Dietary Adequacy among Multi-Ethnic Urban Youth in Edmonton: Findings from the Wellness and Health in Youth - Aboriginal and All Communities in Transition NOW (WHY ACT NOW) Project.

OBJECTIVE: The development of obesity and chronic diseases in adulthood often results from a childhood pattern of dietary excesses. This study aimed to identify dietary inadequacies and excesses of multiethnic youth in Edmonton. METHODS: A cross-sectional survey of a convenience sample of 473 multiethnic youth between 11 and 18 years was conducted in 12 schools in Edmonton between October 2013 and March 2014. Data were analyzed to determine for each participant mean daily energy and nutrient intakes, dietary adequacy, and nutrient densities. Participants were divided by self-identified ethnicity (Indigenous, European, African and Middle Eastern, and Asian). RESULTS: For all nutrients examined, the mean percentage of calories from fat was higher among European (31.7%) and Indigenous youth (31.8%) compared to African and Middle Eastern (28.3%) and Asian youth (29.0%), while Asian youth had the highest percentage of calories from protein (17.7%) compared to other ethnic groups (Indigenous = 15.5%; African & Middle Eastern = 16.5%; European = 16.2%). The majority of youth fell below the recommended values for dietary fiber (83.3-92.0%), vitamins D (84.4-90.2%), and E (89.5-92.0%). More than 50% fell below the dietary reference intakes (DRIs) for vitamin A, vitamin B5, calcium, and magnesium; >30% were below the DRI for folate, zinc, and vitamins B6, and C. The diet of girls contained a greater density of fiber compared to boys (9.3 vs. 8.0 g/1000 kcal; p-value = 0.002). CONCLUSIONS: Inadequate dietary intake is evident among the majority of multiethnic youth in Edmonton. There is a need to develop strategies to reduce the burden of poor nutrition status for youth.

Elevated Blood Pressure and Associations with Sodium Intake Among Multiethnic Youth in Edmonton, Canada: Findings from WHY ACT NOW.

INTRODUCTION: This study examined the prevalence of pre-hypertension (PHT) and hypertension (HT) in urban youth, and assessed the effects of sodium intake and obesity on blood pressure (BP) by ethnicity. METHODS: A convenience sample of 557 multiethnic youth, aged 11-23 years, was recruited from 12 schools and institutions in Edmonton, Alberta, Canada. Participants were divided by self-identified ethnicity into four groups (Indigenous, African and Middle Eastern (AME), Asian, and European). RESULTS: Between October 2013 and March 2014, one-on-one interviews were conducted to collect data on demographics, physical activity, diet, and Body Mass Index (BMI). BP was obtained at two different times during the interview and measured a third time in cases of high variability. The standard deviation scores (SDS) of systolic BP (SBP) and diastolic BP (DBP) were used to estimate associations with sodium intake (per 1000 mg/day). Overall, 18.2% and 5.4% of the participants had PHT and HT, respectively. Indigenous and AME participants showed the highest rates of PHT (23.1%). Indigenous and European participants showed higher rates of HT (8.3% and 5.3%, respectively) than other ethnic groups (AME = 4.4%, Asian = 3.9%). There was a positive association between 1000 mg/day increase in sodium intake and SDS of SBP by 0.041 (95% CI 0.007-0.083; p = 0.04) among pre-hypertensive participants. Over 85% of participants exceeded the recommended dietary sodium intake. Mean BMI and dietary sodium intake were higher among pre-hypertensive participants (4219 mg/day) than normotensive (3475 mg/day). CONCLUSIONS: The prevalence of HT varied by ethnicity. High dietary sodium intake was of concern. There is a need for culturally-tailored, population-based interventions to reduce sodium intake.

Prevalence of Known Risk Factors for Type 2 Diabetes Mellitus in Multiethnic Urban Youth in Edmonton: Findings From the WHY ACT NOW Project.

