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ABSTRACT: BACKGROUND: The mode of delivery has recently gained attention as another potential perinatal risk factor for childhood obesity but results are conflicting. OBJECTIVE: To examine whether caesarean section is independently associated with childhood obesity after adjusting for a broad range of confounding factors. METHODS: The current study used a population-based survey in Grade 5 students linked to a provincial perinatal registry in the Canadian province of Nova Scotia. Associations between caesarean section and childhood overweight and obesity at age 10/11 years were examined using multiple logistic regression. RESULTS: Of the 4298 students who participated in the 2003 Children's Lifestyle and School Performance Study (response rate 51.1%), 3426 (80%) could be linked with information in the Atlee Perinatal Database, and 2988 mother-child pairs (70%) had complete information on the exposure and outcome. Compared to vaginal delivery, caesarean section was associated with offspring obesity (OR) 1.49, 95% CI 1.10 to 2.00) in the univariate analysis. After adding maternal prepregnancy weight to the multiple regression model, the OR for obesity dropped from 1.48 to 1.20 (95% CI 0.87 to 1.65). When caesarean section with and without labour were considered separately, we found no statistically significant associations relative to the vaginal delivery group (OR 1.24, 95% CI 0.84 to 1.82 and OR 1.03, 95% CI 0.58 to 1.84). CONCLUSION: Our results do not support a causal association between caesarean section and childhood obesity. Maternal prepregnancy weight was an important confounder in the association between caesarean delivery and childhood obesity and needs to be considered in future studies.
Archives of Disease in Childhood 05/2013; · 2.88 Impact Factor
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ABSTRACT: BACKGROUND: Rapid changes in lifestyle have led to a global obesity epidemic. Understanding the economic burden associated with the obesity epidemic is essential to decision making of cost-effective interventions. This study reviewed costs of obesity and intervention programs in Canada, assessed the scope and quality of existing cost analyses, and identified implications for economic evaluations and public health decision makers. METHODS: A systematic search of costs associated with obesity or intervention program in Canada between 1990 and 2011 yielded 10 English language articles eligible for review. RESULTS: The majority of studies was prevalence-based or top-down costing; 40% had excellent quality assessed using the Quality of Health Economic Study scale. The aggregated annual costs of obesity in Canada ranged from 1.27 to 11.08 billion dollars. Direct costs accounted for 37.2% to 54.5% of total annual costs. Between 2.2% and 12.0% of Canada's total health expenditures were attributable to obesity. The average annual physician cost of overweight male ($ 427) and female ($ 578) adults was lower than that of obese male ($ 475) and female ($ 682) adults; this cost differential across weight status groups was comparable to that found in adolescents. The cost for implementation and maintenance of a school-based obesity prevention program was $ 23 per student. CONCLUSIONS: We observed high costs associated with overweight and obesity and modest costs for obesity prevention programs; however, no cost-effectiveness study of obesity interventions has been performed in Canada. Cost-effectiveness analyses of preventive programs that constitute incidence-based life-time modeling of costs and health outcomes from societal perspective are urgently needed.
Cost Effectiveness and Resource Allocation 02/2013; 11(1):3. · 0.87 Impact Factor
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ABSTRACT: Objective: Poor nutritional habits and physical inactivity are two health behaviours believed to be linked with increasing rates of overweight and obesity in children. The objective of the present study was to determine whether children who reported healthier behaviours, specifically in relation to nutrition and physical activity, also had lower health-care utilization. Design: Population-based cross-sectional study, linking survey data from the 2003 Children's Lifestyle and School Performance Study (CLASS) with Nova Scotia administrative health data. Health-care utilization was defined as both (i) the total physician costs and (ii) the number of physician visits, for each child from 2001 to 2006. Exposures were two indices of healthy eating, the Diet Quality Index and the Healthy Eating Index, and self-reported physical activity and screen time behaviours. Setting: Elementary schools in the Canadian province of Nova Scotia. Subjects: Grade 5 students and their parents; of the 5200 students who participated in CLASS and completed surveys, 4380 (84 %) could be linked with information in the administrative data sets. Results: The study found a relationship between both indices of healthy eating and a borderline significant trend towards lower health-care utilization in this population sample of children. No statistically significant relationships were seen for physical activity or screen time. Conclusions: Both measures of diet quality produced similar results. The study suggests that healthy eating habits established in childhood may be associated with lower health-care utilization, although further research over a longer time frame is needed to demonstrate statistical significance.
