Gender identity and sexual attraction among Canadian youth: findings from the 2019 Canadian Health Survey on Children and Youth. / Identité de genre et attirance sexuelle chez les jeunes Canadiens : résultats de l'Enquête canadienne sur la santé des enfants et des jeunes de 2019.

Gender identity and sexual attraction are important determinants of health. This study reports distributions of gender identity and sexual attraction among Canadian youth using data from the 2019 Canadian Health Survey on Children and Youth. Among youth aged 12 to 17, 0.2% are nonbinary and 0.2% are transgender. Among youth aged 15 to 17, 21.0%, comprising more females than males, report attraction not exclusive to the opposite gender. Given known associations between health and gender and sexual attraction, oversampling of sexual minority groups is recommended in future studies to obtain reliable estimates for identifying inequities and informing policy.

Gender and sexual attraction as a dimension of sexual orientation are important determinants of health among youth. Collecting gender and sexual attraction information as a routine part of public health surveillance is important for identifying inequities and informing policy. This study provides nationally representative estimates for the distribution of gender and sexual attraction among Canadian youth. This study identifies populations (nonbinary, transgender and same gender­attracted youth) that require oversampling or other approaches to ensure that reliable estimates can be obtained in public health surveillance.

Le genre et l'attirance sexuelle en tant que dimension de l'orientation sexuelle sont des déterminants importants de la santé chez les jeunes. La collecte de renseignements sur le genre et l'attirance sexuelle dans le cadre des activités habituelles de surveillance de la santé publique est importante pour relever les iniquités et orienter les politiques. Cette étude fait état d'estimations représentatives à l'échelle nationale de la répartition des genres et de l'attirance sexuelle chez les jeunes Canadiens. Cette étude répertorie les populations (non binaires, transgenres et jeunes ayant une attirance envers des personnes du même genre) devant faire l'objet d'un suréchantillonnage ou d'autres approches afin de garantir que des estimations fiables puissent être obtenues dans le cadre de la surveillance de la santé publique.

The association between social media use and physical activity among Canadian adolescents: a Health Behaviour in School-aged Children (HBSC) study.

OBJECTIVE: To determine the association between social media use (SMU) and physical activity (PA) among Canadian adolescents. METHODS: We used data from 12,358 participants in grades 6 to 10 who responded to the Canadian component of the 2017/2018 Health Behaviour in School-aged Children (HBSC) survey. Social media intensity and problematic SMU were assessed using a 4-point mutually exclusive scale that contained three categories based on intensity (non-active, active, and intense SMU) and one category based on the presence of addiction-like symptoms irrespective of intensity (problematic SMU). PA was assessed for five domains (i.e., school curriculum, organized sport, exercise, outdoor play, and active transport) and dichotomized using the first quartile to represent high PA engagement in each domain. Meeting PA recommendation of 60 min per day of moderate-to-vigorous PA was calculated using the sum of the five domains. Logistic regression models were used to assess the association between SMU and PA, with active SMU used as the reference group for all models. RESULTS: Non-active SMU was associated with lower odds of meeting the daily PA recommendations and of high engagement in all five domains of PA when compared to active SMU. Intense SMU was associated with higher odds of meeting the daily PA recommendations. Problematic SMU was not associated with meeting daily PA recommendations, but it was significantly associated with lower odds of high PA engagement in the exercise domain. CONCLUSION: The findings of this study suggest that non-active SMU was significantly associated with lower PA levels. Problematic SMU was only significantly associated with lower PA levels in the exercise domain. Intense SMU was associated with higher odds of meeting the PA recommendation.

