chroniques ­ diabète, asthme/maladie pulmonaire obstructive chronique et troubles neurologiques. Le questionnaire est accessible à partir du site Web de Statistique Canada; des résultats descriptifs ont été publiés par l'Agence de la santé publique du Canada.

The development of national indicators for the surveillance of osteoporosis in Canada.

INTRODUCTION: The Public Health Agency of Canada, in collaboration with bone health and osteoporosis experts from across Canada (n = 12), selected a core set of indicators for the public health surveillance of osteoporosis using a formal consensus process. METHODS: A literature review identified candidate indicators that were subsequently categorized into an osteoporosis-specific indicator framework. A survey was then administered to obtain expert opinion on the indicators' public health importance. Indicators that scored less than 3 on a Likert scale of 1 (low) to 5 (high) were excluded from further consideration. Subsequently, a majority vote on the remaining indicators' level of public health importance was sought during a face-to-face meeting. RESULTS: The literature yielded 111 indicators, and 88 were selected for further consideration via the survey. At the face-to-face meeting, more than half the experts considered 39 indicators to be important from the public health perspective. CONCLUSION: This core set of indicators will serve to inform the development of new data sources and the integration, analysis and interpretation of existing data into surveillance products for the purpose of public health action.

Perception of uncontrolled blood pressure and behaviours to improve blood pressure: findings from the 2009 Survey on Living with Chronic Diseases in Canada.

Individuals with hypertension should lower and maintain their blood pressure levels through lifestyle modification and/or pharmacotherapy. To determine whether perception of blood pressure control is related to behaviours and intentions for improving blood pressure, data from 6142 Canadians age 20+ years with self-reported hypertension were analysed. Relationships between perception of control, current behaviours for blood pressure control and intentions to improve these behaviours were examined. Although individuals who reported uncontrolled blood pressure were equally likely to report engaging in lifestyle behaviours for blood pressure control, they were more likely to indicate an intention to improve their health, compared with those who reported well-controlled/low blood pressure. These individuals were also less likely to report having enough information to control their blood pressure. In addition, they were less likely to report having been advised to take antihypertensive medication, and to be taking and adhering to medications. Individuals who perceive their blood pressure as uncontrolled have intentions to make health-enhancing changes but may lack the information to do so. The study highlights the potential need for programmes/services to help those with uncontrolled blood pressure make lifestyle changes and/or take appropriate medication.

Life with arthritis in Canada: a personal and public health challenge.

"Arthritis" describes more than 100 conditions that affect the joints, the tissues that surround joints and other connective tissue. These conditions range from relatively mild forms of tendonitis and bursitis to systemic illnesses, such as rheumatoid arthritis. Life with arthritis in Canada: a personal and public health challenge presents the latest knowledge about arthritis in the Canadian population and its wide-ranging impact. It provides an overview of the impact of arthritis, and is designed to increase public awareness of the importance of prevention and timely management. Although progress has been made on interventions, arthritis remains common, disabling and costly. Increasing participation in physical activity and maintaining a healthy body weight may help to mitigate the effects of arthritis.

Population-based Canadian hip fracture rates with international comparisons.

SUMMARY: We identified hospitalizations throughout Canada during 2000-2005 in which the most responsible diagnosis was a proximal femoral fracture. Use of the US fracture risk assessment tool (FRAX) would be inappropriate for Canada as it would overestimate fracture risk in Canadian women and older men. INTRODUCTION: It is recommended that the WHO fracture risk assessment tool should be calibrated to the target population. METHODS: We identified hospitalizations for women and men throughout Canada during the study period 2000-2005 in which the most responsible diagnosis was a proximal femoral fracture (147,982 hip fractures). Age-standardized hip fracture rates were compared between Canadian provinces, and national rates were compared with those reported for the USA and Germany. RESULTS: There were relatively small differences in hip fracture rates between provinces, and most did not differ appreciably from the Canadian average. Hip fracture rates for women in Canada in 2001 were substantially lower than in the USA (population-weighted rate ratio 0.70) and were also lower than in Germany for 2004 (population-weighted rate ratio 0.74). CONCLUSIONS: Overall hip fracture rates for Canadian women were found to be substantially lower than those for the USA and Germany. This study underscores the importance of assessing country-specific fracture patterns prior to adopting an existing FRAX tool.

Stress on the farm and its association with injury.

