The role of air pollution in the relationship between a heat stress index and human mortality in Toronto

In this study we considered confounding from air pollutants and chronological variables in the relation between humidex, a summer temperature and humidity index, and nonaccidental mortality, from 1980-1996 in Toronto, Canada. Changes in the risk of death by age group, gender, and combined cardiac-respiratory cause of death were estimated for both 1 degree C and 50-95th percentile increases in humidex using a generalized additive linear model. With air pollution terms in the models, relative risk (RR) point estimates narrowly exceeded 1.0 for all groups. Humidex effects were most apparent for females (RR=1.006, 95% CI=1.004-1.008 per 1 degree C humidex and RR=1.089, 95% CI=1.058-1.121 for 50th to 95th percentile humidex). When air pollution was omitted from the model, RR in the 50-95th percentile analysis increased less than 1.71% for all groups except females, for which RR decreased 1.42%. Differences in RR per 1 degree C humidex were all less than 0.12%. Confidence intervals narrowed slightly for all groups investigated. Heat stress has a statistically significant, yet minimal impact on Toronto populations, and air pollution does appear to have a small, but consistent confounding effect on humidex effect estimates.     

The relation between ambulance transports stratified by heat stroke and air temperature in all 47 prefectures of Japan in August, 2009: ecological study

Objective  

Our aim was to investigate the link between ambulance transports stratified by heat stroke and air temperature in August 2009 in Japan.     

Population Structure and Antimicrobial Resistance of Invasive Serotype IV Group B Streptococcus,Toronto, Ontario,Canada

We recently showed that 37/600 (6.2%) invasive infections with group B Streptococcus (GBS) in Toronto, Ontario, Canada, were caused by serotype IV strains. We report a relatively high level of genetic diversity in 37 invasive strains of this emerging GBS serotype. Multilocus sequence typing identified 6 sequence types (STs) that belonged to 3 clonal complexes. Most isolates were ST-459 (19/37, 51%) and ST-452 (11/37, 30%), but we also identified ST-291, ST-3, ST-196, and a novel ST-682. We detected further diversity by performing whole-genome single-nucleotide polymorphism analysis and found evidence of recombination events contributing to variation in some serotype IV GBS strains. We also evaluated antimicrobial drug resistance and found that ST-459 strains were resistant to clindamycin and erythromycin, whereas strains of other STs were, for the most part, susceptible to these antimicrobial drugs.     

Temperature related mortality and ambulance service interventions during the heat waves of 2003 in Ticino (Switzerland)

Summary. Objectives This study investigates a potential increase in mortality and in the demand for ambulance emergency services among the elderly in particular, in Ticino in the summer of 2003. Methods Mortality rates and emergency ambulance interventions rates were compared with records from the previous years. We considered the whole population, aged 65 and over, as well as 75 and over. Results The 2003 mortality in the population was not signifi cantly different from the previous years. The number of deaths among the elderly showed a small but significant deviation from the expected values during the first heat wave in June 2003, with no significant impact on the seasonal results. The number of ambulance service interventions was larger than during the previous years. Conclusion These results are consistent with findings in other studies. The heat waves (especially in June), were correlated with a higher number of ambulance callouts. In addition to some geographic, climatic, and social factors that had a protective impact, the response of the emergency services is likely to have contributed to a certain reduction in mortality. Submitted: 29 October 2004; Accepted: 29 August 2005     

Ethnicity and utilization of family physicians: a case study of Mainland Chinese immigrants in Toronto, Canada

This paper seeks to examine how immigrants in a multicultural society access and utilize culturally- and linguistically-diverse family physicians. It focuses on Mainland Chinese (MLC) immigrants - the most important source of immigrants to Canada since 1996 - in the Toronto Census Metropolitan Area (CMA), Canada. Specifically, the paper aims to explore the choice between Chinese-speaking and non-Chinese-speaking family physicians by MLC immigrants and to determine the underlying reasons for MLC immigrants use of ethnically- and linguistically-matched family physicians. A wide range of data are analyzed including survey and focus group data, physician data from the College of Physicians and Surgeons of Ontario (CPSO) and geo-referenced 2001 Canadian Census data. A mixed-method approach is employed combining quantitative analysis of survey data and Census data, spatial analysis of patient travel behaviour based on the survey and qualitative analysis based on focus groups. The paper reveals an overwhelming preference among MLC survey respondents for Chinese-speaking family physicians regardless of study areas and socioeconomic and demographic status. The focus groups suggest that language, culture and ethnicity are intertwined in a complex way to influence the choice of health care providers and health management strategies in the host society. The paper yields important policy implications for identifying health professional shortage areas for culturally-diverse populations, addressing issues related to foreign-trained physicians and enhancing primary care delivery relevant for immigrant populations.     

