Functional difficulties in children and youth with autism spectrum disorder: analysis of the 2019 Canadian Health Survey on Children and Youth. / Difficultés fonctionnelles chez les enfants et les jeunes atteints d'un trouble du spectre de l'autisme : une analyse de l'Enquête canadienne sur la santé des enfants et des jeunes de 2019.

INTRODUCTION: This study examined the prevalence of functional difficulties and associated factors in Canadian children/youth aged 5 to 17 years diagnosed with autism spectrum disorder (ASD). METHODS: We analyzed data from the 2019 Canadian Health Survey on Children and Youth (CHSCY), a nationally representative survey of Canadian children/youth that used the Washington Group Short Set on Functioning (WG-SS) to evaluate functioning in six daily tasks. For each functional domain, binary outcomes were derived (no/some difficulty, a lot of difficulty/no ability). We used logistic regression to identify associations between demographic characteristics, educational experiences, and perceived mental and general health and the most common functional difficulties, namely those related to remembering/concentrating, communication and self-care. All estimates were weighted to be representative of the target population. The bootstrap method was used to calculate variance estimates. RESULTS: Analysis of the records of 660 children/youth with ASD revealed that the most common functional difficulties were remembering/concentrating (22%; 95% CI: 18-27), communicating (19%; 95% CI: 15-23) and self-care (13%; 95% CI: 10-17). Lower perceived mental health was associated with increased functional difficulties with remembering/concentrating. ASD diagnosis at a lower age and lower perceived general health were associated with increased functional difficulty with communication. Parental expectations for postsecondary education were associated with decreased functional difficulty for self-care. CONCLUSION: One or more functional difficulties from the WG-SS was present in 39% of Canadian children/youth aged 5 to 17 years with ASD. Functional difficulties with remembering/concentrating, communication and self-care were most common.

Accuracy of administrative database algorithms for autism spectrum disorder, attention-deficit/hyperactivity disorder and fetal alcohol spectrum disorder case ascertainment: a systematic review. / Exactitude des algorithmes des bases de données administratives pour la détermination des cas de trouble du spectre de l'autisme, de trouble du déficit de l'attention/hyperactivité et de trouble du spectre de l'alcoolisation fœtale : revue systématique.

INTRODUCTION: The purpose of this study was to perform a systematic review to assess the validity of administrative database algorithms used to identify cases of autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD) and fetal alcohol spectrum disorder (FASD). METHODS: MEDLINE, Embase, Global Health and PsycInfo were searched for studies that validated algorithms for the identification of ASD, ADHD and FASD in administrative databases published between 1995 and 2021 in English or French. The grey literature and reference lists of included studies were also searched. Two reviewers independently screened the literature, extracted relevant information, conducted reporting quality, risk of bias and applicability assessments, and synthesized the evidence qualitatively. PROSPERO CRD42019146941. RESULTS: Out of 48 articles assessed at full-text level, 14 were included in the review. No studies were found for FASD. Despite potential sources of bias and significant between-study heterogeneity, results suggested that increasing the number of ASD diagnostic codes required from a single data source increased specificity and positive predictive value at the expense of sensitivity. The best-performing algorithms for the identification of ASD were based on a combination of data sources, with physician claims database being the single best source. One study found that education data might improve the identification of ASD (i.e. higher sensitivity) in school-aged children when combined with physician claims data; however, additional studies including cases without ASD are required to fully evaluate the diagnostic accuracy of such algorithms. For ADHD, there was not enough information to assess the impact of number of diagnostic codes or additional data sources on algorithm accuracy. CONCLUSION: There is some evidence to suggest that cases of ASD and ADHD can be identified using administrative data; however, studies that assessed the ability of algorithms to discriminate reliably between cases with and without the condition of interest were lacking. No evidence exists for FASD. Methodologically higher-quality studies are needed to understand the full potential of using administrative data for the identification of these conditions.

Population coverage of the Canadian Chronic Disease Surveillance System: a survey of the contents of health insurance registries across Canada. / Couverture de la population dans le Système canadien de surveillance des maladies chroniques : enquête sur le contenu des registres d'assurance-maladie au Canada.

INTRODUCTION: Health insurance registries, which capture insurance coverage and demographic information for entire populations, are a critical component of population health surveillance and research when using administrative data. Lack of standardization of registry information across Canada's provinces and territories could affect the comparability of surveillance measures. We assessed the contents of health insurance registries across Canada to describe the populations covered and document registry similarities and differences. METHODS: A survey about the data and population identifiers in health insurance registries was developed by the study team and representatives from the Public Health Agency of Canada. The survey was completed by key informants from most provinces and territories and then descriptively analyzed. RESULTS: Responses were received from all provinces; partial responses were received from the Northwest Territories. Demographic information in health insurance registries, such as primary address, date of birth and sex, were captured in all jurisdictions. Data captured on familial relationships, ethnicity and socioeconomic status varied among jurisdictions, as did start and end dates of coverage and frequency of registry updates. Identifiers for specific populations, such as First Nations individuals, were captured in some, but not all jurisdictions. CONCLUSION: Health insurance registries are a rich source of information about the insured populations of the provinces and territories. However, data heterogeneity may affect who is included and excluded in population surveillance estimates produced using administrative health data. Development of a harmonized data framework could support timely and comparable population health research and surveillance results from multi-jurisdiction studies.