The objectives of this study were to examine associations between perceived psychosocial stress and farm injury among men and women in Ontario, Canada. Cross-sectional data from the Ontario Farm Family Health Study were used to investigate perceived levels of stress, farm injuries and their interrelationships. Age-standardized rates of injury were 13.3/100/year and 3.8/100/year for men and women, respectively. The most common types of injury were strains/sprains/torn ligaments and cuts/lacerations. Approximately 18% of men and 11% of women reported that their lives were "very stressful." Common sources of stress were money worries and feeling overworked. The risk for farm injury increased with level of stress. For men, the adjusted odds ratios for injury were: 1.00 (referent), 1.02 (95% CI: 0.72, 1.42), and 1.61 (95% CI: 1.08, 2.41)for lowest to highest stress levels, respectively. For women, adjusted odds ratios were: 1.00 (referent), 1.43 (95% CI: 0.83, 2.47), and 2.73 (95% CI: 1.38, 5.39). These risks were especially pronounced among women who were not employed off the farm. This study represents a novel quantitative analysis examining associations between perceived psychological stress and farm injury. Future research should investigate these associations in other farm populations, confirm their temporal directions, and further explore the effect of gender on the strength of these associations.

Contribution of clinical breast examination to mammography screening in the early detection of breast cancer.

OBJECTIVES: As the benefit of clinical breast examination (CBE) over that of screening mammography alone in reducing breast cancer mortality is uncertain, it is informative to monitor its contribution to interim measures of effectiveness of a screening programme. Here, the contribution of CBE to screening mammography in the early detection of breast cancer was evaluated. SETTING: Four Canadian organised breast cancer screening programmes. METHODS: Women aged 50-69 receiving dual screening (CBE and mammography) (n = 300,303) between 1996 and 1998 were followed up between screen and diagnosis. Outcomes assessed by mode of detection (CBE alone, mammography alone, or both CBE and mammography) included referral rate, positive predictive value, pathological features of tumours (size, nodal status, morphology), and cancer detection rates overall and for small cancers (< or = 10 mm or node-negative). Heterogeneity in findings across programmes was also assessed. RESULTS: On first versus subsequent screen, CBE alone resulted in 28.5-36.7% of referrals, and 4.6-5.9% of cancers compared with 52.6-60.1% of referrals and 60.0-64.3% of cancers for mammography alone. Among cancers detected by CBE, 83.6-88.6% were also detected by mammography, whereas for mammographically detected cancers only 31.7-37.2% were also detected by CBE. On average, CBE increased the rate of detection of small invasive cancers by 2-6% over rates if mammography was the sole detection method. Without CBE, programmes would be missing three cancers for every 10,000 screens and 3-10 small invasive cancers in every 100,000 screens. CONCLUSIONS: Inclusion of CBE in an organised programme contributes minimally to early detection.

Waiting times from abnormal breast screen to diagnosis in 7 Canadian provinces.

BACKGROUND: Delay to breast cancer diagnosis following an abnormal screening result is associated with anxiety and personal disruption. We assessed the patterns and timeliness of diagnostic follow-up after breast cancer screening for women with abnormal results who attended organized screening programs in 7 provinces. METHODS: Using data from the Canadian Breast Cancer Screening Database, we identified 203,141 women aged 50-69 years who underwent screening in 1996 through provincially organized breast cancer screening programs in British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, Nova Scotia and Newfoundland. We prospectively followed women with an abnormal screening result through to the completion of the assessment process. We evaluated the waiting times from screening examination to first assessment, from screening examination to first imaging, from screening examination to diagnosis and from first assessment to diagnosis for 13,958 women, stratified according to screening program, mode of detection, whether a biopsy was performed and whether cancer was diagnosed. RESULTS: We observed considerable variations between and within programs in the time to diagnosis. The median time from screening examination to first assessment was 2.6 weeks. The median time from screening examination to diagnosis was 3.7 weeks; this time increased to 6.9 weeks for women undergoing biopsy. Even when no biopsy was performed, 10% of the women waited 9.6 weeks or longer for a diagnosis, as compared with 15.0 weeks or longer for 10% of the women undergoing biopsy. Among the women who had a biopsy, the use of core biopsy was associated with a shorter median time to diagnosis than was open biopsy, and those found to have cancer had shorter waiting times than women with benign biopsy findings. INTERPRETATION: Women undergoing assessment of an abnormal breast cancer screening result waited many weeks for a diagnosis, especially when a biopsy was performed. To ensure that targets for timeliness, adopted nationally in 1999, are realized, improved models of care or dissemination of existing efficient techniques to reach a diagnosis will be needed.

Factors important in promoting cervical cancer screening among Canadian women: findings from the 1996-97 National Population Health Survey (NPHS).

Although routine Pap screening represents an effective tool in the early detection of cervical cancer, it remains underused by some Canadian women. This study examines selected sociodemographic, health, lifestyle, and system barriers to Pap test participation among 33,817 women aged 18+ years in the cross-sectional 1996-97 National Population Health Survey (NPHS). Among women 18 years and over, 87% reported ever having had a Pap test while 72% reported a recent (< 3 years) test. A report of ever and recent use was most common among women 25-34 (92% and 86.9%, respectively). Only 0.6% of recently screened women reported access problems. Among those without a recent test, most (53%) reported that they did not think it was necessary. Pap test use varied little across provinces and was less common among older and single women, those with lower education, a spoken language other than English, a birth place outside Canada and negative health and lifestyle characteristics.