RéSUMé: OBJECTIF: Établir la relation entre l'utilisation des médias sociaux et l'activité physique chez les adolescents canadiens. MéTHODES: Nous avons utilisé les données de 12 358 participants de la 6e à la 10e année qui ont répondu au volet canadien de l'Enquête sur les comportements de santé des jeunes d'âge scolaire de 2017­2018 (HBSC). L'intensité des médias sociaux et leur utilisation problématique ont été évaluées à l'aide d'une échelle à quatre points mutuellement exclusifs contenant trois catégories basées sur l'intensité (utilisation non active, active et intense des médias sociaux) et une catégorie basée sur la présence de symptômes de dépendance indépendamment de l'intensité (utilisation problématique des médias sociaux). L'activité physique a été évaluée pour cinq domaines (c'est-à-dire le programme scolaire, le sport organisé, l'exercice, le jeu en plein air et le transport actif) et dichotomisée en utilisant le premier quartile pour représenter la participation à une activité physique élevée dans chaque domaine. Le respect de la recommandation de 60 min par jour d'activité physique modérée à vigoureuse a été calculé en utilisant la somme des cinq domaines. Des modèles de régression logistique ont été utilisés pour évaluer la relation entre l'utilisation des médias sociaux et l'activité physique, l'utilisation active des médias sociaux étant utilisée comme groupe de référence pour tous les modèles. RéSULTATS: L'utilisation non active des médias sociaux était associée à une probabilité plus faible de respecter les recommandations en matière d'activité physique quotidienne et à une participation élevée dans les cinq domaines de l'activité physique, par rapport à l'utilisation active des médias sociaux. Une utilisation intense des médias sociaux était associée à une probabilité plus élevée de respecter les recommandations en matière d'activité physique quotidienne. Une utilisation problématique des médias sociaux n'était pas associée au respect des recommandations en matière d'activité physique quotidienne, mais elle était fortement associée à une probabilité moindre de participation élevée à une activité physique dans le domaine de l'exercice. CONCLUSION: Les résultats de cette étude suggèrent que l'utilisation non active des médias sociaux est fortement associée à des niveaux d'activité physique plus faibles. Une utilisation problématique des médias sociaux n'était fortement associée à des niveaux d'activité physique plus faibles que dans le domaine de l'exercice. Une utilisation intense des médias sociaux était associée à une probabilité plus élevée de respecter la recommandation en matière d'activité physique.

Adolescent use of social media and associations with sleep patterns across 18 European and North American countries.

OBJECTIVE: Over the past decade, concurrent with increasing social media use (SMU), there has been a shift toward poorer sleep among adolescents in many countries. The purpose of this study was to examine the cross-national associations between adolescent SMU and sleep patterns, by comparing 4 different categories of SMU (nonactive, active, intense, and problematic use). DESIGN, SETTING, AND PARTICIPANTS: Data were from 86,542 adolescents in 18 European and North American countries that participated in the 2017/18 Health Behaviour in School-aged study. MEASUREMENTS: Mixed-effects linear regression models were used to examine cross-national associations between 4 SMU categories and adolescent sleep duration, bedtime and social jetlag derived from self-reported data. RESULTS: For all countries combined, nonactive SMU was associated with longer sleep, earlier bedtimes, and less social jetlag, compared to active SMU, although the differences were minor. By comparison, intense and problematic SMU were associated with less sleep and later bedtimes on both school and nonschool days, and greater social jetlag, compared to active SMU. While findings were relatively consistent between countries, some differences were observed, suggesting that the national and cultural context may be important in interpreting results. CONCLUSIONS: These findings suggest that both intense and problematic SMU are associated with poorer sleep patterns in adolescents across most countries. Further research is needed to identify effective policies, programs, and messaging to promote the healthy use of social media and prevent potential negative impacts on adolescent sleep.

Assessing the impact of sports and recreation facility density within school neighbourhoods on Canadian adolescents' substance use behaviours: quasi-experimental evidence from the COMPASS study, 2015-2018.

OBJECTIVES: There has been relatively little exploration to date of potential protective effects within school neighbourhoods, such as those conferred by facilities that seek to promote health with respect to substance use and related harms. This study examined how the density of sports and recreation facilities in the school neighbourhood is associated with the likelihood of binge drinking, e-cigarette use, cigarette smoking and cannabis use among Canadian secondary school students. DESIGN: Longitudinal data from the COMPASS study on Canadian youth health behaviours from 2015/2016 to 2017/2018 was linked with school neighbourhood data capturing the number of sports and recreation facilities within a 1500 m radius of schools. SETTING: Secondary schools and school neighbourhoods in Alberta, British Columbia, Ontario and Quebec who participated in the COMPASS study. PARTICIPANTS: 16 471 youth who participated in the COMPASS study over three school years (2015/2016-2017/2018). PRIMARY AND SECONDARY OUTCOME MEASURES: Binge drinking, e-cigarette use, cigarette use, cannabis use. RESULTS: Logistic regression models using generalised estimating equations identified that greater density of sports and recreation facilities within the school neighbourhood was significantly associated with lower likelihood of binge drinking and e-cigarette use but was not associated with cigarette smoking or cannabis use. CONCLUSIONS: This research can help to support evidence-informed school community-based efforts to prevent substance-related harms among youth.

