Children and parents perspectives on children's dental treatment under general anesthesia: a narratology from Saskatoon, Canada.

AIM: This study aimed to explore the emotional and psychological effects of dental treatment under general anesthesia (DTGA) on children and parents in Saskatoon city, Saskatchewan, Canada. DESIGN: Semi-structured interviews, video diaries, drawings, and a questionnaire were used to collect data. The study used a narrative perspective and thematic analysis to analyze data. RESULTS: The findings from children and their parents (N = 25) indicated DTGA is disconcerting from both views. Parental guilt and the desire of both parents and children to not have to go through the experience again fueled at least short-term compliance with brushing, flossing, and changes in dietary habits. CONCLUSION: The children participants provided valuable information to augment that gathered from parents. As the study revealed that the DTGA is psychologically and emotionally troubling for both children and their caregivers, it is imperative to explore ways to ease the GA experience. Specific recommendations were provided for optimizing dental and health services for those children and their families.

Immigrant and ethnic neighbourhood concentration and reduced child developmental vulnerability: A Canadian cohort study.

INTRODUCTION: Studies have consistently demonstrated a gradient between median neighbourhood income and child developmental outcomes. By investigating statistical outliers-neighbourhoods with children exhibiting less or more developmental vulnerability than that predicted by median neighbourhood income-there is an opportunity to identify other neighbourhood characteristics that may be enhancing or impeding early childhood development. OBJECTIVE: Testing a variety of neighbourhood factors, including immigrant or ethnic concentration and characteristics of structural disadvantage (proportion of social assistance recipients, homes in need of major repair, residents with high school education only, lone parent families, and residents moving in the last year) we sought to identify factors associated with more or less developmental vulnerability than that predicted by median neighbourhood income, for young children. METHODS: For this cross-sectional study we used validated Early Development Instrument (EDI) data (2003-2013) linked to demographic and socioeconomic Census and Tax Filer data for 98.3% of Canadian neighbourhoods (n=2,023). The purpose of the instrument is to report, at a population-level, children's school readiness. Children's developmental vulnerability was assessed in five domains (physical health and well-being, emotional maturity, social competence, language and cognitive development, and communication and general knowledge) in relation to the 10th percentile from a national normative sample. Levels of children's neighbourhood vulnerability were determined per domain, as percent of children vulnerable at a given domain. Neighbourhoods were grouped into three cohorts, those having lower than predicted, as predicted, or higher than predicted children's vulnerability according to neighbourhood median income. Using multivariable binary logistic regression we modelled the association between select neighbourhood characteristics and neighbourhoods with lower or higher than predicted vulnerability per domain, compared to neighbourhoods with predicted vulnerability. This allowed us to determine neighbourhood characteristics associated with better or worse child developmental outcomes, at a neighbourhood-level, than that predicted by income. RESULTS: In neighbourhoods with less child developmental vulnerability than that predicted by income, high or low immigrant concentration and ethnic homogeneity was associated with less vulnerability in physical (adjusted odds ratio (aOR) 1.66, 95% CI: 1.43, 1.94), social (aOR 1.30, 95% CI: 1.11, 1.51), and communication domains (aOR 1.24, 95% CI: 1.03, 1.47) compared to neighbourhoods with vulnerability concordant with income. Neighbourhood ethnic homogeneity was consistently associated with less developmental vulnerability than predicted by income across all developmental domains. Neighbourhood-level structural disadvantage was strongly associated with child developmental vulnerability beyond that predicted by median neighbourhood income. CONCLUSION: Canadian neighbourhoods demonstrating less child developmental vulnerability than that predicted by income have greater ethnic and ethnic-immigrant homogeneity than neighbourhoods with child developmental vulnerability concordant with income. Neighbourhood social cohesion and cultural identity may be contributing factors. Neighbourhood structural disadvantage is associated with poorer early childhood development, over and above that predicted by neighbourhood income. Neighbourhood-level policy and programming should address income and non-income related barriers to healthy child development.

At what age do normal weight Canadian children become overweight adults? Differences according to sex and metric.

