Suchergebnisse

OBJECTIVES: This cross-sectional study examines the dental caries experience of new Canadian Armed Forces (CAF) members in relation to enrollment from municipalities with and without water fluoridation. METHODS: The study population consisted of recruits who enrolled in the CAF between 2006 and 2017 with an enrollment address in municipalities with known fluoridation status (n = 24,552). Odontogram statistics from dental examinations were used to calculate the number of decayed, missing, and filled teeth (DMFT) and tooth surfaces (DMFS) for each recruit. The average difference between recruits from municipalities with and without fluoridation was determined using a linear regression model which adjusted for confounding by age and gender and allowed effect modification based on socio-economic status. RESULTS: The average recruit was male, 24 years of age, with 5.6 DMFT and 11.6 DMFS. After adjusting for age and gender, recruits residing in municipalities with water fluoridation had lower DMFT by 0.67 (CI − 0.55, − 0.79) points and lower DMFS by 1.77 (− 1.46, − 2.09) points. When allowing for effect modification by median income quintile of the recruits' home census tract, the average reduction in DMFT and DMFS was similar in all income quintiles, with average reductions in DMFT ranging from 0.47 to 1.02 and average reductions in DMFS ranging from 1.33 to 2.70. CONCLUSION: Residence in a municipality with water fluoridation was associated with reduced caries experience in a national sample of newly enrolled CAF members. The benefits of water fluoridation were uniform across neighbourhood income and military rank classes.

LAY SUMMARY The focus of this study was on family and community. Interviews with 23 adult children of Canadian Armed Forces Veterans who served between the Korean War and the Gulf War suggested key capabilities were developed that supported them in meeting demands and contributed to adaptation over the course of their lives. Living on military bases was identified as a significant resource shaping identities, intensifying bonds with others who also grew up as military children in that era. Participants shared insights on how their experiences could inform contemporary military family support programs and policies.

Abstract Background Health services utilization by Veterans following release may be different than the general population as the result of occupational conditions, requirements and injuries. This study provides the first longitudinal overview of Canadian Veteran healthcare utilization in the Ontario public health system. Methods This is a retrospective cohort study designed to use Ontario's provincial healthcare data to study the demographics and healthcare utilization of Canadian Armed Forces (CAF) & RCMP Veterans living in Ontario. Veterans were eligible for the study if they released between January 1, 1990 and March 31, 2013. Databases at the Institute for Clinical Evaluative Sciences were linked by a unique identifier to study non-mental health related hospitalizations, emergency department visits, and physician visits. Overall and age-stratified descriptive statistics were calculated in five-year intervals following the date of release. Results The cohort is comprised of 23, 818 CAF or RCMP Veterans. Following entry into the provincial healthcare system, 82.6 % (95 % CI 82.1–83.1) of Veterans saw their family physician at least once over the first five years following release, 60.7 % (95 % CI 60.0–61.3) saw a non-mental health specialist, 40.8 % (95 % CI 40.2–41.5) went to the emergency department in that same time period and 9.9 % (9.5–10.3) were hospitalized for non-mental health related complaints. Patterns of non-mental health services utilization appeared to be time and service dependant. Stratifying health services utilization by age of the Veteran at entry into the provincial healthcare system revealed significant differences in service use and intensity. Conclusion This study provides the first description of health services utilization by Veterans, following release from the CAF or RCMP. This work will inform the planning and delivery of support to Veterans in Ontario.

LAY SUMMARY Veterans and their families in the military-to-civilian transition (MCT) face a multitude of changes and challenges. Family members of those Veterans experiencing a significant mental health problem (e.g., posttraumatic stress disorder, depression, anxiety) may find that navigating the MCT is made more complex, especially as they seek to find social support during this transition. The present study set out to hear from family members and learn about their obstacles and successes in accessing formal and informal support during the MCT and how this was affected by the Veteran's mental health problems. Interviews and focus groups were completed with 36 English- and French-speaking Veteran family members across Canada. Family members shared how significant issues (e.g., mental health stigma, caregiver burden and burnout) were barriers to seeking and finding both informal (i.e., extended family, friends, online support) and formal (i.e., operational stress injury clinics, Military Family Resource Centres) support systems helpful in navigating the MCT. Despite setbacks and frustrations in accessing these supports, Veteran military families demonstrated resiliency and resolve as they pursued comfort, financial aid, respite, and counsel for themselves and for the Veteran with mental health problems during the MCT.