Determination of Rheumatoid Arthritis Incidence and Prevalence in Alberta Using Administrative Health Data.

OBJECTIVE: The objective of the study was to estimate the incidence and prevalence of rheumatoid arthritis (RA) in Alberta using administrative health data. METHODS: We identified RA cases in patients 16 years and older by applying a national case definition to linked administrative health data (ie, hospital discharge abstract records, physician claims, and health insurance registry records) using a unique personal identifier. Incidence and prevalence are reported for the 2015-2016 fiscal year and a trend analysis from 2011-2012 to 2015-2016. Incidence and prevalence estimates were standardized using the 2011 Canadian census population. RESULTS: In 2015-2016, the overall crude incidence was 0.74 [95% confidence interval (CI): 0.71-0.77] per 1000 and crude prevalence was 1.08% (95% CI: 1.07-1.09). The women-to-men crude incidence and prevalence sex ratios were 2.04 and 2.19, respectively. People aged 65 to 79 years had the highest incidence of RA, and the highest prevalence was observed among those 80 years and older. From 2011-2012 to 2015-2016, the overall age-standardized incidence decreased [0.97 (95% CI: 0.94-1.01) to 0.79 (95% CI: 0.76-0.82) per 1000], whereas age-standardized prevalence remained constant [1.17 (95% CI: 1.15-1.18) to 1.18 (95% CI: 1.17-1.19)]. CONCLUSION: In Alberta, there was a decreasing trend in RA incidence over the study period, whereas prevalence was stable. These estimates, combined with clinical data, will be used to measure system performance for quality improvement and to inform simulation modeling for planning the expected demand for health services for patients living with RA.

Early Mobilization in the Pediatric Intensive Care Unit: A Quality Improvement Initiative.

Mobilizing patients during an intensive care unit admission results in improved clinical and functional outcomes. The goal of this quality improvement project was to increase the percentage of patients in the pediatric intensive care unit (PICU) mobilized early from 62% to 80%. Early mobilization was within 18 hours of admission for nonmechanically ventilated (non-MV) patients and 48 hours for mechanically ventilated (MV) patients. METHODS: We collected data from September 15, 2015, to December 15, 2016, identified key drivers and barriers, and developed interventions. Interventions included the development of an algorithm to identify patients appropriate for mobilization, management of barriers to mobilization, and education on the benefits of early mobilization. The percentage of PICU patients mobilized early; the percentage of patients with physical therapy, occupational therapy (OT), speech-language pathology (SLP), and activity orders; identified barriers; PICU and hospital length of stay (LOS) and discharge disposition, were compared between the pre- and postintervention groups and the non-MV and MV subgroups. The MV subgroup was too small for statistical testing. RESULTS: All measures in the combined postintervention group improved and reached significance (<0.05), except for the percentage of SLP orders and discharged home. Percentage mobilized early increased 25%, activity orders 50%, physical therapist orders 14%, OT orders 11%, SLP orders 7%, and discharged home 6%. Hospital LOS decreased by 35%, and PICU LOS decreased by 34%. All measures in the postintervention, non-MV subgroup improved and reached significance (<0.05). CONCLUSIONS: This early mobilization program was associated with statistically significant improvements in the rate of early mobilization, activity and therapy orders, and hospital and PICU LOS.

Childhood Maltreatment as a Risk Factor for Arthritis: Findings From a Population-Based Survey of Canadian Adults.

OBJECTIVE: To establish whether there is a relationship between the frequency and severity of different types of childhood maltreatment and adulthood arthritis. METHODS: Analysis of the 2012 Canadian Community Health Survey-Mental Health included 21,889 respondents ages ≥18 years. Severity and frequency of childhood physical abuse (CPA), and childhood sexual abuse (CSA), and the frequency of childhood exposure to intimate partner violence (CEIPV) were assessed by asking about "things that may have happened to you before you were 16 in your school, in your neighborhood, or in your family." Respondents were also asked about chronic conditions diagnosed by a health professional, including arthritis. Covariates were sociodemographic characteristics, health risk variables (e.g., obesity), mental disorders, and a count of other chronic conditions. Multivariate logistic regression analysis was used to examine associations between childhood maltreatment and arthritis. RESULTS: A total of 17.5% of respondents reported arthritis. A higher prevalence of arthritis was observed for those who had experienced severe and/or frequent childhood maltreatment (32% for CPA and 27% for both CSA and CEIPV). These relationships persisted after controlling for sociodemographic variables. After controlling for all covariates, arthritis remained independently associated with severe and/or frequent CPA (dose-response relationship) and frequent CEIPV. CONCLUSION: We found that the greater the frequency and severity of childhood maltreatment, the greater the magnitude of association with arthritis. This might reflect the role of the enduring immune and metabolic abnormalities and chronic inflammation associated with childhood maltreatment in the etiopathogensis of osteoarthritis (OA) or be an indicator of the role of joint injury in causing OA.

Screening, prevention and management of osteoporosis among Canadian adults. / Dépistage, prévention et prise en charge de l'ostéoporose chez les adultes canadiens.