BACKGROUND: The prevalence of overweight and obesity doubles between adolescence and young adulthood; however, the exact age, and appropriate metric to use to identify when overweight develops is still debated. AIM: To examine the age of onset of overweight by sex and four metrics: body mass index (BMI), fat mass (%FM), waist circumference (WC) and waist-to-height ratio (WHtR). SUBJECTS AND METHODS: Between 1991 and 2017, serial measures of body composition were taken on 237 (108 males) individuals (aged 8-40 years of age). Hierarchical random effects models were used to develop growth curves. Curves were compared to BMI, %FM and WC overweight age- and sex-specific cut-points. RESULTS: In males, the BMI growth curve crossed the cut-point at 22.0 years, compared to 23.5 and 26.5 years for WHtR and %FM, respectively; WC cut-off was not reached until 36 years. In females, the BMI growth curve crossed the overweight cut-point at 21.5 years, compared to 14.2 years for %FM and 21.9 and 27.5 years for WC and WHtR, respectively. CONCLUSION: In summary, overweight onset occurs during young adulthood with the exception of WC in males. BMI in males and %FM in females were the metrics identifying overweight the earliest.

Experiences of housing insecurity among participants of an early childhood intervention programme.

OBJECTIVES: To understand the barriers to programme success among high-needs families in KidsFirst, an early childhood intervention programme. METHODS: Using a qualitative approach, a secondary analysis was performed using the qualitative data set (111 interviews and focus groups with 242 participants) from the KidsFirst programme evaluation. Data analysis was conducted to identify common experiences among high-needs families in the programme and barriers to programme success. RESULTS: Participants identified housing insecurity as a major factor impeding programme delivery, retention and successful outcomes. Housing insecurity was shown to create or exacerbate ongoing crises among high-needs families. Only after housing insecurity was addressed were families able to benefit from the KidsFirst programme. CONCLUSIONS: The findings of this research suggest that until baseline material security is established for high-needs families, early childhood development (ECD) interventions will be limited in meeting their objectives. In order to have the most effect for those living in poverty, helping families to achieve basic material security, including secure housing, should precede the targeted provision of psychosocial ECD supports. This finding has implications for how ECD intervention programmes could more effectively be designed and whom they should target.

Equity-focused knowledge translation: a framework for "reasonable action" on health inequities.

OBJECTIVES: To identify gaps in procedural approaches to knowledge translation and outline a more relational approach that addresses health inequities based on creating collaborative environments for reasonable action. METHODS: A literature review encompassing approaches to critical inquiry of the institutional conditions in which knowledge is created combined with a process for encouraging reflexive professional practice provide the conceptual foundation for our approach, called equity-focused knowledge translation (EqKT). RESULTS: The EqKT approach creates a matrix through which teams of knowledge stakeholders (researchers, practitioners, and policymakers) can set common ground for taking collaborative action on health inequities. CONCLUSIONS: Our approach can contribute to the call by the WHO Commission on the Social Determinants of Healths for more reasonable action on health inequities by being incorporated into numerous public health settings and processes. Further steps include empirical applications and evaluations of EqKT in real world applications.

The relationship between girls' (8-14 years) physical activity and maternal education.

BACKGROUND: Mothers with higher levels of education are more likely to engage in health-promoting behaviour; thus, it is intuitive that a child's physical activity would be positively related to maternal education. The literature on this area, however, is inconclusive and may be due to the methods used to assess physical activity (i.e. the use of aggregated and self-reported physical activity that may not reflect the true and detailed variation of physical activity). AIM: To profile the physical activity behaviours of girls with mothers of differing educational attainment. SUBJECTS AND METHODS: 77 girls (grades 4-8) wore an Actical accelerometer for 7 days. Minutes spent sedentary and in light, moderate and vigorous physical activity per day over 7 days, 5 weekdays, 2 weekends, and 1 h commuting period to and from school of girls of University educated (UE) and non-UE mothers were analysed. RESULTS: After controlling for confounders, girls with UE mothers were more likely to participate in vigorous physical activity at the weekend and moderate-to-vigorous physical activity during the morning commute to school. CONCLUSIONS: Research investigating the relationship between maternal education and child's physical activity should explore, at higher resolution, when activity is accumulated, in particular separating weekday and weekend physical activity.