OBJECTIVES: The Canadian Diabetes Risk Assessment Questionnaire (CANRISK) is a validated, evidence-based, self-administered tool to assess the risk for type 2 diabetes mellitus in multiethnic Canadian adults. Identifying individuals at high risk for type 2 diabetes allows early intervention that improves modifiable risk factors. This study examined the risk factors for type 2 diabetes in multiethnic urban youth in Edmonton, Alberta. METHODS: An interviewer-administered questionnaire was developed based on CANRISK variables, such as age, gender, ethnicity, family history of diabetes, medical history of high blood sugar or high blood pressure, anthropometric measurements, physical activity and dietary intake. Between October 2013 and March 2014, data were collected from a convenience sample of 557 (328 girls and 229 boys) multiethnic youth 11 to 23 years of age in 12 institutions in Edmonton, such as public schools, after-school programs and colleges. RESULTS: Participating youth (N=529) with self-identified ethnicity were included in the analyses: 109 Indigenous (20.6%); 96 African and Middle Eastern (18.1%); 129 Asian (24.4%); and 195 European (36.9%). More than 70% of the youth had 2 or more risk factors for type 2 diabetes. The participants were classified as low risk (75.6%; n=400); moderate risk (21.2%; n=112); or high risk (3.2%; n=17), with the highest proportion of moderate- and high-CANRISK score categories (52.7%) found in the Asian youth. Boys (p<0.0001) and Indigenous participants (p<0.001) were more likely to have a greater number of risk factors for type 2 diabetes compared to girls and non-Indigenous youth, respectively. Of the participants, 26.7% (n=141) were overweight or obese, more than 45% of the participants (n=245) were physically inactive, and 17.8% of the participants (n=94) did not consume sufficient amounts of fruits and vegetables to meet daily recommendations. CONCLUSIONS: Almost 25% of the participating multiethnic youth 11 to 23 years of age scored in the moderate or high category of CANRISK. The most prevalent risk factors were ethnicity, followed by physical inactivity, overweight or obesity and low fruit and vegetable consumption. A validated type 2 diabetes screening tool for youth as well as culturally appropriate, evidence-based and multidisciplinary diet and lifestyle interventions aiming to improve modifiable type 2 diabetes risk factors in multiethnic youth, particularly targeting socioeconomically disadvantaged and immigrant children and youth, should be developed, implemented and evaluated.

Assessing Health Care Access and Use among Indigenous Peoples in Alberta: a Systematic Review.

Alberta's Indigenous population is growing, yet health care access may be limited. This paper presents a comprehensive review on health care access among Indigenous populations in Alberta with a focus on the health care services use and barriers to health care access. Scientific databases (PubMed, EMBASE, CINAHL, and PsycINFO) and online search engines were systematically searched for studies and grey literature published in English between 2000 and 2013 examining health care services access, use and barriers to access among Indigenous populations in Alberta. Information on health care services use and barriers to use or access was synthesized based on the MOOSE guidelines. Overall, compared to non-Indigenous populations, health care use rates for hospital/emergency room services were higher and health care services use of outpatient specialists was lower among Indigenous peoples. Inadequate numbers of Indigenous health care professionals; a lack of cross-cultural training; fear of foreign environments; and distance from family and friends were barriers to health care use and access. Inequity in social determinants of health among Indigenous peoples and inadequate "health services with prevention approaches," may contribute to present health disparities between Indigenous and non-Indigenous populations in the province.

Understanding the social determinants of health among Indigenous Canadians: priorities for health promotion policies and actions.

BACKGROUND: Indigenous Canadians have a life expectancy 12 years lower than the national average and experience higher rates of preventable chronic diseases compared with non-Indigenous Canadians. Transgenerational trauma from past assimilation policies have affected the health of Indigenous populations. OBJECTIVE: The purpose of this paper is to comprehensively examine the social determinants of health (SDH), in order to identify priorities for health promotion policies and actions. DESIGN: We undertook a series of systematic reviews focusing on four major SDH (i.e. income, education, employment, and housing) among Indigenous peoples in Alberta, following the protocol Preferred Reporting Items for Systematic Reviews and Meta-Analysis-Equity. RESULTS: We found that the four SDH disproportionately affect the health of Indigenous peoples. Our systematic review highlighted 1) limited information regarding relationships and interactions among income, personal and social circumstances, and health outcomes; 2) limited knowledge of factors contributing to current housing status and its impacts on health outcomes; and 3) the limited number of studies involving the barriers to, and opportunities for, education. CONCLUSIONS: These findings may help to inform efforts to promote health equity and improve health outcomes of Indigenous Canadians. However, there is still a great need for in-depth subgroup studies to understand SDH (e.g. age, Indigenous ethnicity, dwelling area, etc.) and intersectoral collaborations (e.g. community and various government departments) to reduce health disparities faced by Indigenous Canadians.