Understanding the interaction between human activities and physical health under extreme heat environment in Phoenix,Arizona

Long-term community resilience, which privileges a long view look at chronic issues influencing communities, has begun to draw more attention from city planners, researchers and policymakers. In Phoenix, resilience to heat is both a necessity and a way of life. In this paper, we attempt to understand how residents living in Phoenix experience and behave in an extreme heat environment. To achieve this goal, we introduced a smartphone application (ActivityLog) to study spatio-temporal dynamics of human interaction with urban environments. Compared with traditional paper activity log results we have in this study, the smartphone-based activity log has higher data quality in terms of total number of logs, response rates, accuracy, and connection with GPS and temperature sensors. The research results show that low-income residents in Phoenix mostly stay home during the summer but experience a relatively high indoor temperature due to the lack/low efficiency of air-conditioning (AC) equipment or lack of funds to run AC frequently. Middle-class residents have a better living experience in Phoenix with better mobility with automobiles and good quality of AC. The research results help us better understand user behaviors for daily log activities and how human activities interact with the urban thermal environment, informing further planning policy development. The ActivityLog smartphone application is also presented as an open-source prototype to design a similar urban climate citizen science program in the future.     

Modelling the social determinants of health and simulating short-term and long-term intervention impacts for the city of Toronto,Canada

There is a substantial body of evidence highlighting the importance of the social determinants of health in shaping the health of urban populations in Canada. The low socio-economic status of marginalized, disadvantaged, and precarious populations in urban settings has been linked to adverse health outcomes including chronic and infectious disease, negative health behaviours, barriers to accessing health care services, and overall mortality. Given the dynamic complexities and inter-relationships surrounding the underlying drivers of population health outcomes and inequities, it is difficult to assess program and policy intervention tradeoffs, particularly when such interventions are studied with static models. To address this challenge, we have adopted a systems science approach and developed a simulation model for the City of Toronto, Canada, utilizing system dynamics modelling methodology. The model simulates changes in health, social determinants, and disparities from 2006 and projects forward to 2046 under different assumptions. Most of the variables in the model are stratified by ethnicity, immigration status, and gender, and capture the characteristics of adults aged 25–64. Intervention areas include health care access, behaviour, income, housing, and social cohesion. The model simulates alternative scenarios to help demonstrate the relative impact of different interventions on poor health outcomes such as chronic disease rates, disability rates, and mortality rate. It gives insight into how much, and how quickly, interventions can reduce mortality and morbidity. We believe this will serve as a useful learning tool to allow diverse stakeholders and policy makers to ask “what if” questions and map effective policy directions for complex population health problems, and will enable communities to think about their health futures.     

Depression and discrimination in the lives of women,transgender and gender liminal people in Ontario,Canada

This article uses an intersectionality lens to explore how experiences of race, gender, sexuality, class and their intersections are associated with depression and unmet need for mental healthcare in a population of 704 women and transgender/gender liminal people from Ontario, Canada. A survey collecting demographic information, information about mental health and use of mental healthcare services, and data for the Everyday Discrimination Scale and the PHQ‐9 Questionnaire for Depression was completed by 704 people via Internet or pen‐and‐paper between June 2011 and June 2012. Bivariate and regression analyses were conducted to assess group differences in depression and discrimination experiences, and predictors of depression and unmet need for mental healthcare services. Analyses revealed that race, gender, class and sexuality all corresponded to significant differences in exposure to discrimination, experiences of depression and unmet needs for mental healthcare. Use of interaction terms to model intersecting identities and exclusion contributed to explained variance in both outcome variables. Everyday discrimination was the strongest predictor of both depression and unmet need for mental healthcare. The results suggest lower income and intersections of race with other marginalised identities are associated with more depression and unmet need for mental healthcare; however, discrimination is the factor that contributes the most to those vulnerabilities. Future research can build on intersectionality theory by foregrounding the role of structural inequities and discrimination in promoting poor mental health and barriers to healthcare.     

The role of defamilialization in the relationship between partnership and self-rated health: A cross-national comparison of Canada and the United States

Partnered individuals live longer, healthier lives. In explaining this association, processes involving both social causation (in which partnership provides health benefits to individuals) and health selection (in which those who find partners were healthier than those who do not) have been invoked. Since much of this literature is focused in the U.S., comparative studies of the potential impact of policy on the causation and selection components of this association have been scant. Using comparable data from the U.S. Panel Study of Income Dynamics (N = 25,862, followed from 1984 to 2005) and the Canadian Survey of Labour and Income Dynamics (N = 15,632, followed from 1999 to 2005), we test the selective and causal relationships evident during entrance into partnership. We use fixed change-point analysis with multilevel models to fit trajectories of change in both the U.S. and Canada. In Canada, partnership benefits were evident, while health selection was limited. In contrast, in the U.S., health selection was prominent in both men and women, but partnership benefits were not significant. We argue that the differences in the extent of defamilialization of social policy between the two countries may impact the way and extent to which people choose partners and benefit from those partnerships.     