Antenatal depression in socially high-risk women in Canada.

BACKGROUND: Antenatal depression is potentially deleterious to the mother and baby. Canadian Aboriginal women have an increased risk for living in poverty, family violence, and substance use; however, little is known about antenatal depression in this group. The aim of this study was to determine the prevalence and correlates of depression in socially high-risk, mostly Aboriginal pregnant women. METHODS: Women (Aboriginal and non-Aboriginal), in two prenatal outreach programmes were approached and depressive symptoms between the two groups were compared, using the Edinburgh Postnatal Depression Scale (EPDS). RESULTS: Sixty per cent (n = 402) of potential participants were recruited for the study. The prevalence of depression was 29.5% (n = 402). Depression was associated with a history of depression, mood swings, increased stressors, current smoker, and lack of social support. Aboriginal women were more likely to be depressed, but this was not significantly higher than non-Aboriginal women; however, they did experience significantly more self-harm thoughts. Exercise was a significant mediator for depression. CONCLUSION: The prevalence of antenatal depression confirms rates in other high-risk, ethnic minority groups of women. A previous history of depression and mood problems were associated with depression, thus prenatal care should include a careful mental health assessment. On a positive note, the present study suggests that exercise may mediate antenatal depression.

Occurrence of chronic obstructive pulmonary disease among Canadians and sex-related risk factors.

The etiology of chronic obstructive pulmonary disease (COPD) has not been fully understood. This analysis assessed the prevalence of COPD and its risk factors among Canadian men and women. The analysis was based on the data from 7210 subjects aged 35 to 64 years who participated in the first cycle of National Population Health Survey in 1994-1995. COPD was considered present if an affirmative response was given to the question: "Do you have chronic bronchitis or emphysema diagnosed by a health professional?" In order to take the complex survey design into account, analytic weights incorporating a design effect were used in all statistical analyses. The prevalence of COPD was 2.1% in nonsmokers, 2.7% in ex-smokers, and 8.2% in smokers in women. In men, the corresponding prevalence was 0.8%, 2.9%, and 3.5%, respectively. The adjusted odds ratio for current smoking men and women who started smoking before age of 18 years was 3.0 and 5.9 compared with their nonsmoking counterparts. Overweight women demonstrated a 2.4-fold increase in the prevalence of COPD compared with women with normal weight. Men from low-income families had an odds ratio of 3.7 compared with those from high-income families. A history of allergy was significantly related to COPD in both men and women. COPD was common among Canadian women. Early initiation of smoking and being overweight had stronger relationships to the prevalence of COPD in women than in men. On the contrary, household income was more strongly related to COPD for men than for women.

Concurrent consultations with physicians and providers of alternative care: results from a population-based study.

OBJECTIVE: We examined the factors related to consultations with both physicians and alternative practitioners, compared with visits to physicians only. METHODS: A telephone survey (random-digit dialling) collected information from 818 adults living in and around Saskatoon. Respondents reported consultations with alternative practitioners and physicians in the previous 12 months. RESULTS: Approximately one in five respondents had consulted both a physician and an alternative practitioner. Among respondents under 65 years of age, having one or more chronic medical conditions significantly increased the likelihood of concurrent use of care. Men, individuals suffering from back pain or migraines, those reporting an elevation level of distress, and those for whom spiritual values were important were also more likely to use both types of care. INTERPRETATION: Consultations with alternative care providers occur as an adjunct to, rather than a replacement of visits to physicians. Particular types of medical conditions as well as psychosocial and spiritual factors are determinants of concurrent use of physicians and alternative practitioners.

Physical abuse during pregnancy: prevalence and risk factors.