Opioid and Cannabis Use During Pregnancy and Breastfeeding in Relation to Sociodemographics and Mental Health Status: A Descriptive Study.

OBJECTIVE: This study of Canadian women estimates the prevalence of opioid and cannabis use during pregnancy and cannabis use during the breastfeeding period and explores the sociodemographic and mental health characteristics associated with use. METHODS: A total of 13 000 women who gave birth between January and June 2018 were invited to participate in the Survey on Maternal Health by Statistics Canada; 7111 women participated for a response rate of 54.7%. Participants were asked about their mental health, supports during pregnancy, and substance use. Multivariable logistic regression was used to describe the relationship between sociodemographic and mental health characteristics and substance use during pregnancy and while breastfeeding. RESULTS: The prevalence of self-reported opioid use during pregnancy was 1.4% (95% confidence interval [CI] 1.1%-1.8%). A higher proportion of women reported using cannabis during pregnancy and while breastfeeding, at 3.1% (95% CI 2.5%-3.6%) and 2.6% (95% CI 2.1%-3.1%), respectively. Younger age, not being in a relationship, lower level of education, and thoughts of self-harm were significantly associated with cannabis use during pregnancy. Lower level of education and thoughts of self-harm were also significantly associated with cannabis use while breastfeeding, as were symptoms of postpartum depression and/or generalized anxiety. Lower level of education and symptoms of postpartum depression and/or generalized anxiety were also significantly associated with opioid use during pregnancy. CONCLUSION: The results of this survey show relatively low levels of opioid and cannabis use during pregnancy and cannabis use while breastfeeding in Canada. Different sociodemographic and mental health characteristics are associated with the use of these substances, and public health interventions and policies should take into account these factors.

Symptoms of postpartum anxiety and depression among women in Canada: findings from a national cross-sectional survey.

OBJECTIVE: This study presents national estimates on symptoms consistent with postpartum anxiety (PPA) and postpartum depression (PPD) and the association between these conditions and possible risk and protective factors in women who gave birth in Canada. METHODS: Data were collected through the Survey on Maternal Health, a cross-sectional survey administered in Canada's ten provinces between November 2018 and February 2019 among women who gave birth between January 1 and June 30, 2018. A total of 6558 respondents were included. Weighted prevalence estimates were calculated, and logistic regression was used to model the relationship between symptoms consistent with PPA, PPD, and potential risk factors. RESULTS: Overall, 13.8% of women had symptoms consistent with PPA, while the prevalence of having symptoms consistent with PPD was 17.9%. Results of the logistic regression models indicated that women who had a history of depression were 3.4 times (95% CI 2.7-4.2) more likely to experience symptoms consistent with PPA and 2.6 times more likely to experience symptoms consistent with PPD (95% CI 2.2-3.2) compared with those who did not. Women who reported good, fair, or poor physical health were 2.4 times more likely to experience symptoms consistent with PPD (95% CI 2.0-2.9) and 2.0 times more likely to experience symptoms consistent with PPA (95% CI 1.7-2.4) compared with those who reported very good or excellent health. Maternal marital status, other postpartum maternal support, and sense of community belonging were also significant. CONCLUSION: This study highlights that a history of depression and good, fair, or poor physical health are associated with an increased odds of symptoms consistent with PPA and PPD, while other maternal support and sense of community belonging are associated with a decreased odds of these conditions.