Public Health Nutrition 05/2012; · 2.17 Impact Factor
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ABSTRACT: Objective: Poor nutritional habits and physical inactivity are two health behaviours believed to be linked with increasing rates of overweight and obesity in children. The objective of the present study was to determine whether children who reported healthier behaviours, specifically in relation to nutrition and physical activity, also had lower health-care utilization. Design: Population-based cross-sectional study, linking survey data from the 2003 Children's Lifestyle and School Performance Study (CLASS) with Nova Scotia administrative health data. Health-care utilization was defined as both (i) the total physician costs and (ii) the number of physician visits, for each child from 2001 to 2006. Exposures were two indices of healthy eating, the Diet Quality Index and the Healthy Eating Index, and self-reported physical activity and screen time behaviours. Setting: Elementary schools in the Canadian province of Nova Scotia. Subjects: Grade 5 students and their parents; of the 5200 students who participated in CLASS and completed surveys, 4380 (84 %) could be linked with information in the administrative data sets. Results: The study found a relationship between both indices of healthy eating and a borderline significant trend towards lower health-care utilization in this population sample of children. No statistically significant relationships were seen for physical activity or screen time. Conclusions: Both measures of diet quality produced similar results. The study suggests that healthy eating habits established in childhood may be associated with lower health-care utilization, although further research over a longer time frame is needed to demonstrate statistical significance.
Public Health Nutrition 05/2012; · 2.17 Impact Factor
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ABSTRACT: OBJECTIVE: Poor nutritional habits and physical inactivity are two health behaviours believed to be linked with increasing rates of overweight and obesity in children. The objective of the present study was to determine whether children who reported healthier behaviours, specifically in relation to nutrition and physical activity, also had lower health-care utilization. DESIGN: Population-based cross-sectional study, linking survey data from the 2003 Children's Lifestyle and School Performance Study (CLASS) with Nova Scotia administrative health data. Health-care utilization was defined as both (i) the total physician costs and (ii) the number of physician visits, for each child from 2001 to 2006. Exposures were two indices of healthy eating, the Diet Quality Index and the Healthy Eating Index, and self-reported physical activity and screen time behaviours. SETTING: Elementary schools in the Canadian province of Nova Scotia. SUBJECTS: Grade 5 students and their parents; of the 5200 students who participated in CLASS and completed surveys, 4380 (84 %) could be linked with information in the administrative data sets. RESULTS: The study found a relationship between both indices of healthy eating and a borderline significant trend towards lower health-care utilization in this population sample of children. No statistically significant relationships were seen for physical activity or screen time. CONCLUSIONS: Both measures of diet quality produced similar results. The study suggests that healthy eating habits established in childhood may be associated with lower health-care utilization, although further research over a longer time frame is needed to demonstrate statistical significance.
Public Health Nutrition 05/2012; · 2.17 Impact Factor
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ABSTRACT: OBJECTIVE: To examine the association between diet quality and the diagnosis of an internalizing disorder in children and adolescents. DESIGN: A prospective study examining the relationship between diet quality and mental health. FFQ responses of 3757 children were used to calculate a composite score for diet quality and its four components: variety, adequacy, moderation and balance. Physicians' diagnoses on internalizing disorders were obtained by linking the children's dietary information to administrative health data. Negative binomial regression models were used to examine the association between diet quality and diagnosis of an internalizing disorder. SETTING: The Canadian province of Nova Scotia. SUBJECTS: A provincially representative sample of grade 5 students (age 10-11 years). RESULTS: Diet quality was not found to be associated with internalizing disorder in a statistically significant manner (incidence rate ratio = 1·09; 95 % CI 0·73, 1·63). However, relative to children with little variety in their diets, children with greater variety in their diet had statistically significant lower rates of internalizing disorder in subsequent years (incidence rate ratio = 0·45; 95 % CI 0·25, 0·82). CONCLUSIONS: These findings suggest the importance of variety in children's diet and opportunities in the prevention of adolescent depression and anxiety.