Introduction: Social determinants of health are associated with the risk of disease and health services utilization. Understanding the distributions of sex, age, income, and other demographic variables in Canadian Veterans and how they change over time is necessary to optimize service delivery and enhance research validity. This study describes the demographic patterns over time and by age at release in an Ontario cohort of Canadian Armed Forces (CAF) and Royal Canadian Mounted Police (RCMP) Veterans following release. Methods: This is a retrospective cohort study using administrative healthcare data in Ontario from the Institute for Clinical Evaluative Sciences. Veterans were identified using codes housed at the Ministry of Health and Long-Term Care. A descriptive analysis of key demographic variables was presented and stratified by five-year time intervals following release (0–5 years, 5–10 years, 10–15 years, and 15–20 years) and age at release. Results: This cohort includes 23, 818 CAF and RCMP Veterans. At baseline, the average age of the cohort was 41, and 14% were female. Age-specific patterns of median community income and geographic location of residence were noted. In the first five years following release, younger Veterans had a lower income than older Veterans. The majority of older Veterans lived in the Ottawa and Kingston areas following release. Overall, the demographic profile of the cohort was stable over time. Discussion: We have identified a valuable resource to inform the development of relevant provincial public health policy and resource allocation for Veterans. The use of routinely collected healthcare data in Ontario will augment our current understanding of Veteran health in Canada.

Introduction: Canadian military spouses have reported issues accessing and maintaining high quality health care. There is no Canadian research quantifying the scope of the problem. Methods: This is a retrospective cohort study using administrative data. We included military spouses and dependents relocated to Ontario between January 8, 2008 and March 31, 2013, along with a matched civilian reference group. We measured hospitalizations, emergency department (ED) visits, and physician visits. Comparisons of first health care contact, medical health services use, and time to first health services use controlled for age, sex, and geography. Results: The cohort included 7,508 military family members and 30,032 matched civilians. Point of first health care system contact differed between military family members and the civilian reference group ( p < 0.001). Military family members had a longer time to their first health care contact than the civilian reference group (median 118 days vs. 84 days, p < 0.001). Similarities and differences between military family and civilian health services use existed. For example, military children and youth were less likely to see a paediatrician than the civilian reference group (17.7% vs. 26.0%, p < 0.001), and less likely to receive non-influenza vaccinations (23.2% vs. 32.3%, p < 0.001). Discussion: This study provides evidence supporting the hypothesis that military families have different access to, and use of, provincial health services than the general Ontario population and suggests support during relocations is needed. It is important to further understand how these patterns impact health outcomes and continuity of care and to contextualize these findings with potential differences in the underlying need for health services.

IntroductionBreast cancer screening is intended to identify cancer in early stages when prognosis is better and treatments less invasive.
Objectives and ApproachWe describe Canadian inter- and intra-provincial variation in the percentage of screen-detected cases and identify factors related to having a screen-detected versus a non-screen detected breast cancer.
Breast cancers diagnosed from 2004/7 to 2010/11/12 in 5 Canadian provinces were included. Standard provincial datasets were created using screening program and claims data. A common algorithm (Alberta, Ontario) or variable from the screening dataset (British Columbia, Manitoba, Nova Scotia) was used to identify the mode of diagnosis (screening versus not). Relationship between screen-detected cancer and several demographic, clinical and healthcare utilization factors were explored.
ResultsThe percentage of screen-detected breast cancers varied from 25 to 40 percent across provinces; it ranged 43 to 51 percent for those aged 50-69. Within provinces, the percentage of screen-detected cancers varied across regional health authorities by a low of 1\% to a high of 33\%. Urban residence was positively associated with screen-detection in some provinces and negatively in others. Women in the lowest neighborhood income quintile had the smallest proportion of screen-detected cancers; the absolute difference from those in the highest quintiles ranged from 3.3-11.5\% across provinces. High continuity of care with a usual primary care provider was positively associated with having a screen-detected cancer compared to those with no usual care provider.
Conclusion/ImplicationsThe proportion of screen-detected breast cancers varied significantly across and within provinces suggesting geographic variability in access to screening services. Variation across provinces in terms of factors associated with screen-detected breast cancer also likely reflect access issues. The positive association of high continuity of care with screen-detection in all provinces suggests that regular care with a primary care physician is an important factor in improving screening rates and detection.