INTRODUCTION: This study provides a benchmark for the nationwide use of osteoporosis screening, prevention and management strategies among Canadians aged 40 years and older (40+) using data collected one year prior to the release of Osteoporosis Canada's latest (2010) clinical practice guidelines. METHODS: Data are from the 2009 Canadian Community Health Survey-Osteoporosis Rapid Response Component. The study sample (n = 5704) was divided into four risk subgroups: (1) osteoporosis diagnosis and major fracture; (2) osteoporosis diagnosis only; (3) major fracture only; or (4) neither osteoporosis diagnosis nor major fracture. We calculated descriptive statistics and performed multinomial multivariate logistic regression analyses to examine factors independently associated with osteoporosis screening, prevention and management strategies. Estimates were weighted to represent the Canadian household population (40+) living in the 10 provinces. RESULTS: Approximately 10.1% of the population or 1.5 million Canadians 40+ reported having been diagnosed with osteoporosis. The majority related taking vitamin D or calcium supplements and having been prescribed osteoporosis medication(s), while less than 40% reported regular physical activity. Among those without a reported osteoporosis diagnosis, an estimated 6.7% or 1 million reported having had a major fracture, of which one-third reported having had a bone density test and less than half reported taking vitamin D supplements, calcium supplements or engaging in regular physical activity. Major fracture history was not associated with bone density testing or osteoporosis medication use. CONCLUSION: A large proportion of Canadians at risk for osteoporosis-those with a major fracture history-are not undergoing bone density testing nor are they engaging in lifestyle approaches known to help maintain healthy bones. This study provides the historical information required to evaluate whether the latest clinical practice guidelines have had an impact on osteoporosis care in Canada.

INTRODUCTION: Cette étude constitue une référence pour l'emploi à l'échelle nationale des stratégies de dépistage, de prévention et de prise en charge de l'ostéoporose chez les Canadiens de 40 ans et plus. Elle repose sur des données recueillies un an avant la publication des dernières Lignes directrices de pratique clinique (2010) d'Ostéoporose Canada. MÉTHODOLOGIE: Les données proviennent de la composante Réponse rapide sur l'ostéoporose de l'Enquête sur la santé dans les collectivités canadiennes de 2009. L'échantillon de l'étude (n = 5704) a été divisé en quatre sous-groupes de risque : 1) diagnostic d'ostéoporose et fracture majeure, 2) diagnostic d'ostéoporose seulement, 3) fracture majeure seulement et 4) aucun diagnostic d'ostéoporose et aucune fracture majeure. Nous avons calculé des statistiques descriptives et effectué des analyses de régression logistique multinomiale multivariée pour déterminer les facteurs indépendants associés aux stratégies de dépistage, de prévention et de prise en charge de l'ostéoporose. Les estimations ont été pondérées afin d'être représentatives de la population des ménages canadiens de 40 ans et plus vivant dans les dix provinces. RÉSULTATS: Environ 10,1 % de la population, soit 1,5 million de Canadiens de 40 ans et plus, ont déclaré avoir reçu un diagnostic d'ostéoporose. La majorité d'entre eux ont déclaré avoir pris des suppléments de vitamine D ou de calcium et avoir reçu une ordonnance de médicaments pour l'ostéoporose, mais moins de 40 % ont déclaré faire de l'activité physique régulière. Parmi les personnes sans diagnostic d'ostéoporose, environ 6,7 % (1 million) ont déclaré avoir subi une fracture majeure. Sur ce nombre, le tiers a déclaré avoir passé une densitométrie osseuse et moins de la moitié a déclaré avoir pris des suppléments de vitamine D ou de calcium ou faire de l'activité physique régulière. Les antécédents de fracture majeure n'ont pas été associés aux examens de densitométrie osseuse ni à la consommation de médicaments contre l'ostéoporose. CONCLUSION: Une grande partie des Canadiens qui risquent de souffrir d'ostéoporose ­ ceux ayant des antécédents de fracture majeure ­ ne passent pas de densitométrie osseuse et n'adoptent pas de mode de vie favorable à la santé osseuse. Cette étude fournit les données de référence dans le temps nécessaires pour évaluer si les dernières lignes directrices de pratique clinique vont avoir eu une incidence sur les soins liés à l'ostéoporose au Canada.

The Canadian Chronic Disease Surveillance System: A model for collaborative surveillance.