Public Health Nutrition 03/2012; · 2.17 Impact Factor
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ABSTRACT: Fetal growth restriction and maternal smoking during pregnancy are independently implicated in lowering intellectual attainment in children. We hypothesized that only reduction of fetal growth that is attributable to extrinsic causes (e.g., maternal smoking) affects intellectual development of a child. Cross-sectional survey of 3,739 students in Nova Scotia (Canada) in 2003 was linked with the perinatal database, parental interviews on socio-demographic factors and the performance on standardized tests when primarily 11-12 years of age, thereby forming a retrospective cohort. Data was analyzed using hierarchical logistic regression with correction for clustering of children within schools. The risk of poor test result among children born small-for-gestational-age (SGA) to mothers who smoked was 29.4%, higher than in any other strata of maternal smoking and fetal growth. The adjusted odds ratio among SGA children born to mothers who smoked was the only one elevated compared to children who were not growth restricted and born to mothers who did not smoke (17.0%, OR = 1.46, 95% CI 1.02, 2.09). Other perinatal, maternal and socio-demographic factors did not alter this pattern of effect modification. Heterogeneity of etiology of fetal growth restriction should be consider in studies that address examine its impact on health over life course.
International Journal of Environmental Research and Public Health 02/2012; 9(2):408-20. · 1.61 Impact Factor
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ABSTRACT: Administrative health databases are a valuable research tool to assess health care utilization at the population level. However, their use in obesity research limited due to the lack of data on body weight. A potential workaround is to use the ICD code of obesity to identify obese individuals. The objective of the current study was to investigate the sensitivity and specificity of an ICD code-based diagnosis of obesity from administrative health data relative to the gold standard measured BMI.
Linkage of a population-based survey with anthropometric measures in elementary school children in 2003 with longitudinal administrative health data (physician visits and hospital discharges 1992-2006) from the Canadian province of Nova Scotia. Measured obesity was defined based on the CDC cut-offs applied to the measured BMI. An ICD code-based diagnosis obesity was defined as one or more ICD-9 (278) or ICD-10 code (E66-E68) of obesity from a physician visit or a hospital stay. Sensitivity and specificity were calculated and health care cost estimates based on measured obesity and ICD-based obesity were compared.
The sensitivity of an ICD code-based obesity diagnosis was 7.4% using ICD codes between 2002 and 2004. Those correctly identified had a higher BMI and had higher health care utilization and costs.
An ICD diagnosis of obesity in Canadian administrative health data grossly underestimates the true prevalence of childhood obesity and overestimates the health care cost differential between obese and non-obese children.
BMC Medical Research Methodology 12/2011; 11:173. · 2.67 Impact Factor
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ABSTRACT: To explore the commonly recorded diagnoses in overweight and obese children presenting to a clinical care setting compared with their normal-weight peers.
This was a cross-sectional study linking data from 3361 fifth grade students from the 2003 Children's Lifestyle and School Performance Study with Nova Scotia administrative health data over 6 years.
Overweight and obese children were more likely to have had a diagnosis of internalizing disorders, asthma, other respiratory disorders, obesity, otitis media, and chronic adenoid/tonsil disorder. Conversely, normal-weight children were more likely to have a diagnosis of conduct disorder or other mental diseases. Except for internalizing disorders, overweight and obese children also had significantly higher health care costs for these conditions.
Overweight and obese children had higher health care utilization across a range of diagnoses, further confirming that health care utilization patterns of overweight and obese children differ from those of their normal-weight peers. Greater attention to the relationship between more common childhood conditions and overweight and obesity is needed, given the greater prevalence in overweight and obese children and the fact that some of the more established obesity-related conditions occur less frequently, particularly in younger children.
The Journal of pediatrics 08/2011; 160(2):216-221.e1. · 4.02 Impact Factor
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ABSTRACT: Aboriginal people are more vulnerable to food insecurity and morbidity than is the Canadian population overall. However, little information is available about the association between food insecurity and health in Aboriginal households.