RéSUMé: OBJECTIF: La présente étude présente des estimations nationales sur les symptômes correspondant à de l'anxiété post-partum (APP) et à une dépression post-partum (DPP) et sur l'association entre ces affections et les éventuels facteurs de risque et de protection chez les femmes ayant accouché au Canada. MéTHODOLOGIE: Les données ont été recueillies dans le cadre de l'Enquête sur la santé maternelle, une enquête transversale menée dans les dix provinces canadiennes entre novembre 2018 et février 2019 auprès des femmes ayant accouché entre le 1er janvier et le 30 juin 2018. Au total, 6 558 personnes ont répondu à l'enquête. Des estimations de la prévalence pondérée ont été calculées, et une régression logistique a été utilisée pour modéliser la relation entre les symptômes correspondant à de l'APP, à une DPP et aux facteurs de risque possibles. RéSULTATS: Dans l'ensemble, 13,8 % des femmes présentaient des symptômes compatibles avec de l'APP, tandis que la prévalence des symptômes compatibles avec une DPP était de 17,9 %. Les résultats des modèles de régression logistique ont indiqué que les femmes ayant des antécédents de dépression étaient 3,4 fois (IC à 95 % : 2,7 à 4,2) plus susceptibles de présenter des symptômes compatibles avec de l'APP et 2,6 fois plus susceptibles de présenter des symptômes compatibles avec une DPP (IC à 95 % : 2,2 à 3,2) par rapport à celles qui n'en avaient pas. Les femmes qui ont déclaré être en bonne, moyenne ou mauvaise santé physique étaient 2,4 fois plus susceptibles d'éprouver des symptômes correspondant à une DPP (IC à 95 % : 2,0 à 2,9) et 2,0 fois plus susceptibles d'éprouver des symptômes correspondant à de l'APP (IC à 95 % : 1,7 à 2,4) par rapport à celles qui ont déclaré être en très bonne ou en excellente santé. L'état matrimonial de la mère, les autres formes de soutien maternel post-partum et le sentiment d'appartenance à la collectivité étaient également significatifs. CONCLUSION: Cette étude souligne que des antécédents de dépression et une bonne, moyenne ou mauvaise santé physique sont associés à une augmentation de la probabilité de symptômes correspondant à de l'APP et à une DPP, tandis que d'autres formes de soutien maternel et le sentiment d'appartenance à la collectivité sont associés à une diminution de la probabilité de ces affections.

Prevalence of Positive Mental Health and Associated Factors Among Postpartum Women in Canada: Findings from a National Cross-Sectional Survey.

OBJECTIVES: The objectives of this study were to compare the prevalence of three positive mental health (PMH) outcomes (self-rated mental health, life satisfaction, sense of community belonging) in postpartum women to the general population, and to examine the relationship between protective factors and the three PMH outcomes among postpartum women. METHODS: The national cross-sectional Survey on Maternal Health (n = 6558) was analyzed. Analyses were weighted and 95% confidence intervals were calculated. Three adjusted logistic regression models were generated. To compare this sample to the general population of women, estimates from the Canadian Community Health Survey-Annual Component (2018) were used. RESULTS: Compared to the general population of women, a larger proportion of postpartum women reported a strong sense of community belonging. The odds of postpartum women with high self-rated physical health having high self-rated mental health were approximately seven times greater (aOR 6.9, 95% confidence interval [CI] 5.9, 8.1) than postpartum women with lower self-rated physical health. The absence of symptoms of postpartum depression (PPD) or generalized anxiety disorder (GAD) and high self-rated physical health were significantly associated with all three PMH outcomes. Frequent availability of maternal support was associated with greater odds of high life satisfaction (aOR 1.6, 95% CI 1.4, 1.9) and sense of community belonging (aOR 1.4, 95% CI 1.2, 1.6). CONCLUSIONS: Our study demonstrated that availability of maternal support, self-rated physical health and absence of symptoms of PPD or GAD were associated with PMH among postpartum women. As physical health had the strongest association with mental health, we encourage further examination of this relationship.

Association of urinary polycyclic aromatic hydrocarbons and obesity in children aged 3-18: Canadian Health Measures Survey 2009-2015.

