Conceptualizing childhood health problems using survey data: a comparison of key indicators

<p>Abstract</p> <p>Background</p> <p>Many definitions are being used to conceptualize child health problems. With survey data, commonly used indicators for identifying children with health problems have included chronic condition checklists, measures of activity limitations, elevated service use, and health utility thresholds. This study compares these different indicators in terms of the prevalence rates elicited, and in terms of how the subgroups identified differ.</p> <p>Methods</p> <p>Secondary data analyses used data from the National Longitudinal Survey of Children and Youth, which surveyed a nationally representative sample of Canadian children (n = 13,790). Descriptive analyses compared healthy children to those with health problems, as classified by any of the key indicators. Additional analyses examined differences between subgroups of children captured by a single indicator and those described as having health problems by multiple indicators.</p> <p>Results</p> <p>This study demonstrates that children captured by any of the indicators had poorer health than healthy children, despite the fact that over half the sample (52.2%) was characterized as having a health problem by at least one indicator. Rates of child ill health differed by indicator; 5.6% had an activity limitation, 9.2% exhibited a severe health difficulty, 31.7% reported a chronic condition, and 36.6% had elevated service use. Further, the four key indicators captured different types of children. Indicator groupings differed on child and socio-demographic factors. Compared to children identified by more than one indicator, those identified only by the severe health difficulty indicator displayed more cognitive problems (p < 0.0001), those identified only by the chronic condition checklist had a greater likelihood of reporting allergies or asthma (p < 0.0001), and those identified as having elevated service use only were more affluent (p = 0.01) and showed better overall health (p < 0.0001). Children identified by only a single indicator were less likely to have serious health problems than those identified by two or more indicators.</p> <p>Conclusion</p> <p>We provide information useful to researchers when selecting indicators from survey data to identify children with health problems. Researchers and policy makers need to be aware of the impact of such definitions on prevalence rates as well as on the composition of children classified as being in poor health.</p

Using GIS to create synthetic disease outbreaks

BACKGROUND: The ability to detect disease outbreaks in their early stages is a key component of efficient disease control and prevention. With the increased availability of electronic health-care data and spatio-temporal analysis techniques, there is great potential to develop algorithms to enable more effective disease surveillance. However, to ensure that the algorithms are effective they need to be evaluated. The objective of this research was to develop a transparent user-friendly method to simulate spatial-temporal disease outbreak data for outbreak detection algorithm evaluation. A state-transition model which simulates disease outbreaks in daily time steps using specified disease-specific parameters was developed to model the spread of infectious diseases transmitted by person-to-person contact. The software was developed using the MapBasic programming language for the MapInfo Professional geographic information system environment. RESULTS: The simulation model developed is a generalised and flexible model which utilises the underlying distribution of the population and incorporates patterns of disease spread that can be customised to represent a range of infectious diseases and geographic locations. This model provides a means to explore the ability of outbreak detection algorithms to detect a variety of events across a large number of stochastic replications where the influence of uncertainty can be controlled. The software also allows historical data which is free from known outbreaks to be combined with simulated outbreak data to produce files for algorithm performance assessment. CONCLUSION: This simulation model provides a flexible method to generate data which may be useful for the evaluation and comparison of outbreak detection algorithm performance

Using Canadian administrative health data to measure the health of caregivers of children with and without health problems: A demonstration of feasibility.

Introduction Caregivers of children with health problems experience poorer health than the caregivers of healthy children. To date, population-based studies on this issue have primarily used survey data. Objectives We demonstrate that administrative health data may be used to study these issues, and explore how non-categorical indicators of child health in administrative data can enable population-level study of caregiver health. Methods Dyads from Population Data British Columbia (BC) databases, encompassing nearly all mothers in BC with children aged 6-10 years in 2006, were grouped using a non-categorical definition based on diagnoses and service use. Regression models examined whether four maternal health outcomes varied according to indicators of child health. Results 162,847 mother-child dyads were grouped according to the following indicators: Child High Service Use (18%) vs. Not (82%), Diagnosis of Major and/or Chronic Condition (12%) vs. Not (88%), and Both High Service Use and Diagnosis (5%) vs. Neither (75%). For all maternal health and service use outcomes (number of physician visits, chronic condition, mood or anxiety disorder, hospitalization), differences were demonstrated by child health indicators. Conclusions Mothers of children with health problems had poorer health themselves, as indicated by administrative data groupings. This work not only demonstrates the research potential of using routinely collected health administrative data to study caregiver and child health, but also the importance of addressing maternal health when treating children with health problems. Keywords Population data, linked data, case-mix, children with special health care need