Data from the 2004 Canadian Community Health Survey-Nutrition were used to examine the relationships between household food security and self-reported health, well-being and health behaviours in a sample of 837 Aboriginal adults living off reserve. Household food security status was based on Health Canada's interpretation of the United States Household Food Security Survey Module. Multivariable logistic regression was used to identify significant relationships, while adjusting for potential confounders.
An estimated 29% of Aboriginal people aged 18 or older lived in food-insecure households. They were more likely to report poor general and mental health, life dissatisfaction, a very weak sense of community belonging, high stress and cigarette smoking, compared with their counterparts in food-secure households. When age, gender and household education were taken into account, respondents from food-insecure households had significantly higher odds of poor general health, high stress, life dissatisfaction, and a very weak community belonging.
Reductions in household food insecurity may improve the health and well-being of Aboriginals living off-reserve.
Health reports / Statistics Canada, Canadian Centre for Health Information = Rapports sur la santé / Statistique Canada, Centre canadien d'information sur la santé 06/2011; 22(2):15-20. · 3.26 Impact Factor
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ABSTRACT: Along with a dramatic rise in the rates of childhood obesity, obesity-related disorders, such as type 2 diabetes, hypertension, and obstructive sleep apnea, are seen with increasing frequency in children. As a consequence, overweight and obese children may use health care services more often than their normal weight peers. The aim of the current study was to assess health service use and costs across categories of weight status.
Prospective cohort study using data from a population-based survey among grade 5 children in the Canadian province of Nova Scotia linked with administrative health data, using a combination of deterministic and probabalistic matching (n = 4 380). Total health care costs (physician and hospital costs), lifetime (up to age 14 years) physician costs and number of physician visits were assessed in a series of multiple regression models.
There was a gradient for higher costs and utilization across the three weight groups. Total health care costs in the three years following the survey were 21% (95% CI: 2-43) higher in obese children compared with normal weight children. Obese children also had significantly higher lifetime physician costs and more physician visits than their normal weight peers. The health care cost trajectories of normal weight and obese children drift apart as early as 3 years of age. Interpretation. Obese children in the Canadian province of Nova Scotia have significantly higher health care costs and more physician visits and specialist referrals than their normal weight peers, highlighting the need for cost-effectiveness studies of obesity prevention programs.
International journal of pediatric obesity: IJPO: an official journal of the International Association for the Study of Obesity 04/2011; 6(2):142-8. · 2.00 Impact Factor
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ABSTRACT: Obstructive sleep apnea (OSA) is characterized by partial or complete upper airway obstruction during sleep. Approximately 1% to 4% of children are affected by OSA, with adenotonsillar hypertrophy the most common underlying risk factor. Surgical removal of enlarged tonsils and adenoids is the most commonly used treatment for OSA. Given the perioperative risk of the intervention and an estimated recurrence rate of up to 20%, there has recently been an increased interest in non-surgical treatment modalities. As the enlarged adenoids and tonsils consist of hypertrophied lymphoid tissue, anti-inflammatory agents have been proposed as a useful non-invasive treatment option in children with OSA.
To assess the efficacy of anti-inflammatory drugs for the treatment of OSA in children.
We identified trials using searches of the Cochrane Airways Group Specialized Register, MEDLINE (1950 to 2010), EMBASE (1988 to 2010), CINAHL (1982 to 2010), CENTRAL (1964 to 2010), Web of Science (1900 to 2010), LILACS (1982 to 2010) and International Pharmaceutical Abstracts (IPA) (1970 to 2010).
Randomized controlled trials (RCTs) comparing anti-inflammatory drugs against placebo, other anti-inflammatory drugs, or other treatment in children between one and 16 years with objectively diagnosed OSA (Apnea Hypopnea Index (AHI) ≥ 1/hour (h)).
Both authors independently performed data extraction and quality assessment. It was not possible to combine data from the included studies; we summarized data in a narrative fashion.