BACKGROUND: Violence during pregnancy is a health and social problem that poses particular risks to the woman and her fetus. To address the lack of Canadian information on this issue, the authors studied the prevalence and predictors of physical abuse in a sample of pregnant women in Saskatoon. METHODS: Of 728 women receiving prenatal services through the Saskatoon District public health system between Apr. 1, 1993, and Mar. 31, 1994, 605 gave informed consent to participate in the study and were interviewed in the second trimester. Of these, 543 were interviewed again late in the third trimester. During the initial interview, information was collected on the women's sociodemographic characteristics, the current pregnancy, health practices and psychosocial variables. The second interview focused on the women's experience of physical abuse during the pregnancy and during the preceding year, the demographic characteristics and the use of alcohol or illicit drugs by their male partner. RESULTS: In all, 31 (5.7%) of the women reported experiencing physical abuse during pregnancy; 46 (8.5%) reported experiencing it within the 12 months preceding the second interview. Of the 31 women 20 (63.3%) reported that the perpetrator was her husband, boyfriend or ex-husband. Although all ethnic groups of women suffered abuse, aboriginal women were at greater risk than nonaboriginal women (adjusted odds ratio 2.8, 95% confidence interval [CI] 1.0-7.8). Women whose partner had a drinking problem were 3.4 times (95% CI 1.2-9.9) more likely to have been abused than women whose partner did not have a drinking problem. Perceived stress and number of negative life events in the preceding year were also predictors of abuse. Abused women tended to report having fewer people with whom they could talk about personal issues or get together; however, they reported socializing with a larger number of people in the month before the second interview than did the women who were not abused. INTERPRETATION: Physical abuse affects a significant minority of pregnant women and is associated with stress, lack of perceived support and a partner with a drinking problem.

Comparison of survey and physician claims data for detecting hypertension.

Using linked data from the Manitoba (Canada) Heart Health Survey (MHHS) and physician service claims files we assessed the degree to which self-reported hypertension and clinically measured hypetension agreed with physician claims hypertension, and examined the likely sources of disagreement. The overall agreement between survey and claims data for hypertension detection was moderate to high: 82% (kappa = 0.56) for self-reported and physician claims hypertension, and 85% (kappa = 0.60) for clinically measured and physician claims hypertension. In the comparison between self-report and physician claims, those who were classified as obese, diabetic, or a homemaker were significantly more likely to have a hypertension measure not confirmed by the other. Disagreement between clinically measured and physician claims was also more common among the obese and homemakers, as well as those on medication for heart diseases, elevated cholesterol levels (LDL), and 35 years of age and older. The high overall level of agreement among these three measures suggest that each may be used with confidence as an indication of hypertension; however, the agreement appears lower among individuals presenting a more complicated clinical profile.

Prevalence and predictors of health risk behaviours during early pregnancy: Saskatoon Pregnancy and Health Study.

Canadian data on prenatal exposure to alcohol, tobacco, psychoactive drugs, and caffeine are sparse. This study presents prevalence rates in Saskatoon for these four risk behaviours during the first trimester of pregnancy and their associations with sociodemographic factors. Personal interviews were conducted with 605 pregnant women (83% participation rate). The most commonly used substance was caffeine (87%), followed by alcohol (46%), tobacco (30%), and psychoactive drugs (7%). Overall, 36% of women reported using two substances, 16% three, and 4% all four substances. In general, risk behaviours were more prevalent among women with lower education and income levels, Aboriginal or Métis background, those not living with a partner, those with previous births, and, in some cases, younger women. The findings illuminate the needs of particular groups of pregnant women and the importance of understanding maternal risk behaviour within the structural and cultural realities of women's lives.

Evaluation of the Heart Smart Restaurant Program in Saskatoon and Regina, Saskatchewan.

The consumer-driven Heart Smart Restaurant Program was developed by the Heart and Stroke Foundation of Saskatchewan and the Saskatoon Community Health Unit, with the aim of improving the nutritional quality of food consumed in table-service restaurants. To participate, restaurateurs must agree to provide smoke-free seating and specific more healthful food choices upon request of the customer. The program was evaluated through telephone interviews with 999 individuals in randomly selected households in Saskatoon and Regina. While public awareness of the program was satisfactory, over half of those who knew of the program misunderstood its function, believing that more healthful choices are indicated on the menu. When choosing a restaurant, individuals are not greatly influenced by whether it is Heart Smart, but in Saskatoon, they are more likely to request a more healthful alternative in a Heart Smart restaurant than in others. Implications of these and other findings for future program development and research are discussed.