Chronic diseases have a major impact on populations and healthcare systems worldwide. Administrative health data are an ideal resource for chronic disease surveillance because they are population-based and routinely collected. For multi-jurisdictional surveillance, a distributed model is advantageous because it does not require individual-level data to be shared across jurisdictional boundaries. Our objective is to describe the process, structure, benefits, and challenges of a distributed model for chronic disease surveillance across all Canadian provinces and territories (P/Ts) using linked administrative data. The Public Health Agency of Canada (PHAC) established the Canadian Chronic Disease Surveillance System (CCDSS) in 2009 to facilitate standardized, national estimates of chronic disease prevalence, incidence, and outcomes. The CCDSS primarily relies on linked health insurance registration files, physician billing claims, and hospital discharge abstracts. Standardized case definitions and common analytic protocols are applied to the data for each P/T; aggregate data are shared with PHAC and summarized for reports and open access data initiatives. Advantages of this distributed model include: it uses the rich data resources available in all P/Ts; it supports chronic disease surveillance capacity building in all P/Ts; and changes in surveillance methodology can be easily developed by PHAC and implemented by the P/Ts. However, there are challenges: heterogeneity in administrative databases across jurisdictions and changes in data quality over time threaten the production of standardized disease estimates; a limited set of databases are common to all P/Ts, which hinders potential CCDSS expansion; and there is a need to balance comprehensive reporting with P/T disclosure requirements to protect privacy. The CCDSS distributed model for chronic disease surveillance has been successfully implemented and sustained by PHAC and its P/T partners. Many lessons have been learned about national surveillance involving jurisdictions that are heterogeneous with respect to healthcare databases, expertise and analytical capacity, population characteristics, and priorities.

Introduction. / Introduction.

We are pleased to bring you the second of two special issues on mood and anxiety disorders focussing on data from the 2014 Survey on Living with Chronic Diseases in Canada-Mood and Anxiety Disorder Component (SLCDC-MA). In December of 2016, we published the first issue, which included three articles describing various aspects of Canadian adults with a self-reported diagnosed mood and/or anxiety disorder including their sociodemographic characteristics, health status, activity limitations and level of disability and factors associated with well-being. The three articles in this (second) issue investigate topics related to the management of these disorders. Collectively, the articles explore key sociodemographic factors known to influence health-related outcomes and discuss strategies aimed at promoting the recovery and well-being of Canadian adults with a self-reported mood and/or anxiety disorder diagnosis.

RÉSUMÉ: C'est avec plaisir que nous vous présentons le second de nos deux numéros spéciaux sur les troubles de l'humeur et d'anxiété, fondés sur les résultats de l'Enquête sur les personnes ayant une maladie chronique au Canada − Composante des troubles de l'humeur et d'anxiété (EPMCC-THA). Le premier numéro, publié en décembre 2016, contenait trois articles brossant un portrait des adultes canadiens ayant déclaré avoir reçu un diagnostic de troubles de l'humeur ou d'anxiété, à savoir leurs caractéristiques sociodémographiques, leur état de santé, les limitations dans leurs activités ainsi que leur degré d'invalidité et enfin les facteurs associés à leur bien-être. Les trois articles publiés ici portent quant à eux sur des thèmes liés à la prise en charge de ces troubles. Globalement, ces articles explorent les facteurs sociodémographiques clés dont on sait qu'ils ont un impact sur les résultats de santé, et ils traitent également des stratégies visant à favoriser la guérison et le mieux-être des adultes canadiens ayant déclaré avoir reçu un diagnostic de troubles de l'humeur ou d'anxiété.

Factors associated with delayed diagnosis of mood and/or anxiety disorders. / Facteurs associés au diagnostic tardif d'un trouble de l'humeur et/ou d'anxiété.

INTRODUCTION: This study examined the association between time to diagnosis and sociodemographic and clinical characteristics as well as time to diagnosis and physical and mental health status, among Canadian adults with a self-reported mood and/or anxiety disorder diagnosis. METHODS: We used data from the 2014 Survey on Living with Chronic Diseases in Canada-Mood and Anxiety Disorders Component. The study sample (n=3212) was divided into three time to diagnosis subgroups: long (> 5 years), moderate (1-5 years) and short (< 1 year). We performed descriptive and multinomial multivariate logistic regression analyses. Estimates were weighted to represent the Canadian adult household population living in the 10 provinces with diagnosed mood and/or anxiety disorders. RESULTS: The majority (61.6%) of Canadians with a mood and/or anxiety disorder diagnosis reported having received their diagnosis more than one year after symptom onset (30.0% reported a moderate delay and 31.6% a long delay). Upon controlling for individual characteristics, we found significant associations between a moderate delay and having no or few physical comorbidities; a long delay and older age; and both moderate and long delays and early age of symptom onset. In addition, a long delay was significantly associated with "poor" or "fair" perceived mental health and the greatest number of activity limitations. CONCLUSION: These findings affirm that a long delay in diagnosis is associated with negative health outcomes among Canadian adults with mood and/or anxiety disorders. Time to diagnosis is particularly suboptimal among older adults and people with early symptom onset. Tailored strategies to facilitate an early diagnosis for those at greatest risk of a delayed diagnosis, especially for those with early symptom onset, are needed.