We included three RCTs. The first study was a six-week parallel-group trial (25 participants, mean age 3.8 years, mean AHI 10.8/h) of intranasal fluticasone versus placebo showed a statistically significant effect of the drug on improving the AHI. The second study compared intranasal budesonide with placebo in a six-week cross-over trial (62 participants, mean age 8.2 years, mean AHI 3.7/h). The authors reported an advantage of the drug over placebo in reducing the AHI. However, the patients were not analyzed as randomized so the result must be interpreted with caution. No valid group comparisons were reported for the third trial (30 participants, oral montelukast versus placebo in a 12-week parallel-group trial), which has so far only been published as an abstract.
A single small study has found a short-term beneficial effect on the AHI in children with mild to moderate OSA. However, long-term safety and efficacy data are not available yet. Further RCTs are needed to evaluate anti-inflammatory drugs for OSA in children.
Cochrane database of systematic reviews (Online) 01/2011; · 5.72 Impact Factor
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ABSTRACT: Background: Standardized ginseng extract has become the best-selling cold and flu remedy in Canada, yet much controversy regarding the efficacy of ginseng in preventing common colds remains. Objective: To assess the efficacy of ginseng preparations for the prevention of common colds in healthy adults. Methods: Comprehensive bibliographic database, trial registry and grey literature searches were conducted up to December 2007. Randomized controlled trials or controlled clinical trials comparing North American (Panax quinquefolius) or Asian ginseng (Panax ginseng) root extract to placebo or no treatment in healthy adults were included. Two reviewers independently applied the study selection criteria and assessed methodological quality. Results: Five trials involving 747 participants were included. All five trials examined North American ginseng. The methodological quality of the trials varied widely. Ginseng preparations significantly reduced the total number of common colds by 25% compared to placebo (one trial; 95% CI: 5-45). There was a tendency toward a lower incidence of having at least one common cold or other acute respiratory infection (ARI) in the ginseng group compared to the placebo group (five trials; relative risk: 0.70; 95% CI: 0.48-1.02). Compared to placebo, ginseng significantly shortened the duration of colds or ARIs by 6.2 days (two trials; 95% CI: 3.4-9.0). Conclusions: There is insufficient evidence to conclude that ginseng reduces the incidence or severity of common colds. North American ginseng appears to be effective in shortening the duration of colds or ARIs in healthy adults when taken preventatively for durations of 8-16 weeks.
Evidence-based Complementary and Alternative Medicine 08/2009; 2011:282151. · 4.77 Impact Factor
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ABSTRACT: The risk of obesity is determined by a complex interaction of prenatal, lifestyle, genetic, and environmental factors.
To investigate the differential impact of prenatal, child, and family factors on body weight status in childhood.
The current study links population-based survey data of Grade 5 students who participated in the 2003 Children's Lifestyle and School Performance Study in Nova Scotia, Canada, with a provincial perinatal registry. Multilevel logistic regression was used to investigate the association between prenatal, lifestyle, and socioeconomic factors and childhood overweight.
Of the 4 298 participating children, 3 426 (80%) could be linked with information in the perinatal registry. Small-for-gestational age infants appeared to be less likely to be overweight at age 10 or 11 years (odds ratio [OR]=0.68) whereas those born large-for-gestational age were more likely to be overweight (OR=1.23). Maternal pre-pregnancy weight was associated with childhood overweight (OR=4.42 for >80 kg vs. <60 kg) as were the child's physical activity (OR=0.65 for >7x/week vs. < or =2x/week) and screen time (OR=1.82 for >6 h/day vs. < or =1h/day). Smoking during pregnancy increased the child's odds for being overweight (OR=1.42 for >0.5 packs/day vs. none). Children living in neighborhoods with higher housing values were less likely to be overweight (OR=0.68 for highest vs. lowest tertile).
Overweight young women should be advised on the importance of healthy eating, active living and maintaining a healthy weight in the pre-pregnancy years to reduce the risk of overweight in their offspring.
International journal of pediatric obesity: IJPO: an official journal of the International Association for the Study of Obesity 07/2009; 5(1):88-96. · 2.00 Impact Factor
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ABSTRACT: To examine whether eating while watching television poses a risk for poor nutrition and excess body weight over and above that of time spent watching television.
