Optimizing spinal cord injury care in Canada: Development of a framework for strategy and action.

National health strategies are integral in defining the vision and strategic direction for ensuring the health of a population or for a specific health area. To facilitate a national coordinated approach in spinal cord injury (SCI) research and care in Canada, Praxis Spinal Cord Institute, with support from national experts and funding from the Government of Canada, developed a national strategy to advance SCI care, health, and wellness based on previous SCI strategic documents. This paper describes the development process of the SCI Care for Canada: A Framework for Strategy and Action. Specifically, it covers the process of building on historical and existing work of SCI in Canada through a thorough review of literature to inform community consultations and co-creation design. Furthermore, this paper describes planning for communication, dissemination, and evaluation. The SCI Care Strategic Framework promotes an updated common understanding of the goals and vision of the SCI community, as well as strengths and priorities within the SCI system regarding care, health, and wellness. Additionally, it supports the coordination and scaling up of SCI advancements to make a sustainable impact nationwide focusing on the needs of people living with SCI.

Geographic variation in radon and associated lung cancer risk in Canada.

OBJECTIVE: Radon is an important risk factor for lung cancer. Here we use maps of the geographic variation in radon to estimate the lung cancer risk associated with living in high radon areas of Canada. METHODS: Geographic variation in radon was estimated using two mapping methods. The first used a Health Canada survey of 14,000 residential radon measurements aggregated to health regions, and the second, radon risk areas previously estimated from geology, sediment geochemistry and aerial gamma-ray spectrometry. Lung cancer risk associated with living in these radon areas was examined using a population-based case-control study of 2,390 lung cancer cases and 3,507 controls collected from 1994-1997 in eight Canadian provinces. Residential histories over a 20-year period were used in combination with the two mapping methods to estimate ecological radon exposures. Hierarchical logistic regression analyses were used to estimate odds ratios for lung cancer incidence, after adjusting for a comprehensive set of individual and geographic covariates. RESULTS: Across health regions in Canada, significant variation in average residential radon concentrations (range: 16-386 Bq/m3) and in high geological-based radon areas (range: 0-100%) is present. In multivariate models, a 50 Bq/m3 increase in average health region radon was associated with a 7% (95% CI: -6-21%) increase in the odds of lung cancer. For every 10 years that individuals lived in high radon geological areas, the odds of lung cancer increased by 11% (95% CI: 1-23%). CONCLUSIONS: These findings provide further evidence that radon is an important risk factor for lung cancer and that risks are unevenly distributed across Canada.