INTRODUCTION: Cette étude examine les relations entre le délai écoulé avant l'établissement d'un diagnostic et les caractéristiques sociodémographiques et cliniques, ainsi que les relations entre ce délai de diagnostic et l'état de santé physique et mental des adultes canadiens ayant déclaré avoir reçu un diagnostic de trouble de l'humeur et/ou d'anxiété. MÉTHODOLOGIE: L'Enquête sur les personnes ayant une maladie chronique au Canada ­ Composante sur les troubles de l'humeur et d'anxiété de 2014 a été utilisée pour cette étude. L'échantillon de l'étude (n = 3 212) a été divisé en trois sous-groupes en fonction du délai de diagnostic : long (plus de 5 ans), modéré (1 à 5 ans) et court (moins d'un an). Nous avons réalisé des analyses de régression logistique multivariées descriptives et multinomiales. Nous avons pondéré toutes les estimations afin que les données soient représentatives de la population canadienne adulte vivant en logement privé dans l'une des 10 provinces et ayant déclaré avoir reçu un diagnostic de troubles de l'humeur et/ou d'anxiété. RÉSULTATS: La plupart (61,6 %) des adultes canadiens ayant déclaré avoir reçu un diagnostic de trouble de l'humeur et/ou d'anxiété ont dit avoir reçu leur diagnostic plus d'un an après l'apparition des symptômes (délai modéré : 30,0 %; délai long : 31,6 %). Après ajustement des caractéristiques individuelles, nous avons constaté qu'un délai modéré était significativement associé à la présence d'un faible nombre de comorbidités physiques ou d'aucune, qu'un délai long était significativement associé à un âge plus avancé, et qu'un délai long ou modéré étaient significativement associés à l'apparition de symptômes à un jeune âge. Finalement, un délai long était significativement associé à une santé mentale perçue comme « mauvaise ¼ ou « passable ¼ et à un nombre plus élevé de limitations d'activité. CONCLUSION: Ces résultats confirment qu'un long délai de diagnostic est associé à des résultats de santé négatifs chez les adultes canadiens atteints de trouble de l'humeur et/ou d'anxiété. Le délai de diagnostic est particulièrement sous-optimal chez les adultes plus âgés et les personnes dont les symptômes sont apparus à un jeune âge. La mise en oeuvre de stratégies adaptées facilitant l'établissement d'un diagnostic précoce chez les personnes les plus susceptibles d'obtenir un diagnostic tardif, surtout chez celles dont les symptômes sont apparus à un jeune âge, est nécessaire.

Use of medication and psychological counselling among Canadians with mood and/or anxiety disorders. / Recours aux médicaments et aux consultations psychologiques chez les Canadiens atteints d'un trouble de l'humeur et/ou d'anxiété.

INTRODUCTION: This study describes the use of prescription medications and psychological counselling in the past 12 months among Canadian adults with a self-reported mood and/or anxiety disorder diagnosis; the sociodemographic and clinical characteristics associated with their use; and reasons for not using them. METHODS: We used data from the 2014 Survey on Living with Chronic Diseases in Canada-Mood and Anxiety Disorders Component. The study sample (n = 2916) was divided into four treatment subgroups: (1) taking medication only; (2) having received counselling only; (3) both; or (4) neither. We combined the first three subgroups and carried out descriptive and multivariate logistic regression analyses comparing those who are taking medication and/or have received counselling in the past 12 months, versus those doing neither. Estimates were weighted to represent the Canadian adult household population living in the 10 provinces with diagnosed mood and/or anxiety disorders. RESULTS: The majority (81.8%) of Canadians with a mood and/or an anxiety disorder diagnosis reported they are taking medications and/or have received counselling (47.6% taking medications only; 6.9% received counselling only; and 27.3% taking/having received both). Upon controlling for individual characteristics, taking medications and/or having received counselling was significantly associated with older age; higher household income; living in the Atlantic region or Quebec versus Ontario; and having concurrent disorders or mood disorders only. Symptoms controlled without medication was the most common reason for not taking medications, while preferring to manage on their own and taking medications were among the common reasons for not having received counselling. CONCLUSION: The majority of Canadian adults with a mood and/or an anxiety disorder diagnosis are taking medications, while few have received counselling. Insights gained regarding the factors associated with these treatments, and reasons for not using them, emphasize the importance of discussing treatment options and perceived barriers with patients to ensure they receive the best treatment according to their needs and preference.

INTRODUCTION: L'étude décrit le recours aux médicaments sur ordonnance et aux consultations psychologiques au cours des 12 derniers mois chez les Canadiens adultes ayant déclaré avoir reçu un diagnostic de trouble de l'humeur et/ou d'anxiété, les caractéristiques sociodémographiques et cliniques associées à ce recours et les raisons invoquées pour ne pas y recourir. MÉTHODOLOGIE: L'Enquête sur les personnes ayant une maladie chronique au Canada ­ Composante sur les troubles de l'humeur et d'anxiété de 2014 a été utilisée. L'échantillon de l'étude (n = 2 916) a été divisé en quatre sous-groupes de traitement : (1) prend des médicaments seulement; (2) a reçu des consultations psychologiques seulement; (3) prend des médicaments et a reçu des consultations psychologiques; ou (4) n'a eu recours à aucun de ces deux traitements. Nous avons combiné les trois premiers sous-groupes et effectué des analyses descriptives et de régression logistique multivariée pour comparer ceux qui prenaient des médicaments et/ou avaient reçu des consultations psychologiques par rapport à ceux n'ayant pas eu recours à ces deux traitements. Nous avons pondéré toutes les estimations afin que les données soient représentatives de la population canadienne adulte vivant en logement privé dans l'une des 10 provinces et ayant déclaré avoir reçu un diagnostic de troubles de l'humeur et/ou d'anxiété. RÉSULTATS: La majorité (81,8 %) des Canadiens adultes ayant déclaré avoir reçu un diagnostic de trouble de l'humeur et/ou d'anxiété ont indiqué prendre des médicaments et/ou avoir reçu des consultations psychologiques (47,6 % prenaient des médicaments seulement, 6,9 % avaient reçu des consultations psychologiques seulement et 27,3 % avaient eu recours aux deux modalités de traitement). Après ajustement des caractéristiques individuelles, le recours aux médicaments et/ou aux consultations psychologiques était significativement associé à un âge plus avancé, à un revenu du ménage plus élevé, à une résidence dans la région de l'Atlantique ou au Québec et à un trouble de l'humeur et d'anxiété concomitants ou à un trouble de l'humeur seulement. Le contrôle des symptômes sans l'utilisation de médicaments était la raison le plus souvent invoquée pour ne pas prendre de médicaments, et le désir de se débrouiller seul et la prise de médicaments figuraient parmi les raisons le plus souvent citées pour ne pas avoir bénéficié de consultations psychologiques. CONCLUSION: La majorité des Canadiens adultes atteints d'un trouble de l'humeur et/ou d'anxiété diagnostiqué prenaient des médicaments, mais une moins grande proportion d'entre eux avaient reçu des consultations psychologiques. En dégageant les facteurs associés au recours à ces traitements et les raisons invoquées pour ne pas y recourir, cette étude met en lumière l'importance de discuter avec les patients des options de traitement et des obstacles perçus afin d'offrir un traitement adapté à leurs besoins et leurs préférences.