How do Iranian physicians report notifiable diseases? The first report from Iran.

BACKGROUND: Epidemiologic surveillance through notifiable diseases is an essential component of a public health program. Surveillance systems relay mostly on physicians to report notifiable diseases The aim of this study was to identify physicians' knowledge about reporting of notifiable diseases as well as their self-reported practices and perceptions regarding disease reporting barriers and ways to improve compliance. METHOD: A validated, reliable self-administered questionnaire addressing knowledge of notifiable diseases, self-reported practices, reasons for noncompliance with reporting requirements, and suggestions to improve compliance with reporting was distributed to 400 general physicians (GPs) attending medical conferences in Shiraz, Iran between March and July 2006. Knowledge was quantified by evaluating the answers to 45 questions (with 1 point awarded for each correct answer). Associations between the independent variables and physician knowledge were modeled using analysis of covariance. RESULT: The response rate was 75%. The overall mean score was 17.03 +/- 7.45 (range, 4 to 31). Knowledge of the location of the posted notifiable diseases list was positively associated with score on knowledge questions (F = 4.431; P = .036). Fully 88% of the participants stated that they had never reported a notifiable disease. There was no significant association between the participants' self-reported practices and knowledge question scores. The major barriers to reporting notifiable diseases were the extra time required for reporting and poor knowledge of the list of reportable diseases and reporting requirements. The most frequent suggestions for improving physicians' compliance with disease reporting were to simplify the reporting process and to shift the responsibility for notification to another person, such as a secretary or a nurse. CONCLUSION: Our findings suggest poor knowledge of disease notification requirements among GPs. Modifying physisicans' knowledge and motivation, eliminating barriers to disease reporting, and promoting some facilitating factors could help reduce the underreporting of notifiable diseases.

Annual International Geographic Medicine Congress Meetings in Shiraz, Iran: Publication Rates during 1999-2006.

The present study aimed to examine which portion of abstracts presented between 1999 to 2006 at Annual International Geographic Medicine Congress meetings in Shiraz, Iran, were published during 1999-2006, and to identify factors affecting publication rate of those abstracts. Two hundred fifty abstracts were reviewed and categorized according to the type of presentation, study design, sample size, main findings, source of funding, and statistical significance of the results. Principal investigators of those abstracts were provided with a questionnaire inquiring whether their abstracts lead to full-length publications in peer-reviewed journals indexed under PubMed. One hundred twenty five authors responded to the questionnaire. The publication rate of the meeting presentations was found 27.2%. Statistically significant associations were found between publication rate and certain characteristics of the presentations including type of the study, achieving positive results, and conducting multi-center trial funded by a sponsor. Insufficient fluency in English, insufficient time to prepare the manuscript, and assuming journals are unlikely to accept those studies were most common reasons for not preparing or submitting the manuscripts. The publication rate of research studies presented in this annual scientific meeting in Shiraz, Iran, is lower than many similar meetings in other countries.

Patient sources for drug information in Iran: a questionnaire-based survey.

OBJECTIVES: To identify sources used by patients to obtain drug-related information and to find which portion of patients study the Patient Information Leaflet (PIL). METHODS: A cluster random sampling was used to select 19 community pharmacies in Shiraz, Iran, from 192 pharmacies registered by Food and Drug Office of Shiraz University of Medical Sciences. Using a questionnaire, an independent assessor surveyed outpatients immediately after their prescriptions were dispensed. Results were subjected to statistical analysis. RESULTS: Total of 671 patients were interviewed, of which 188 patients (28%) reported they received no information from pharmacists or physicians and 169 patients (25%) received their medications without prescription. Nearly half of the patients (46%) were informed on the frequency of use and dose of their medications. Very few patients (6%) were appropriately informed about the frequency of use, dosage, duration of treatment, and potential side effects, allergies and drug interactions. Patients with college education used PILs as a source of information more than those with lower education levels. CONCLUSION: A significant portion of patients obtained medicines without a prescription. Only a few portion of patients in Shiraz received adequate drug information from their physician or pharmacist. A considerable portion of patients did not study PILs.