A surveillance system to monitor excess mortality of people with mental illness in Canada

Objective: Outcome measures are rarely available for surveillance and system performance monitoring for mental disorders and addictions. Our study aims to demonstrate the feasibility and face validity of routinely measuring the mortality gap in the Canadian context at the provincial and regional levels using the methods and data available to the Canadian Chronic Disease Surveillance System (CCDSS) of the Public Health Agency of Canada. Methods: We used longitudinal data from the Quebec Integrated Chronic Disease Surveillance System, which also provides aggregated data to the CCDSS. This includes data from the health insurance registry physician claims and the hospital discharge abstract for all mental disorder diagnoses (International Classification of Diseases [ICD]-9 290-319 or ICD-10 F00-F99). Patients were defined as having had received a mental disorder diagnosis at least once during the year. Life expectancy was measured using Chiang's method for abridged life tables, complemented by the Hsieh method for adjustment of the last age interval. Results: We found a lower life expectancy among psychiatric patients of 8 years for men and 5 years for women. For patients with schizophrenia, life expectancy was lowered by 12 years for men and 8 years for women. Cardiovascular disease and cancer were the most common causes of premature death. Findings were consistent across time and regions of the province. Lower estimates of the mortality gap, compared with literature, could be explained by the inclusion of primary care patients and methods. Conclusions: Our study demonstrates the feasibility of using administrative data to measure the impact of current and future mental health plans in Canada provided the techniques can be replicated in other Canadian provinces

Quality assessment of primary care for common mental disorders in isolated communities: Taking advantage of health records.

INTRODUCTION: This article is part of a research study on the organization of primary health care (PHC) for mental health in two of Quebec's remote regions. It introduces a methodological approach based on information found in health records, for assessing the quality of PHC offered to people suffering from depression or anxiety disorders. METHODS: Quality indicators were identified from evidence and case studies were reconstructed using data collected in health records over a 2-year observation period. Data collection was developed using a three-step iterative process: (1) feasibility analysis, (2) development of a data collection tool, and (3) application of the data collection method. The adaptation of quality-of-care indicators to remote regions was appraised according to their relevance, measurability and construct validity in this context. RESULTS: As a result of this process, 18 quality indicators were shown to be relevant, measurable and valid for establishing a critical quality appraisal of four recommended dimensions of PHC clinical processes: recognition, assessment, treatment and follow-up. CONCLUSIONS: There is not only an interest in the use of health records to assess the quality of PHC for mental health in remote regions but also a scientific value for the rigorous and meticulous methodological approach developed in this study. From the perspective of stakeholders in the PHC system of care in remote areas, quality indicators are credible and provide potential for transferability to other contexts. This study brings information that has the potential to identify gaps in and implement solutions adapted to the context

Estimation de l’espérance de vie optimale au tournant du xxie siècle

La mesure de l’espérance de vie optimale est un exercice qui vise à estimer le nombre d’années que peut espérer vivre une population à partir des taux les plus faibles de mortalité, selon la cause, l’âge et le sexe, observés parmi les pays les plus industrialisés. Les résultats de cet exercice révèlent que l’espérance de vie optimale à la naissance, basée sur les données de 2001, serait de 87,6 ans chez les femmes et de 81,1 ans chez les hommes. En comparaison pour la même année, les valeurs d’espérance de vie à la naissance les plus élevées dans le monde industrialisé étaient enregistrées au Japon avec 85,0 ans chez les femmes et 78,1 ans chez les hommes. Au Québec, les valeurs se situaient à 82,2 ans chez les femmes et à 76,4 ans chez les hommes. Ces résultats suggèrent que des gains importants sont encore possibles en ce qui concerne la longévité moyenne des populations nationales.Optimal life expectancy measurement aims to estimate the number of years of life a population can expect, based on the lowest mortality rates by cause, age and sex observed in the most industrialised countries. The results of this exercise show that optimal life expectancy at birth, based on 2001 data, would be 87.6 years for women and 81.1 years for men. In comparison, the highest actual life expectancies at birth for the same year, recorded for Japan, are 85.0 years for women and 78.1 years for men. In Quebec these values are 82.2 years for women and 76.4 years for men. These results suggest that important gains in average longevity of national populations are still possible

Déterminants Du Vieillissement En Sante Chez Les Personnes De Troisième Age De La Ville De Buta

The main purpose of our study is to identify the determinants of healthy aging among elderly people in the city of Buta; to improve lifestyle habits/behaviours and promote their health. We opted for a cross-sectional analytical estimate, in order to allow us to identify the determinants of healthy aging among the elderly inhabitants of the city of Buta, from 03/17/2021 to 07/25/2021. A total of 471 senior citizens (55 years or older) were surveyed. The association between health-promoting factors and cumulative chronic health problems (3 or more problems, 0 problems) was verified using a logistic regression model adjusted for age, sex, and level of health. education of our respondents, because all study characteristics are strongly linked to the variables studied (p<0.05 each). Daily consumption of leaves/vegetables, beans, meat, rice + fruits; the practice of a physical activity; a good body weight index; a cumulative index of 4 health-promoting factors; are factors that protect the elderly person from a chronic health problem and this is significant (p<0.05 significant at the conventional threshold of 5%)