We analysed data of grade 5 students participating in a comprehensive population-based survey in the Canadian province of Nova Scotia. This survey included the Harvard's Youth Food Frequency Questionnaire, students' height and weight measurements, and a parent survey. We applied multivariable linear and logistic random effects models to quantify the associations of watching television and eating while watching television with diet quality and body weight.
The province of Nova Scotia, Canada.
Grade 5 students (n 4966).
Eating supper while watching television negatively affected the consumption of fruits and vegetables and overall diet quality. More frequent supper while watching television was associated with more soft drink consumption, a higher percentage energy intake from sugar out of total energy from carbohydrate, a higher percentage energy intake from fat, and a higher percentage energy intake from snack food. These associations appeared independent of time children spent watching television. Both watching television and eating while watching television were positively and independently associated with overweight.
Our observations suggest that both sedentary behaviours from time spent watching television as well as poor nutrition as a result of eating while watching television contribute to overweight in children. They justify current health promotion targeting time spent watching television and call for promotion of family meals as a means to avoid eating in front of the television.
Public Health Nutrition 06/2009; 12(12):2457-63. · 2.17 Impact Factor
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ABSTRACT: Increasing the starting dose of enoxaparin results in the early achievement of therapeutic anti-factor Xa levels in children receiving enoxaparin which is critical for effective therapy and the reduction of venipunctures. The aim of this study was: i) to determine the enoxaparin dose required to achieve therapeutic anti-factor Xa levels in infants and children, and ii) to establish whether increasing the starting dose of enoxaparin influenced the time required to reach the therapeutic range and the number of venipunctures required for dose-adjustment, and iii) the radiographic outcome of the thrombosis, where applicable. A retrospective chart review of children who received enoxaparin was carried out at the Stollery Children's Hospital, Edmonton, Alberta, Canada. Patients treated with standard-dose enoxaparin (1.5 mg/kg for children < or =3 months of age, 1.0 mg/kg for children > or =3 months of age), were compared with children who received a higher initial starting dose of enoxaparin (1.7 mg/kg for children > or =3 months of age, 1.2 mg/kg for children > or =3 months of age). Infants <3 months required an enoxaparin dose of 1.83 mg/kg, and those who received an increased initial enoxaparin dose resulted in faster attainment of therapeutic anti-factor Xa levels requiring significantly fewer venipunctures. Similarly, infants > or =3-12 months, 1-5 years, and 6-18 years, require enoxaparin 1.48 mg/kg, 1.23 mg/kg and 1.13 mg/kg, respectively, in order to achieve a therapeutic anti-factor Xa level. In conclusion, increasing the starting dose of enoxaparin may result in more rapid attainment of therapeutic range with fewer venipunctures, dose adjustments, and without an increase in adverse events.
Thrombosis and Haemostasis 02/2009; 101(1):86-92. · 5.04 Impact Factor
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ABSTRACT: In developed countries, there is a negative association between socioeconomic status (SES) and a variety of health outcomes, known as the social gradient in health. This is contrasted by a weak, absent or even positive gradient for overweight. The objective of this study was to investigate why overweight does not follow the social gradient.
Data from adult respondents to the 2004 Canadian Community Health Survey (cycle 2.2) were used. A series of multivariate models regressing overweight and determinants of overweight on household education and household income were performed, stratified by gender.
Except for education among women, negative associations between SES measures and overweight emerged. Respondents from higher household income groups reported more meals away from home, compared with those from lower household income groups. In addition, adults in higher-education households were more likely than those in lower-education households to have quit smoking.
Differences in food consumption patterns and smoking cessation between SES groups may have contributed to the lack of a clear negative association between household education and income and overweight in the CCHS.
Health reports / Statistics Canada, Canadian Centre for Health Information = Rapports sur la santé / Statistique Canada, Centre canadien d'information sur la santé 01/2009; 19(4):7-15. · 3.26 Impact Factor
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ABSTRACT: Obstructive sleep apnea (OSA) is characterized by habitual snoring, heavy breathing, sleep-related hypoxia and arousals from sleep, and is found in approximately 3% of children.
To review the efficacy of medical, behavioral, mechanical and surgical interventions in improving OSA in children.