Polycyclic aromatic hydrocarbons (PAHs) may contribute to obesity. Childhood obesity is a strong predictor of adult obesity and morbidity; however, the relationship between PAHs and obesity in young children (e.g., aged 3-5) has not been studied. We examined the association between urinary PAH metabolites and measures of obesity in children. We analyzed data from 3667 children aged 3-18 years who participated in the Canadian Health Measures Survey (CHMS, 2009-2015). We ran separate multivariable linear models to estimate the association between quartiles of PAH metabolites and each of body mass index (BMI) percentile, waist circumference (WC), and waist-to-height ratio (WHtR) in the total population, as well as in the age subgroups 3-5, 6-11, and 12-18, adjusting for age, sex, ethnicity, education, income quintile, diet, creatinine, and exposure to environmental tobacco smoke. A multinomial logistic regression model estimated adjusted odds ratios for risk of central obesity. BMI, WC, and WHtR were positively associated with total PAH and naphthalene metabolites in the total population aged 3-18 and in age groups 6-11 and 12-18. In 3-5 year olds, WHtR, but not BMI, was significantly associated with total PAH, naphthalene, and phenanthrene metabolites. Overall, those in the highest quartile for naphthalene or total PAH metabolites had three times greater odds of having central obesity compared with those in the lowest quartile. Urinary PAH metabolites are associated with WHtR, an indicator of central obesity and predictor of health risks associated with obesity, in children as young as 3-5.

Normative-referenced percentile values for physical fitness among Canadians.

BACKGROUND: This study developed age- and sex-specific normative-referenced percentile values for five physical fitness tests across a wide age range of Canadians, using a nationally representative sample. DATA AND METHODS: The data are from 5,188 Canadians (50.1% female) and were collected as part of cycle 5 of the Canadian Health Measures Survey (2016 to 2017). RESULTS: Males had slightly better cardiorespiratory fitness and substantially better grip strength, jumping height and jumping power scores than females, whereas females had better sit-and-reach flexibility. Among females, there were pronounced increases in jumping height (P50: 25%) and jumping power (P50: 58%) between ages 8 and 13, and in grip strength (P50: 193%) between ages 6 and 19. Performance gradually declined with age, beginning in adolescence for jumping ability and at approximately age 35 for grip strength. Among males, there were pronounced increases in jumping height (P50: 69%) and jumping power (P50: 233%) between ages 8 and 20, and in grip strength (P50: 365%) between ages 6 and 20. Performance gradually declined with age, beginning immediately after adolescence for jumping ability and at approximately age 30 for grip strength. Sit-and-reach flexibility remained relatively stable with age in both sexes. Cardiorespiratory fitness scores in both sexes declined steadily with age beginning (generally) at age 8, with a larger decline evident in females until age 18. DISCUSSION: These normative-referenced values for physical fitness could be useful for screening in public health and clinical practice.

Infant bed sharing in Canada.

BACKGROUND: There is debate about the practice of bed sharing, which is defined as sharing a sleep surface with an infant. Most public health guidance in Canada, including the 2011 Joint Statement on Safe Sleep, advises parents against it because of an association with infant injury and death. However, proponents cite potential physical and psychological benefits, and evidence suggests that the risks associated with bed sharing are low in the absence of other risk factors. Until now, little has been known about the prevalence of and reasons for bed sharing in Canada. DATA AND METHODS: Canadian Community Health Survey data from 2015 and 2016 were used to estimate the prevalence of and reasons for bed sharing by selected characteristics among women aged 15 to 55 who had given birth in the past five years. Multivariate analysis examined factors independently associated with frequent bed sharing. RESULTS: An estimated 33% of women reported that their infant had frequently (every day or almost every day) shared a sleep surface with someone else; 27% had bed shared occasionally (once or twice a week, a few times a month or less than once a month) and 40% had never bed shared. Breastfeeding was the most common reason for bed sharing (39%), followed by facilitating the mother's or infant's sleep (29%). In multivariate analysis, age group, marital status, province or territory of residence, region of mother's birth and breastfeeding were significantly associated with frequent bed sharing. DISCUSSION: The data indicate that bed sharing is relatively common and suggest that parents are doing it for practical reasons. The results of this study will provide baseline data and inform policies and programs related to safe sleep practices.

Does Size Matter When Calculating the "Correct" Tidal Volume for Pediatric Mechanical Ventilation?: A Hypothesis Based on FVC.

