Larry W. Chambers

Preventive health care

Do you have children? [ ] Yes [ ] No If yes, please list their ages and health status: Age/year of birth: _______________________ Health Status: _______________________ Age/year of birth: _______________________ Health Status: _______________________ Age/year of birth: _______________________ Health Status: _______________________ Age/year of birth: _______________________ Health Status: _______________________

The development and application of indices of health: general methods and a summary of results.

A multidisciplinary group has developed a health index questionnaire designed to measure the social, emotional, and physical function of free-living populations. The strategy has been found to be generally applicable, capable of application by lay interviewers, acceptable to interviewees, and amenable to index construction. Furthermore, initial evaluations of the resulting health indices suggest that they are biologically and clinically valid. These health indices have been successfully applied in a randomized trial of innovative primary care services. The comceptualization of individual sections of the health index questionnaire for each of these three functional areas, the generation of the instrument, and the evaluation of questionnaire responses for their biologic and clinical validity are summarized here.

Improving cardiovascular health at population level: 39 community cluster randomised trial of Cardiovascular Health Awareness Program (CHAP)

Objective To evaluate the effectiveness of the community based Cardiovascular Health Awareness Program (CHAP) on morbidity from cardiovascular disease. Design Community cluster randomised trial. Setting 39 mid-sized communities in Ontario, Canada, stratified by location and population size. Participants Community dwelling residents aged 65 years or over, family physicians, pharmacists, volunteers, community nurses, and local lead organisations. Intervention Communities were randomised to receive CHAP (n=20) or no intervention (n=19). In CHAP communities, residents aged 65 or over were invited to attend volunteer run cardiovascular risk assessment and education sessions held in community based pharmacies over a 10 week period; automated blood pressure readings and self reported risk factor data were collected and shared with participants and their family physicians and pharmacists. Main outcome measure Composite of hospital admissions for acute myocardial infarction, stroke, and congestive heart failure among all community residents aged 65 and over in the year before compared with the year after implementation of CHAP. Results All 20 intervention communities successfully implemented CHAP. A total of 1265 three hour long sessions were held in 129/145 (89%) pharmacies during the 10 week programme. 15 889 unique participants had a total of 27 358 cardiovascular assessments with the assistance of 577 peer volunteers. After adjustment for hospital admission rates in the year before the intervention, CHAP was associated with a 9% relative reduction in the composite end point (rate ratio 0.91, 95% confidence interval 0.86 to 0.97; P=0.002) or 3.02 fewer annual hospital admissions for cardiovascular disease per 1000 people aged 65 and over. Statistically significant reductions favouring the intervention communities were seen in hospital admissions for acute myocardial infarction (rate ratio 0.87, 0.79 to 0.97; P=0.008) and congestive heart failure (0.90, 0.81 to 0.99; P=0.029) but not for stroke (0.99, 0.88 to 1.12; P=0.89). Conclusions A collaborative, multi-pronged, community based health promotion and prevention programme targeted at older adults can reduce cardiovascular morbidity at the population level. Trial registration Current controlled trials ISRCTN50550004.

Seasonal influenza vaccination campaigns for health care personnel: systematic review

Background: In Canada, vaccination coverage for seasonal influenza among health care personnel remains below 50%. The objective of this review was to determine which seasonal influenza vaccination campaign or campaign components in health care settings were significantly associated with increases in influenza vaccination among staff. Methods: We identified articles in eight electronic databases and included randomized controlled trials, controlled before-and-after studies and studies with interrupted time series designs in our review. Two reviewers independently abstracted the data and assessed the risk of biases. We calculated risk ratios and 95% confidence intervals for randomized controlled trials and controlled before-and-after studies and described interrupted time series studies. Results: We identified 99 studies evaluating influenza vaccination campaigns for health care workers, but only 12 of the studies were eligible for review. In nonhospital health care settings, including long-term care facilities, campaigns with a greater variety of components (including education or promotion, better access to vaccines, legislation or regulation and/or role models) were associated with higher risk ratios (i.e, favouring the intervention group). Within hospital settings, the results reported for various types of campaigns were mixed. Many of the criteria for assessing risk of bias were not reported. Interpretation: Campaigns involving only education or promotion resulted in minimal changes in vaccination rates. Further studies are needed to determine the appropriate components and combinations of components in influenza vaccination campaigns for health care personnel.

Long-term back problems and physical work exposures in the 1990 Ontario Health Survey.