Standing on the Frontline: Having the Courage to Teach

Issues of race, class, and gender along with many other characteristics that define human differences areinextricably woven into the fabric of the social institutions in the United States of America; the universityclassroom is not excluded. This article discusses the teaching experiences of an African-American womanteaching associate/doctoral student while teaching at a predominantly white institution and the resistanceoften encountered from students in the form of challenging authority, questioning credibility and/or grades,and other forms of disrespectful behavior that could be subtle and covert. Despite such challenges, theteaching associate discusses ways in which she used various strategies to successfully manage barriers in theclassroom. Dealing with issues of social justice in the classroom inevitably creates a level of discomfort forindividuals who have never had to deal with these issues; yet, it is critically important to continue to raisethe level of awareness for faculty and administrators of the type of issues women and people of color arefaced with in the classroom when dealing with these topics."When and where I enter, in the quiet, undisputed dignity of my womanhood, without violence and withoutsuing, or special patronage, then and there the whole Negro race enters with me."-Anna Julia Cooper"As subjects, people have the right to define their own reality, establish their own identities, [and] name theirhistory."-bell hook

Using linked health survey and Census data to understand transitions to instutional care among Canadian seniors

ABSTRACT Objectives While existing data sources, such as the 2011 Census, provide an accurate count of who is currently institutionalized, there is a significant gap in terms of our understanding of who is at risk for institutionalization and what the future demand for care will be. The objective of this study is to use linked national health survey, the 2005 Canadian Community health Survey (CCHS), to the 2011 Census to identify factors associated with transitions from private households to alternative living arrangements, specifically long-term care (nursing homes), and retirement homes among Canadians 55 years of age and older. Approach Hierarchical deterministic methods were used to link the 2005 CCHS (n=114,000) to the 2011 Census (n=35 million) using identifying variables common to both data sets (i.e. name, birthdate, sex, postal code, social insurance number). Sex specific multivariate regression models with multiple outcomes were used to assess the impact of a comprehensive set of factors (i.e. demographic, socio-economic, health status, chronic conditions and marital status) available in the CCHS on the likelihood of residing in three possible home environments, relative to living in a private dwelling (PD): long-term care (LTC), retirement homes (RH) or private dwelling with support (PDS) as identified in the 2011 Census. Analyses were adjusted for mortality. Results Over 85% of CCHS records were linked to the 2011 Census (n=92,849). Among those 55 years of age and older (n=29,934), approximately 2.0% and 1.6% were living in LTC and RH respectively: an additional 7.2% were living in PDS. Results of the regression analyses, revealed that those with Alzheimer’s disease were at highest risk of transition to LTC (OR=11.7 females; 6.8 males). Losing a spouse was significantly associated with transitions to LTC, RH and PDS for both men and women. Being an immigrant was protective, with immigrant seniors less likely to transition to LTC and RH. Other factors significantly associated with transitions to LTC included low income, poor mental health (women only), and assistance with activities of daily living (meal preparation for women, finances for men). Regional variations were also noted. Conclusion Newly linked health survey and census data provide a unique opportunity to take a comprehensive look at those most at risk for institutionalization

The Socio-Economic Characteristics of First Nation Teen Mothers

Using data from the 2006 Census, this study examines the socio-economic characteristics of First Nations and non-Aboriginal teenage mothers, and compares these to those of non-teenage mothers in a cohort of women aged 25 to 29 years old. Results indicated that First Nations women were more likely than non-Aboriginal women to be teenage mothers. In general, teenage mothers were less likely to have graduated high school, more likely to live in overcrowded housing, and in a home in need of major repair. Furthermore, teenage mothers had lower household incomes after adjusting for the composition the household. Characteristics also differed significantly between First Nations and non-Aboriginal women, as well as between Registered Indian women living on- and off-reserve

The health and psychosocial functioning of caregivers of children with neurodevelopmental disorders

Purpose: Children with neurodevelopmental disorders (Neuro) pose complex parenting challenges, particularly if the condition co-occurs with behaviour problems. Such challenges are likely to impact caregiver health and well-being. This study explores the extent to which caregivers of children with both Neuro and behaviour problems differ in their physical and psychosocial outcomes from caregivers of children with either condition or neither condition. Method: The first wave of data collected in the National Longitudinal Survey of Children and Youth in Canada (1994) was used to identify four groups of caregivers of 4-to 11-year-old children: caregivers of children with a Neuro disorder and externalising behaviour problems (Both; n = 414), caregivers of children with a Neuro disorder only (Neuro Only; n = 750), caregivers of children with an externalising behaviour problem only (Ext Only; n = 1067), and caregivers of children with neither health condition (Neither; n = 7236). Results: Caregivers in the Both group were least likely to report excellent or very good health, and more frequently reported chronic conditions such as asthma, arthritis, back problems, migraine headaches, and limitations in activities as compared to the Neither group. This group also exhibited higher depression scores, experienced more problematic family functioning and reported lower social support than the Neither group. Scores for caregivers in the Ext Only and Neuro Only groups tended to lie between the Both and Neither group scores and often did not differ from one another. Conclusions: Caregivers of children with both neurovelopmental disorders and behaviour problems exhibited a greater number of health and psychosocial problems. While addressing children's behaviour problems, health care professionals should also consider caregiver physical and psychosocial health, as this may also have an impact on children's well-being