BACKGROUND: Tidal volumes standardized to predicted body weight are recommended for adult mechanical ventilation, but children are frequently ventilated by using measured body weight. The goal of this study was to examine the difference in FVC (in milliliters per kilogram [mL/kg]) by using measured body weight compared with predicted body weight in children. METHODS: This retrospective analysis included outpatient pulmonary function tests (PFTs) from two datasets. Dataset one included 6- to 19-year-old patients undergoing PFTs from the nationally representative Canadian Health Measures Survey. Dataset two included 6- to 20-year-old patients undergoing PFTs at a freestanding children's hospital. FVC mL/kg values were analyzed against BMI z scores to show changes in FVC vs BMI between measured and predicted weight. RESULTS: Dataset one included 5,394 PFTs from the Canadian survey. FVC from measured weight decreased as the BMI z score group increased. The median FVC from measured weight was 81.4 mL/kg in the lowest BMI z score group and 51.7 mL/kg in the highest BMI z score group. FVC from predicted weight increased slightly with increasing BMI z score group. Dataset two included 8,472 patient PFTs from clinical measurement. A decline in median FVC from measured weight (from 69.4 to 37.6 mL/kg) as BMI z score group increased was also seen. CONCLUSIONS: FVC differs significantly when standardizing to measured weight vs predicted weight. Obese children have lung volumes reflecting their predicted body weight from height. Children with low or normal BMI have lung volumes reflecting measured body weight. These findings suggest that targeting tidal volume by using the lower of measured and predicted body weights would be the most lung-protective strategy.

Multiple sclerosis: Prevalence and impact.

This article provides new information about multiple sclerosis (MS) using the 2010/2011 Neurological Conditions Prevalence File, the 2011/2012 Survey of Neurological Conditions in Institutions in Canada, and the 2011 Survey on Living with Neurological Conditions in Canada. An estimated 93,500 Canadians living in private households and 3,800 residents of long-term care institutions had been diagnosed with MS. Prevalence estimates were 159 and 418 cases per 100,000 population for men and women, respectively; 2.6 women reported MS for every man with the condition. Among the household population, MS was generally diagnosed between the ages of 20 and 49 (82%). For the majority (68%), MS was their only neurological condition. The impact of MS included pain that prevented activities, impairments in mobility, cognition or sleep, and limitations in social functioning. Almost two-thirds (64%) stated that MS affected their lives at least moderately.

Duration and quality of sleep among Canadians aged 18 to 79.

This article provides recent estimates of the duration and quality of sleep of Canadian adults and of the percentage who adhere to sleep duration guidelines (7 to 9 hours per night at ages 18 to 64, and 7 to 8 hours per night at age 65 or older). The study is based on 10,976 respondents aged 18 to 79 from the 2007-to-2013 Canadian Health Measures Survey, a nationally representative, cross-sectional survey. Sleep duration and quality were self-reported. Mean sleep duration was 7.12 hours per night at ages 18 to 64 and 7.24 hours per night at ages 65 to 79. An estimated 65% of 18- to 64-year-olds and 54% of seniors slept the recommended number of hours per night. However, short sleep duration and poor sleep quality were relatively common. About a third slept fewer hours than recommended. At ages 18 to 64, an estimated 43% of men and 55% of women reported trouble going to sleep or staying asleep "sometimes/most of the time/all of the time"; the corresponding percentages at ages 65 to 79 were 40% and 59%.

Grip strength reference values for Canadians aged 6 to 79: Canadian Health Measures Survey, 2007 to 2013.

BACKGROUND: Grip strength is a measure of overall muscular strength and has been associated with disability, morbidity and mortality. Normative data are used to interpret an individual's grip strength measurements, but Canadian reference values are not available for a wide age range. DATA AND METHODS: The data pertain to 11,108 respondents aged 6 to 79 to the 2007-to-2013 Canadian Health Measures Survey, whose right-hand and left-hand grip strength were measured with a handgrip dynamometer. Quantile regression was used to develop reference equations for males and females for maximum, right-hand and left-hand grip strength for selected percentiles as a function of age, height and weight. RESULTS: Reference values for grip strength increased through childhood and adolescence, peaked around age 40, and then declined. Reference values were higher for males than for females; differences between the sexes were smaller during childhood than in adolescence and adulthood. Differences between reference values for maximum, right-hand and left-hand grip strength varied by age and sex. INTERPRETATION: Based on a large, healthy, nationally representative sample, reference equations were developed for grip strength of Canadians from childhood to older adulthood. These equations can be used to determine the reference values that correspond to an individual of a given age, sex, height and weight.