Predictors of mammography use among Canadian women aged 50-69: findings from the 1996/97 National Population Health Survey.

BACKGROUND: Screening mammography, although recommended every 2 years for women aged 50-69, is thought to be underused among select groups of Canadian women. METHODS: We used data from the 1996/97 National Population Health Survey to describe current patterns in mammography use (including reasons for not having a mammogram within the 2 years before the survey and future screening intentions) in Canada and to determine factors associated with nonparticipation and time-inappropriate use (mammogram 2 or more years before the survey) among women aged 50-69. RESULTS: Among respondents aged 50-69, 79.1% (95% confidence interval [CI] 76.9%-81.2%) reported ever having had a mammogram, and 53.6% (95% CI 51.4%-55.9%) had had a recent (time-appropriate) mammogram (within the 2 years before the survey). Only 0.6% (95% CI 0.3%-0.9%) of recently screened women reported problems of access, and few reported personal or health system barriers as reasons for not obtaining a recent mammogram. Over 50% of the women who had not had a recent mammogram reported that they did not think it was necessary, and only 28.2% (95% CI 23.8%-32.7%) of those who had never had a mammogram planned to have one within the 2 years following the survey. The rate of time-appropriate mammography varied significantly by province, from 41.1% (95% CI 29.3%-52.9%) in Newfoundland to 69.4% (95% CI 61.3%-77.6%) in British Columbia. Significant predictors of never having had a mammogram included higher age, residence in a rural area, Asia as place of birth, no involvement in volunteer groups, no regular physician or recent medical consultations (including recent blood pressure check), current smoking, infrequent physical activity and no hormone replacement therapy. INTERPRETATION: Despite increases in mammography screening rates since the 1994/95 National Population Health Survey, current estimates indicate that almost 50% of women aged 50-69 have not had a time-appropriate mammogram. Our findings confirm continued low mammography participation rates among older women and those in rural areas, select ethnic groups and women with negative health care and lifestyle characteristics.

Injuries in Ontario farm children: a population based study.

OBJECTIVES: To evaluate injury rates, patterns, and risk factors in 4,916 Ontario farm children aged 0-18 years. SETTING: 1,765 full time family operated Ontario farms with a husband-wife couple where the wife was of reproductive age. METHODS: Injury details were obtained from mothers, while parents and farm operators provided risk factor information retrospectively in a population based mail survey. Rates were calculated based on injury occurrence and person years at risk in different age groups. Descriptive analyses used cross tabulations of injury details by age, sex, and season. Injury risk factors were assessed using multiple logistic regression. RESULTS: Age specific injury rates ranged from 6.3-22.6 per thousand person years, peaking in 1-4 year olds. Although consistently higher for boys, both sexes showed similar trends in age specific rates. Rates likely represent underestimates due to diminished recall of past events. Open wounds to the head/face region were the most prevalent type of injury (17.1%) followed by fractures/dislocations to the upper extremities (14.9%). Mechanism differed by age group, though falls and machinery consistently ranked in the top three. Occurrence peaked in summer. Regression analyses indicated child's sex and parental education were associated with injury risk across age categories. Other risk factors, such as numbers of livestock, parental owner/operator status, and mother's off-site employment, differed between ages. CONCLUSIONS: Patterns and risk factors for injuries to farm children are heterogenous across age categories. Observed age differences are useful for targeting prevention initiatives.

2,4-Dichlorophenoxyacetic acid residues in semen of Ontario farmers.

Although paternal exposures to environmental toxicants probably play a role in adverse pregnancy outcomes, few data are available on the extent of this exposure. One semen and two 24-h urine samples were collected from 97 Ontario farmers who had recently used the phenoxy herbicides 2,4-D (2.4-dichlorophenoxyacetic acid) and/or MCPA ([4-chloro-2-methylphenoxyl acetic acid). Both samples were analyzed for 2,4-D using an immunoassay-based technique. Approximately 50% of the semen samples had detectable levels of 2, 4-D (> or =5.0 pph (ng/mL)). Semen levels of 2.4-D were correlated more closely with the second of the two urine samples. Although several studies have measured 2.4-D in the urine of applicators, this study is the first to attempt to measure 2,4-D levels in semen. As these pesticides can be excreted in the semen, they could be toxic to sperm cells and be transported to the woman and developing embryo/fetus. Further research is needed to understand how pesticide handling practices can affect semen pesticide residues and the relationship between the levels observed and reproductive health.