The burden of generalized anxiety disorder in Canada. / Le fardeau du trouble d'anxiété généralisée au Canada.

INTRODUCTION: Although generalized anxiety disorder (GAD) is common and disabling, there are few Canadian studies on this mental illness. We compared the characteristics, health status, health services use and health care needs of Canadians with GAD to those with depression. METHODS: Data are from the 2012 Canadian Community Health Survey-Mental Health, which surveyed a nationally representative sample of Canadians aged 15 years and older (n = 23 709; response rate of 68.9%). The respondents we studied had selfreported symptoms compatible with GAD and/or major depressive episode (MDE) in the preceding 12 months (n = 1598). Estimates were weighted to represent the Canadian household population. We performed descriptive and multinomial multivariate logistic regression analyses. RESULTS: In 2012, an estimated 700 000 (2.5%) Canadians aged 15 years and older reported symptoms compatible with GAD in the previous 12 months. MDE symptoms co-occurred in 50% of these individuals. Those with GAD only reported fair/poor perceived health (29.7%), moderate to severe psychological distress (81.2%) and moderate to severe disability (28.1%) comparable to (or even slightly worse) than those with MDE only (24.7%, 78.8% and 24.8% respectively). Those with comorbid GAD and MDE demonstrated the worst health outcomes; 47.3% of them reported fair/poor perceived health, 94.0% reported moderate to severe psychological distress and 52.4% reported moderate to severe disability. Nearly 50% of those with comorbid GAD and MDE reported that their need for health care was not met or only partially met, compared to about 30% of those with GAD or MDE only. CONCLUSION: While GAD is associated with levels of distress and disability comparable to (or slightly worse) than those affected by MDE only, the health status of those with comorbid disease is significantly worse than those with GAD or MDE only. Improved diagnosis, screening for comorbidity and management are essential to minimize the impacts of this mental illness.

INTRODUCTION: Bien que le trouble d'anxiété généralisée (TAG) soit une affection courante et incapacitante, peu d'études ont été menées à son sujet au Canada. Nous avons comparé les Canadiens atteints du TAG avec ceux atteints de dépression sur le plan de leurs caractéristiques, de leur état de santé, de leur utilisation des services de santé et de leurs besoins en matière de santé. MÉTHODOLOGIE: : Les données sont tirées de l'Enquête sur la santé dans les collectivités canadiennes ­ Santé mentale de 2012, qui portait sur un échantillon représentatif de la population canadienne de 15 ans et plus (n = 23 709; taux de réponse de 68,9 %). Nous avons sélectionné les répondants ayant fait état de symptômes compatibles avec un TAG ou un épisode dépressif majeur (EDM) dans les 12 mois précédant l'enquête (n = 1 598). Les estimations ont été pondérées afin de représenter la population des ménages au Canada. Nous avons mené des analyses de régression logistiques multidimensionnelles multinomiales et descriptives. RÉSULTATS: En 2012, environ 700 000 (2,5 %) Canadiens de 15 ans et plus ont fait état de symptômes compatibles avec un TAG dans les 12 derniers mois. La moitié d'entre eux ont également mentionné des symptômes d'EDM. La fréquence des perceptions d'une santé passable ou mauvaise (29,7 %), de détresse psychologique modérée et sévère (81,2 %) et d'incapacité modérée et sévère (28,1 %) était comparable (voire légèrement supérieure) chez les personnes présentant un TAG seulement par rapport aux personnes présentant un EDM seulement (respectivement 24,7 %, 78,8 % et 24,8 %). Les pires résultats de santé ont été observés chez les personnes souffrant d'un TAG et d'un EDM en comorbidité : 47,3 % ont fait état d'une santé passable ou mauvaise, 94,0 % d'une détresse psychologique modérée ou sévère et 52,4 % d'une incapacité modérée ou sévère. Près de 50 % des personnes souffrant d'un TAG et d'un EDM en comorbidité ont déclaré que leurs besoins en matière de santé n'avaient pas été satisfaits ou avaient été partiellement satisfaits, contre environ 30 % des personnes souffrant d'un TAG ou d'un EDM seulement. CONCLUSION: Bien que le TAG soit associé à des degrés de détresse et d'incapacité comparables (ou légèrement supérieurs) à l'EDM, l'état de santé des personnes présentant ces deux affections en même temps est nettement moins bon que celui des personnes présentant uniquement l'un ou l'autre. Il est essentiel d'améliorer le diagnostic, le dépistage des comorbidités et la prise en charge pour réduire les impacts de ce trouble mental.

