Jane F. Gentleman

Concerning the role of aluminum in causing dementia

Topics outlined in an earlier paper by Eichhorn are expanded, with particular emphasis on the implications of the associations between aluminum (Al) concentrations and various indications of mental impairment. These associations represent the main thrust of the evidence that Al is a contributory cause for some forms of dementia. Of particular interest are the more recently observed associations between Al concentrations in drinking (finished) water and various indications of mental impairment, and the relevance of other water quality variables such as silica, fluoride, and pH. Various unresolved questions are also identified.

Risk factors, causality, and policy initiatives: the case of aluminum and mental impairment.

The question addressed is when can the evidence concerning a health issue be regarded as adequate to implement policy initiatives. The approach is illustrated by comparing evidence about the effects of cigarette smoking with evidence for the aluminum (Al) hypothesis (that Al contributes to mental impairment and especially to Alzheimers Disease). The criteria for evaluating the evidence are based on the consistency and strength of the association between a putative risk factor and the relevant outcome variable, the likelihood that the relative risk represents a causal relationship, whether possible mechanisms are available, the number of persons affected, and the costs of modifying the risk factor.

Health and gender differences between middle and senior managers in the Canadian Public Service

Most studies of the relationship between socioeconomic status (SES) and health have concentrated on disparities between the richest and poorest men; few studies have examined such relationships for women due to difficulties in measuring SES for women. For the present study, data collected from Canadian Public Service middle and senior managers provided an opportunity to examine associations between SES and health within the upper end of the SES spectrum for both genders, since women managers can be assumed to have a relatively high SES. Demographic, health and lifestyle characteristics are compared for middle and senior managers for each gender separately to determine whether women experience the health benefits associated with higher SES that have been previously observed for men. The results support the hypothesis that achieving a higher SES through work is a more stressful process for women than for men and that womens upward mobility is restricted compared to that of men. Despite these findings, there is little evidence that womens health has been adversely affected. Compared to male managers, fewer female managers smoke or drink and fewer have high body mass index, high blood pressure or high cholesterol levels. Female managers are also more likely to report being in good health.

Dementia and age at death.

The objective of this paper is to investigate changes in dementia mortality, as recorded on death certificates in Canada. Use is made of data available at Statistics Canada for the period 1990-1991. During this period there have been appreciable changes over time in the ages at death and in the percentage of death certificates that mention dementia. This increase in mortality associated with dementia can be explained, in large part, by an increased tendency for dementia to be listed as an underlying cause of death on the death certificate. Also, the median ages at death of persons in Canada for the period 1990-1991, for whom dementia is recorded as the underlying cause of death, are similar to or greater than the ages at death reported for all other causes of death but excluding dementia. Because those who have dementia are living longer, there is an increase in the number of people with dementia (prevalence of dementia); this has important implications concerning public policy on health and aging. We discuss the significance of these changes with respect to the future prevalence of dementia.

Hysterectomy Rates by Diagnosis: Variation among Canadian Census Divisions

Abstract Hysterectomy rates are among the most highly variable surgical procedure rates in Canada. This study examines hysterectomy rates according to the diagnoses associated with the surgery, and compares the variation of the rates as the diagnostic groups progress from cancer to more discretionary indications including leiomyoma, endometriosis, uterine prolapse, and menstrual haemorrhage. The rates, which were analyzed for residents of 255 census divisions across Canada, were least variable for hysterectomy involving cancer and most variable for hysterectomy for menstrual haemorrhage, consistent with the hypothesis that variation in rates is greater when hysterectomy is done for more discretionary indications. The study recommends that chart review findings be compared for selected areas having unusually high and low rates, and that practice guidelines for hysterectomy be established based on such reviews, coupled with an analysis of efficacy of hysterectomy as a treatment choice for the various diagnoses.