Reduced muscular strength among Canadians aged 60 to 79: Canadian Health Measures Survey, 2007 to 2013.

BACKGROUND: Reduced muscular strength is associated with an increased risk of all-cause, cardiovascular and non-cardiovascular mortality, heart attack and stroke. At older ages, reduced strength is associated with impaired mobility, risk of falls, and disability. Various criteria are used to determine reduced strength. DATA AND METHODS: Data on grip strength among 3,181 respondents aged 60 to 79 from the 2007 to 2013 Canadian Health Measures Survey were used to calculate the prevalence of reduced strength based on sex-specific percentile and t-score cut-points and cut-points of the Foundation for the National Institutes of Health. Logistic regression was used to identify significant associations between reduced strength and mobility, disability and self-rated health. RESULTS: Based on stricter criteria, the prevalence of reduced strength among household residents aged 60 to 79 ranged from 3% to 5%; based on less strict criteria, the prevalence ranged from 10% to 18%. Compared with people with normal strength, those with reduced strength had higher odds of impaired mobility (ranging from 3.40 to 8.33, depending on the cut-point), poor or fair self-rated health (2.19 to 4.20), and moderate-to-severe disability (2.21 to 2.60). INTERPRETATION: Estimates of the prevalence of reduced grip strength varied by cut-point. Reduced strength was significantly associated with impaired mobility, moderate-to-severe disability, and poor or fair self-rated health. Further research is required to determine if associations between reduced strength and other health outcomes vary by cut-point.

Epilepsy in Canada: Prevalence and impact.

This article provides information about the prevalence and impact of epilepsy, based on the 2010 and 2011 Canadian Community Health Surveys, the 2011/2012 Survey of Neurological Conditions in Institutions in Canada, and the 2011 Survey on Living with Neurological Conditions in Canada. An estimated 139,200 Canadians had epilepsy. Among the household population, epilepsy was generally diagnosed before age 30 (75%). For the majority of these people (64%), epilepsy was their only neurological condition. People with epilepsy were more than twice as likely to have been diagnosed with a mood disorder, compared with the general population (17% versus 7%), and eight times as likely to experience incontinence (34% versus 4%). Overall, an estimated 18% reported that their life was affected quite a bit or extremely by epilepsy; 44% felt that their life was impacted a little bit or moderately; and 39% felt that their life was not impacted at all. This study examined the impact of epilepsy on interactions with others, sleep, driving, education, and employment.

Alzheimer's disease and other dementias in Canada.

This article provides information on Alzheimer's disease and other dementias, using the 2010/2011 Canadian Community Health Survey, the 2011/2012 Survey of Neurological Conditions in Institutions in Canada, and the 2011 Survey on Living with Neurological Conditions in Canada. Among Canadians aged 45 or older, an estimated 0.8% in private households and 45% in long-term residential care facilities had a diagnosis of dementia. Prevalence rose with age. The vast majority of people with dementia in private households received assistance with medical care (81%), housework and home maintenance (83%), meal preparation (88%), emotional support (90%), transportation (92%), and managing care (92%). Among those receiving assistance, 85% relied, at least in part, on family, friends or neighbours. The primary caregiver tended to be a spouse (46%) or an adult child (44%), most of whom were daughters (71%). The majority of primary caregivers lived in the same household (83%) and provided daily care (86%).

Reference Equations for Spirometry in the Canadian Population.