Childhood maltreatment as a risk factor for diabetes: findings from a population-based survey of Canadian adults.

BACKGROUND: It is well established that childhood maltreatment (CM) is a risk factor for various mental and substance use disorders. To date, however, little research has focused on the possible long-term physical consequences of CM. Diabetes is a chronic disease, for which an association with CM has been postulated. METHODS: Based on data from a sample of 21,878 men and women from the 2012 Canadian Community Health Survey - Mental Health (CCHS - MH), this study examines associations between three types of CM (childhood physical abuse (CPA), childhood sexual abuse (CSA), and childhood exposure to intimate partner violence (CEIPV)) and diabetes in adulthood. Multiple logistic regression models were used to examine associations between CM and diabetes controlling for the effects of socio-demographic characteristics and risk factors for type 2 diabetes. RESULTS: When controlling socio-demographic characteristics, diabetes was significantly associated with reports of severe and frequent CPA (OR = 1.8) and severe and frequent CSA (OR = 2.2). A dose-response relationship was observed when co-occurrence of CSA and CPA was considered with the strongest association with diabetes being observed when both severe and frequent CSA and CPA were reported (OR = 2.6). Controlling for type 2 diabetes risk factors attenuated associations particularly for CPA. CEIPV was not significantly associated with having diabetes in adulthood. CONCLUSION: CPA and CSA are risk factors for diabetes. For the most part, associations between CPA and diabetes are mediated via risk factors for type 2 diabetes. Failure to consider severity and frequency of abuse may limit our understanding of the importance of CM as a risk factor for diabetes.

Arthritis has an impact on the daily lives of Canadians young and old: results from a population-based survey.

BACKGROUND: There is a perception that the impacts of arthritis are greatest among older adults. However, the effect of age on health-related outcomes in individuals with arthritis has not been explicitly studied. This study examined whether the physical and mental health impacts of arthritis are greater in older (75+ years) versus younger (20-44, 45-64 and 65-74 years) Canadian adults. METHODS: Data were from the arthritis component of the 2009 Survey on Living with Chronic Diseases in Canada. The responses were weighted to be representative of Canadians (≥20 years) with arthritis. Associations between age and the prevalence of severe/frequent joint pain, severe/frequent fatigue, sleep limitations, instrumental activities of daily living (IADLs) limitations, high levels of stress, suboptimal general and suboptimal mental health, were examined descriptively prior to conducting multivariate log-binomial regression analyses. RESULTS: A total of 4565 respondents completed the survey (78% response rate). Individuals with arthritis were mostly female (63%), of working age (57%) and overweight or obese (67%). Upon adjusting for covariates, younger (20-44 years) and/or middle aged (45-64 years) adults were more likely than those older (75+ years) to report severe/frequent joint pain, sleep limitations, high levels of stress and suboptimal mental health. After adjusting for covariates, age was not associated with IADL limitations, severe/frequent fatigue or suboptimal general health. CONCLUSIONS: Contrary to the belief that older adults with arthritis experience more severe physical and mental health outcomes, we found that older adults were less likely to report worse outcomes than younger adults. In light of these findings, public health messaging should stress that arthritis does not just affect the elderly and emphasize the importance of timely diagnosis and management at all ages in order to prevent or, minimize arthritis-related impairment.

Systemic autoimmune rheumatic disease prevalence in Canada: updated analyses across 7 provinces.

OBJECTIVE: To estimate systemic autoimmune rheumatic disease (SARD) prevalence across 7 Canadian provinces using population-based administrative data evaluating both regional variations and the effects of age and sex. METHODS: Using provincial physician billing and hospitalization data, cases of SARD (systemic lupus erythematosus, scleroderma, primary Sjögren syndrome, polymyositis/dermatomyositis) were ascertained. Three case definitions (rheumatology billing, 2-code physician billing, and hospital diagnosis) were combined to derive a SARD prevalence estimate for each province, categorized by age, sex, and rural/urban status. A hierarchical Bayesian latent class regression model was fit to account for the imperfect sensitivity and specificity of each case definition. The model also provided sensitivity estimates of different case definition approaches. RESULTS: Prevalence estimates for overall SARD ranged between 2 and 5 cases per 1000 residents across provinces. Similar demographic trends were evident across provinces, with greater prevalence in women and in persons over 45 years old. SARD prevalence in women over 45 was close to 1%. Overall sensitivity was poor, but estimates for each of the 3 case definitions improved within older populations and were slightly higher for men compared to women. CONCLUSION: Our results are consistent with previous estimates and other North American findings, and provide results from coast to coast, as well as useful information about the degree of regional and demographic variations that can be seen within a single country. Our work demonstrates the usefulness of using multiple data sources, adjusting for the error in each, and providing estimates of the sensitivity of different case definition approaches.