OBJECTIVES This study sought to provide data on the relationship of work exposures to long-term back problems in a population survey. METHODS The Ontario Health Survey in 1990 used a representative population sample of the province. It included data on long-term back problems, occupational activity, and physical work exposures. The current study examined relationships between these variables. RESULTS The prevalence of long-term back problems was 7.8% in working-age adults. It generally increased with age. Long-term back problems were more prevalent in blue-collar occupations and among those not working, as well as among people with less formal education, smokers, and those overweight. Physical work exposures--awkward working position, working with vibrating vehicles or equipment, and bending and lifting--were all associated with a greater risk of back problems. The number of simultaneous physical exposures was monotonically related to increased risk. CONCLUSIONS Within the limitations of the data and assuming the relationship to be causal, about one quarter of the excess back pain morbidity in the working population could be explained by physical work exposures.

ARTIFICIAL SWEETENERS AND HUMAN BLADDER CANCER

A positive association between the use of artificial sweetners, particularly saccharin, and risk of bladder cancer in males has been observed in a case-control study of 480 men and 152 women in three Provinces in Canada. The risk ratio for ever versus never used is 1-6 for males (P=0-009, one-tailed test), and a significant dose-response relationship was obtained for both duration and frequency of use. The population attributable risk for males is estimated at 7%, though for diabetics, who have a similar risk ratio for artificial sweetner use as non-diabetics, the attributable risk is 33%.

Chronic conditions and disabilities among seniors: an analysis of population-based health and activity limitation surveys.

PURPOSE To describe the prevalence of disabilities and the medical conditions and risk factors associated with mobility and agility disabilities among seniors. METHODS In the 1986 and 1991 Canadian Census, every fifth person answered a screening question about activity limitation and disabilities. A probability sample of both those reporting and not reporting disability was selected to complete the Health and Activity Limitations Surveys (HALS) in 1986 and 1991. These two cross-sectional surveys conducted five years apart collected detailed activity limitation information about persons over 15 years of age. The current analysis was based on only respondents aged 65 years and older. The sample size for 65 years and older was 38518 in 1986 and 5106 in 1991. A computer link with the Census data provided household income and additional socio-demographic data for all respondents. RESULTS Over 40% of Canadian seniors reported at least one disability, and approximately a quarter of disabled seniors were classified as severely disabled. Mobility and agility disabilities accounted for over 80% of all disabilities reported by seniors, and senior women were more likely than men to report having a mobility or agility disability. Arthritis/rheumatism was reported as the cause of over 30% of all mobility and agility disabilities. CONCLUSIONS The continued monitoring of disabilities through surveys such as HALS will help determine the prevalence as well as aid in the identification of the causes of disabilities. Such information may be used to guide the implementation of appropriate public health interventions that will meet the changing health care needs of seniors.

The Impact of CME A Methodological Review of the Continuing Medical Education Literature

A review of the literature evaluating the effectiveness of Continuing Medical Education (CME) was undertaken using articles from 1935 to 1982.238 studies were reviewed and annotated using previously established and tested assessment criteria. These criteria included the following areas: the study design; the educational or administrative intervention; the evaluation maneuver used to assess the interventions outcome; the health professionals used as subjects; andfinally, the educational and statistical significance of the study. It would appear that CMEinterventions when broadly defied, have an impact on physician competence and (less consistently though still in a positive direction) on physician performance and patient outcomes. Further research in both the methods and evaluation of CME is necessary.

Sensitivity to change and the effect of mode of administration on health status measurement.

A measure of global health status, the McMaster Health Index Questionnaire (MHIQ), was assessed to determine two important measurement properties related to its reliability and validity—sensitivity to change and the effect of mode of administration. Ninety-six patients in a physiotherapy clinic were randomly assigned to three mode-of-administration study groups, administered the MHIQ at four points in time including at admission and discharge from the clinic, and assessed for change by their physiotherapist. MHIQ physical function, social function, and emotional function retest scores obtained by self-completion within a 1-week interval were most stable. Physical function scores by any of self-completion, telephone interview, or personal interview were sensitive to change, that is, they improved dramatically by the time of discharge from the clinic. Mode of administration did not affect the size of the change scores. Changes reflected by the physical function scores correlated with changes in physical function reported by a patients physiotherapist. No systematic changes occurred with social and emotional function scores; this is not surprising in a group of patients with predominantly physical function problems.

An epidemiological description of physical, social and psychological problems in multiple sclerosis

Chronic disorders such as multiple sclerosis have important behavioural consequences on the lives of patients. The purpose of this study was to describe the frequency distribution of psychosocial disability among a referral clinic population of multiple sclerosis patients and to identify associated factors. A cross-sectional survey was conducted of 301 patients using four health indexes to assess quality of life. An 82% response rate was obtained. In the results are presented the frequencies of behavioural problems compared with the general population and a family practice group. While physical function was found to be closely associated with disease severity, psychosocial disability bore little relationship to the underlying disease or to sociodemographic variables including social class. Eighty percent of psychosocial disability remained unexplained. The physical aspects of multiple sclerosis were not predictive of emotional or social morbidity. The major implication of these findings is that the impact of disease on patients, as distinct from the disease itself, should be dealt with as health problems in their own right.