RATIONALE: Spirometry plays a major role in the diagnosis and assessment of severity of lung disease. Determining which lung function values are normal and which are below the lower limit of normal depends on reference equations derived from an appropriate population. OBJECTIVES: The purpose of this study was to derive spirometric reference equations for the Canadian population. METHODS: The Canadian Health Measures Survey consisted of a respiratory questionnaire, urinary cotinine measurements, and spirometry performed in the sitting position with rigorous quality control standards. Of the 16,606 respondents between 6 and 79 years of age, 11,145 were eliminated for positive responses to the respiratory questionnaire, tobacco exposure, or inability to provide high-quality spirograms. Of the remaining 5,461, roughly half were less than 18 years of age. Quantile regression was used to derive predictive (median) and lower limit of normal equations for males and females for FEV1, FVC, and FEV1/FVC ratio for those with ages greater and less than 18 years. MEASUREMENTS AND MAIN RESULTS: The resulting equations were compared with those from the Global Lung Initiative (GLI) and National Health and Nutrition Examination Survey (NHANES) III by using an ideal subject on the 50th percentile for height and between the ages of 6 and 79 years; the comparison showed minor and inconsistent discrepancies among the predictive equations. A plot of residuals (predicted minus measured value for each subject) suggested a marginally better fit compared with the GLI and NHANES III equations, although differences among the equations were small and unlikely to have any clinical significance. CONCLUSIONS: This study provides spirometric reference equations for the Canadian population that were measured under the recommended clinical conditions and with rigorous quality control.

Exposure to industrial air pollutant emissions and lung function in children: Canadian Health Measures Survey, 2007 to 2011.

BACKGROUND: Long-term exposure to ambient air pollution has been associated with adverse effects on children's lung function. Few studies have examined lung function in relation to industrial emissions of air pollutants. DATA AND METHODS: This cross-sectional study was based on 2,833 respondents aged 6 to 18 for whom spirometry data were collected by the Canadian Health Measures Survey, 2007 to 2011. The weighted sum of industrial air emissions of nitrogen oxides (NOₓ) and fine particulate matter (PM2.5) within 25 km of the respondent's residence was derived using National Pollutant Release Inventory data. Multivariate linear regression was used to examine the relationship between NOₓ and PM2.5 emissions and forced vital capacity (FVC), the forced expiratory volume in 1 sec (FEV1), and the ratio of the two (FEV1/FVC). RESULTS: Industrial air emissions of NOₓ were not significantly associated with lung function among males or females. Emissions of PM2.5 were negatively associated with FEV1 and FEV1/FVC, but not FVC, among males. PM2.5 was not significantly related to lung function among females. INTERPRETATION: The associations that emerged between lung function and industrial emissions of PM2.5 among males were consistent with airway obstruction. Further research is warranted to investigate the gender differences observed in this study.

Biochemical marker reference values across pediatric, adult, and geriatric ages: establishment of robust pediatric and adult reference intervals on the basis of the Canadian Health Measures Survey.

BACKGROUND: Biological covariates such as age and sex can markedly influence biochemical marker reference values, but no comprehensive study has examined such changes across pediatric, adult, and geriatric ages. The Canadian Health Measures Survey (CHMS) collected comprehensive nationwide health information and blood samples from children and adults in the household population and, in collaboration with the Canadian Laboratory Initiative on Pediatric Reference Intervals (CALIPER), examined biological changes in biochemical markers from pediatric to geriatric age, establishing a comprehensive reference interval database for routine disease biomarkers. METHODS: The CHMS collected health information, physical measurements, and biosamples (blood and urine) from approximately 12 000 Canadians aged 3-79 years and measured 24 biochemical markers with the Ortho Vitros 5600 FS analyzer or a manual microplate. By use of CLSI C28-A3 guidelines, we determined age- and sex-specific reference intervals, including corresponding 90% CIs, on the basis of specific exclusion criteria. RESULTS: Biochemical marker reference values exhibited dynamic changes from pediatric to geriatric age. Most biochemical markers required some combination of age and/or sex partitioning. Two or more age partitions were required for all analytes except bicarbonate, which remained constant throughout life. Additional sex partitioning was required for most biomarkers, except bicarbonate, total cholesterol, total protein, urine iodine, and potassium. CONCLUSIONS: Understanding the fluctuations in biochemical markers over a wide age range provides important insight into biological processes and facilitates clinical application of biochemical markers to monitor manifestation of various disease states. The CHMS-CALIPER collaboration addresses this important evidence gap and allows the establishment of robust pediatric and adult reference intervals.