Introduction The COVID-19 pandemic, including associated public health measures such as travel restrictions, cancellation of elective surgeries, and the closure of public spaces and retail services (full list available at: https://github.com/jajsmith/COVID-19NonPharmaceuticalInterventions ), has resulted in risks to the health and well-being of Veterans, including disruptions to healthcare, loss of income, social isolation, and viral infection and mortality. Although a few studies are ongoing to better understand who may be at greatest risk, little is known about how Veterans experienced the pandemic and what coping strategies they employed at the outset. This infographic summarizes national cross-sectional survey responses collected from 210 Veterans aged 55 years and older who participated in the Canadian COVID-19 Coping Study between May-June 2020 (Women's College Hospital Research Ethics Board REB # 2020-0045-E). The average age of Veterans who participated was 72 years; 29% were female, 93% completed the survey in English and 84% were retired. This population is older and more likely to be female than the gen-eral Veteran population.4 None of the Veterans included in this study had been diagnosed with COVID-19 at the time of study. A total of 11% had a family member or friend with a diagnosis or symptoms, and less than 5% had a family member or friend hospitalized, or who died as a result of COVID-19.

IntroductionDespite recommendations, most studies examining health inequalities fail to report both absolute and relative summary measures. We examine colorectal cancer (CRC) survival for patients with and without severe psychiatric illness (SPI) to demonstrate the use and importance of relative and absolute effects.
Objectives and ApproachWe conducted a retrospective cohort study of CRC patients diagnosed between 01/04/2007 and 31/12/2012, using linked administrative databases. SPI was defined as diagnoses of major depression, bipolar disorder, schizophrenia, and other psychotic illnesses six months to five years preceding cancer diagnosis and categorized as inpatient, outpatient or none. Associations between SPI history and risk of death were examined using Cox Proportional Hazards regression to obtain hazard ratios and Aalen's semi-parametric additive hazards regression to obtain absolute differences. Both models controlled for age, sex, primary tumour location, and rurality.
ResultsThe final cohort included 24,507 CRC patients, 482 patients had an outpatient SPI history and 258 patients had an inpatient SPI history. 58.1% of patients with inpatient SPI history died, and 47.1% of patients with outpatient SPI history died. Patients with an outpatient SPI history had a 40% (HR 1.40, 95% CI: 1.22-1.59) increased risk of death and patients with an inpatient SPI history had a 91% increased risk of death (HR 1.91, 95% CI: 1.63-2.25), relative to no history of a mental illness. An outpatient SPI history was associated with an additional 33 deaths per 1000 person years, and an inpatient SPI was associated with an additional 82 deaths per 1000 person years after controlling for confounders.
Conclusion / ImplicationsWe demonstrated that reporting of both relative and absolute effects is possible and calculating risk difference is relatively simple using Aalen models. We encourage future studies examining inequalities with time-to-event data to use this method and report both relative and absolute effect measures.

LAY SUMMARY How Veterans use the emergency department (ED) after they leave the military could signal unmet health needs or health crises. Describing patterns of ED use could inform health policy to better support Veterans during military service or design programs and services for them after they leave. ED visit records from Ontario were used to compare how often Veterans and non-Veterans visited the ED. How often a Veteran went to the ED, and how that rate compared with that of non-Veterans, depended on how long the Veteran served in the military and whether they were male or female. For example, Veterans with less than 5 or with 5–9 years of service had a higher rate of ED visits relative to non-Veterans, whereas those who served for 20–29 or for 30 years or more had a lower rate of ED visits. An understanding of how to design health services and programs for female Veterans, and for those serving shorter durations, is needed.