Exercise/physical activity and weight management efforts in Canadians with self-reported arthritis.

OBJECTIVE: To describe the exercise/physical activity and weight management efforts of Canadians with self-reported arthritis, to examine factors associated with their engagement in these strategies to help manage their arthritis, and to explore reasons for lack of engagement. METHODS: Data were from the arthritis component of the 2009 Survey on Living with Chronic Diseases in Canada. The responses (78% response rate; n = 4,565) were weighted to be representative of Canadians (ages ≥20 years) with arthritis. Logistic regression analyses were used to examine factors associated with engaging in exercise/physical activity and weight control/loss (among overweight/obese respondents) for arthritis management purposes. RESULTS: Individuals with arthritis were mostly women (63%), ages ≥45 years (89%), overweight/obese (67%), married (68%), and white (87%), with postsecondary education (69%). Sixty-three percent were exercising and of those who were overweight or obese, 68% were trying to control/lose weight; only 46% were engaged in both. Having received a clinical recommendation was the factor most strongly associated with engaging in exercise/physical activity and/or controlling/losing weight. The most common reason for not exercising was a coexisting health condition/problem (22%), while the most common reason for not controlling/losing weight among those who were overweight/obese was that it was felt not to be necessary (51%). CONCLUSION: The provision of clinical recommendations from a health professional, providing advice on safe and suitable exercises/physical activities, as well as addressing misperceptions of the need to lose weight among the overweight/obese, may facilitate engagement in these health behaviors and ultimately reduce the consequences of arthritis.

Trends in hip fracture rates in Canada: an age-period-cohort analysis.

Age-standardized rates of hip fracture in Canada declined during the period 1985 to 2005. We investigated whether this incidence pattern is explained by period effects, cohort effects, or both. All hospitalizations during the study period with primary diagnosis of hip fracture were identified. Age- and sex-specific hip fracture rates were calculated for nineteen 5-year age groups and four 5-year calendar periods, resulting in 20 birth cohorts. The effect of age, calendar period, and birth cohort on hip fracture rates was assessed using age-period-cohort models as proposed by Clayton and Schiffers. From 1985 to 2005, a total of 570,872 hospitalizations for hip fracture were identified. Age-standardized rates for hip fracture have progressively declined for females and males. The annual linear decrease in rates per 5-year period were 12% for females and 7% for males (both p < 0.0001). Significant birth cohort effects were also observed for both sexes (p < 0.0001). Cohorts born before 1950 had a higher risk of hip fracture, whereas those born after 1954 had a lower risk. After adjusting for age and constant annual linear change (drift term common to both period and cohort effects), we observed a significant nonlinear birth cohort effect for males (p = 0.0126) but not for females (p = 0.9960). In contrast, the nonlinear period effect, after adjustment for age and drift term, was significant for females (p = 0.0373) but not for males (p = 0.2515). For males, we observed no additional nonlinear period effect after adjusting for age and birth cohort, whereas for females, we observed no additional nonlinear birth cohort effect after adjusting for age and period. Although hip fracture rates decreased in both sexes, different factors may explain these changes. In addition to the constant annual linear decrease, nonlinear birth cohort effects were identified for males, and calendar period effects were identified for females as possible explanations.

Consensus statements for the use of administrative health data in rheumatic disease research and surveillance.

OBJECTIVE: Administrative data are increasingly being used for research and surveillance about rheumatic diseases. However, literature reviews have revealed a lack of consistency in methods for conducting observational rheumatic disease studies, a situation that can lead to findings that cannot be compared. Our purpose was to develop best-practice consensus statements about the use of administrative data for rheumatic disease research and surveillance in Canada. METHODS: We convened 52 decision makers, epidemiologists, clinicians, and researchers to a 2-day workshop. Prior to this, participants formed working groups to examine 3 best-practice categories: case definitions, epidemiology methods, and comorbidity and outcomes measurement. The groups conducted systematic or scoping reviews on key topics. At the workshop, evidence from the reviews was presented and consensus-building techniques were used to develop the best-practice statements. The statements were presented, discussed, revised (as needed), and then subjected to voting. RESULTS: Thirteen best-practice consensus statements were developed and endorsed by consensus. For the first category, these consensus statements addressed validation techniques for rheumatic disease case definitions and case ascertainment bias. The consensus statements for epidemiology methods focused on confounding and drug exposure measurement. For comorbidity and outcomes measurement, consensus statements were developed for multiple conditions, including osteoporosis and fragility fractures, cancer, infections, cardiovascular disease, and renal disease. Strengths and limitations of administrative data were identified in relation to each topic. CONCLUSION: Our best-practice consensus statements are consistent with other recent guidelines, including those for rheumatic disease biologics registries, but address additional issues specific to administrative data. Continuing work focuses on disseminating these consensus statements to multiple audiences.