Bibliographic databases, relevant conference proceedings and trial registers were searched. Randomized controlled trials assessing interventions in children with objectively diagnosed OSA (as per polysomnography; apnea/hypopnea index (AHI) or respiratory disturbance index (RDI) > or = 1/h) were considered.
The search identified 1690 potentially relevant studies. The five trials that met the inclusion criteria investigated seven different interventions (intranasal steroids, adenotonsillectomy, maxillary distraction, temperature-controlled radiofrequency ablation, oral appliances, continuous and bilevel positive airway pressure therapy). Intranasal steroids had a significant advantage over placebo in decreasing the AHI (one study). Temperature-controlled radiofrequency ablation and adenotonsillectomy were equally effective in reducing the RDI (one study). Continuous and bilevel positive airway pressure therapy was equally effective in reducing the AHI (one study). There was insufficient evidence to support the use of oral appliances.
Despite a broad array of treatment options for OSA, there is limited evidence to support their use. More research is needed before general recommendations can be made.
Sleep Medicine Reviews 01/2009; 13(2):123-31. · 6.93 Impact Factor
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ABSTRACT: Canada's Aboriginal population is vulnerable to food insecurity and increasingly lives off-reserve. The Canadian Community Health Survey, Cycle 2.2 Nutrition, was used to compare the prevalence and sociodemographic correlates of food insecurity between non-Aboriginal and off-reserve Aboriginal households.
Food insecurity status was based on Health Canada's revised interpretation of responses to the US Household Food Security Survey Module. Logistic regression was used to assess if Aboriginal households were at higher risk for food insecurity than non-Aboriginal households, adjusting for household sociodemographic factors.
Canada.
Households (n 35,107), 1528 Aboriginal and 33 579 non-Aboriginal.
Thirty-three per cent of Aboriginal households were food insecure as compared with 9 % of non-Aboriginal households (univariate OR 5.2, 95 % CI 4.2, 6.3). Whereas 14 % of Aboriginal households had severe food insecurity, 3 % of non-Aboriginal households did. The prevalence of sociodemographic risk factors for household food insecurity was higher for Aboriginal households. Aboriginal households were more likely to have three or more children (14 % v. 5 %), be lone-parent households (2 1 % v. 5 %), not have home ownership (52 % v. 31 %), have educational attainment of secondary school or less (43 % v. 26 %), have income from sources other than wages or salaries (38 % v. 29 %), and be in the lowest income adequacy category (33 % v. 12 %). Adjusted for these sociodemographic factors, Aboriginal households retained a higher risk for food insecurity than non-Aboriginal households (OR 2.6, 95 % CI 2.1, 3.2).
Off-reserve Aboriginal households in Canada merit special attention for income security and poverty alleviation initiatives.
Public Health Nutrition 01/2009; 12(8):1150-6. · 2.17 Impact Factor
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ABSTRACT: Point-of-care INR (POC INR) meters can provide a safe and effective method for monitoring oral vitamin K antagonists (VKAs) in children. Stollery Children's Hospital has a large POC INR meter loan program for children requiring oral VKAs. Our protocol requires that POC INR results be compared to the standard laboratory INR for each child on several consecutive tests to ensure accuracy of CoaguChek XS (Roche Diagnostics, Basel Switzerland) meter. It was the objective of the study to determine the accuracy of the CoaguChek XS by comparing whole blood INR results from the CoaguChek XS to plasma INR results from the standard laboratory in children. POC INR meter validations were performed on plasma samples from two time points from 62 children receiving warfarin by drawing a venous blood sample for laboratory prothrombin (PT)-INR measurements and simultaneous INR determinations using the POC-INR meter. Agreement between CoaguChek XS INR and laboratory INR was assessed using Bland-Altman plots. Bland-Altman's 95% limits of agreement were 0.11 (-0.20; 0.42) and 0.13 (-0.22; 0.48) at the two time points, respectively. In conclusion, the CoaguChek XS meter appraisal generates an accurate and precise INR measure in children when compared to laboratory INR test results.
Thrombosis and Haemostasis 06/2008; 99(6):1097-103. · 5.04 Impact Factor