Re-evaluation of blood mercury, lead and cadmium concentrations in the Inuit population of Nunavik (Québec): a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Arctic populations are exposed to mercury, lead and cadmium through their traditional diet. Studies have however shown that cadmium exposure is most often attributable to tobacco smoking. The aim of this study is to examine the trends in mercury, lead and cadmium exposure between 1992 and 2004 in the Inuit population of Nunavik (Northern Québec, Canada) using the data obtained from two broad scale health surveys, and to identify sources of exposure in 2004.</p> <p>Methods</p> <p>In 2004, 917 adults aged between 18 and 74 were recruited in the 14 communities of Nunavik to participate to a broad scale health survey. Blood samples were collected and analysed for metals by inductively coupled plasma mass spectrometry, and dietary and life-style characteristics were documented by questionnaires. Results were compared with data obtained in 1992, where 492 people were recruited for a similar survey in the same population.</p> <p>Results</p> <p>Mean blood concentration of mercury was 51.2 nmol/L, which represent a 32% decrease (p < 0.001) between 1992 and 2004. Mercury blood concentrations were mainly explained by age (partial r²= 0.20; p < 0.0001), and the most important source of exposure to mercury was marine mammal meat consumption (partial r²= 0.04; p < 0.0001). In 2004, mean blood concentration of lead was 0.19 μmol/L and showed a 55% decrease since 1992. No strong associations were observed with any dietary source, and lead concentrations were mainly explained by age (partial r²= 0.20.; p < 0.001). Blood cadmium concentrations showed a 22% decrease (p < 0.001) between 1992 and 2004. Once stratified according to tobacco use, means varied between 5.3 nmol/L in never-smokers and 40.4 nmol/L in smokers. Blood cadmium concentrations were mainly associated with tobacco smoking (partial r²= 0.56; p < 0.0001), while consumption of caribou liver and kidney remain a minor source of cadmium exposure among never-smokers.</p> <p>Conclusion</p> <p>Important decreases in mercury, lead and cadmium exposure were observed. Mercury decrease could be explained by dietary changes and the ban of lead cartridges use likely contributed to the decrease in lead exposure. Blood cadmium concentrations remain high and, underscoring the need for intensive tobacco smoking prevention campaigns in the Nunavik population.</p

Eau potable et santé publique : défis actuels et futurs

L’eau que nous consommons chaque jour est essentielle à la vie. Sa qualité a toujours été un élément indispensable à un environnement favorable à la santé. Actuellement, loin d’avoir été résolu, le problème de la qualité de l’eau de boisson est toujours une priorité de santé publique, autant dans les pays en voie de développement que dans les pays industrialisés.Ce texte présente six défis pour la santé publique dans le dossier de l’eau potable pour les années futures :Finalement, le problème de la qualité de l’eau potable doit être appréhendé dans une perspective mondiale.Drinking water is essential to human life. Drinking water quality has always been an essential component of a healthy environment. In fact, the risk of waterborne diseases, either from microbiological or chemical contamination of drinking water, is still ubiquitous in both industrialized and non-industrialized countries. Recently, several outbreaks of waterborne enteritis in North America have confirmed the presence of this risk, with some potentially dramatic consequences such as the case that occurred in Walkerton, Ontario. Vulnerable people such as infants, pregnant women, senior citizens and individuals with compromised immune systems are particularly at risk. Other factors such as travel, migration, climate change, and intensive agriculture might increase the risk of emerging diseases. The lack of basic measures of public health such as protection of sources of water, adequate water treatment, or surveillance of drinking water has also been underlined in recent epidemics. Multi-chemical contamination at very low doses by pharmaceuticals or disinfectant by-products is also an issue that public health practitioners must deal with. New technology enables us to detect chemicals that were not detectable a few years ago.With respect to all these potential threats, this paper presents six major challenges in the area of drinking water that are considered by the author as a priority for public health:In conclusion, beyond traditional methods that have to be updated (multi-barriers, quality standards and surveillance of waterborne diseases and investigation of outbreaks), the new components of the public health approach in drinking water are: the quality of the link with the community, the use of transparent and fair criteria for risk management, and a strong research agenda focussing on human health impacts. Finally, the use of a global perspective is paramount. Most drinking water issues are spread worldwide and cooperation between nations and countries is an important component of a healthy world in this twenty-first century

Health over the Life Course: Research and Policy Roundtable Discussion

At this roundtable discussion, researchers and policy makers talked broadly about the most important questions that had been answered by recent empirical research and which questions remained to be answered. They were asked to consider research and policy related to “Population aging and pressure points in a life course framework: disability and long term care.” Valérie Émond is an scientific expert at the Quebec Public Health Institute. Over the past 10 years, she has worked at developing chronic disease surveillance for the province of Quebec using administrative data. After developing the model for diabetes surveillance, she is currently working on an integreted chronic disease surveillance model, with a research focus on the elderly and multimorbidity. She has a background degree in actuarial mathematics from Université Laval and a Masters degree in demography from Université de Montréal. She has also worked for the Canadian Institute for Health Information where she acquired an extensive knowledge of health administrative data across Canada