Intraurban social risk and mortality patterns during extreme heat events: A case study of Moscow, 2010-2017

There is currently an increase in the number of heat waves occurring worldwide. Moscow experienced the effects of an extreme heat wave in 2010, which resulted in more than 10,000 extra deaths and significant economic damage. This study conducted a comprehensive assessment of the social risks existing during the occurrence of heat waves and allowed us to identify the spatial heterogeneity of the city in terms of thermal risk and the consequences for public health. Using a detailed simulation of the meteorological regime based on the COSMO-CLM regional climate model and the physiologically equivalent temperature (PET), a spatial assessment of thermal stress in the summer of 2010 was carried out. Based on statistical data, the components of social risk (vulnerabilities and adaptive capacity of the population) were calculated and mapped. We also performed an analysis of their changes in 2010–2017. A significant differentiation of the territory of Moscow has been revealed in terms of the thermal stress and vulnerability of the population to heat waves. The spatial pattern of thermal stress agrees quite well with the excess deaths observed during the period from July to August 2010. The identified negative trend of increasing vulnerability of the population has grown in most districts of Moscow. The adaptive capacity has been reduced in most of Moscow. The growth of adaptive capacity mainly affects the most prosperous areas of the city.     

The Use of Cremation Data for Timely Mortality Surveillance During the COVID-19 Pandemic in Ontario,Canada: Validation Study

BackgroundEarly estimates of excess mortality are crucial for understanding the impact of COVID-19. However, there is a lag of several months in the reporting of vital statistics mortality data for many jurisdictions, including across Canada. In Ontario, a Canadian province, certification by a coroner is required before cremation can occur, creating real-time mortality data that encompasses the majority of deaths within the province.ObjectiveThis study aimed to validate the use of cremation data as a timely surveillance tool for all-cause mortality during a public health emergency in a jurisdiction with delays in vital statistics data. Specifically, this study aimed to validate this surveillance tool by determining the stability, timeliness, and robustness of its real-time estimation of all-cause mortality.MethodsCremation records from January 2020 until April 2021 were compared to the historical records from 2017 to 2019, grouped according to week, age, sex, and whether COVID-19 was the cause of death. Cremation data were compared to Ontario’s provisional vital statistics mortality data released by Statistics Canada. The 2020 and 2021 records were then compared to previous years (2017-2019) to determine whether there was excess mortality within various age groups and whether deaths attributed to COVID-19 accounted for the entirety of the excess mortality.ResultsBetween 2017 and 2019, cremations were performed for 67.4% (95% CI 67.3%-67.5%) of deaths. The proportion of cremated deaths remained stable throughout 2020, even within age and sex categories. Cremation records are 99% complete within 3 weeks of the date of death, which precedes the compilation of vital statistics data by several months. Consequently, during the first wave (from April to June 2020), cremation records detected a 16.9% increase (95% CI 14.6%-19.3%) in all-cause mortality, a finding that was confirmed several months later with cremation data.ConclusionsThe percentage of Ontarians cremated and the completion of cremation data several months before vital statistics did not change meaningfully during the COVID-19 pandemic period, establishing that the pandemic did not significantly alter cremation practices. Cremation data can be used to accurately estimate all-cause mortality in near real-time, particularly when real-time mortality estimates are needed to inform policy decisions for public health measures. The accuracy of this excess mortality estimation was confirmed by comparing it with official vital statistics data. These findings demonstrate the utility of cremation data as a complementary data source for timely mortality information during public health emergencies.     

潮阳市地氟病与氟源关系的探讨

目的 :了解潮阳市地方性氟中毒的病情并探讨地方性氟中毒的关系 ,为制定科学的防治策略提供依据。方法 :用氟离子电极法分别测定生活饮用水、灌溉水、稻谷、茶叶、土壤中的氟含量 ,并对潮阳市 8～ 15岁该地出生的在校生进行氟斑牙患病情况进行调查。结果 :病区与非病区稻谷、土壤中氟含量无显著性差异 (P>0 .0 5 ) ,灌溉水氟含量有显著性差异 (P<0 .0 5 ) ;病区土壤氟含量与稻谷氟含量、稻谷氟含量与氟斑牙患病率呈正相关 ,相关系数 r值分别为0 .5 2 5、0 .818;茶叶的氟含量高达 30 .88mg/ l,灌溉水氟含量与土壤氟含量、土壤氟含量与氟斑牙患病率的相关性较小 ,相关系数 (r值 )分别为 - 0 .2 37、- 0 .332。结论 :潮阳市经改水降氟 ,氟斑牙呈下降趋势 ;除饮用水 (已改水降氟 )外 ,大米、土壤、灌溉水、茶叶等也是该地区的氟来源。     

The relationship between glycemic response, digestibility, and factors influencing the dietary habits of diabetics

A significant relationship was found between the rate of release of the sugars; glucose, maltose, and maltotriose from amylitic digestion of 10 foods tested in vitro (expressed as the digestibility index) and the blood glucose response to 50-g carbohydrate portions of the same foods eaten by diabetics (expressed as the glycemic index), (r = 0.815, n = 10, p greater than 0.01). The glycemic index related to both the palatability of the foods (r = 0.731, p less than 0.05) and their frequency of use (r = 0.698, p less than 0.05). However, in this group of motivated diabetics food use was not related directly to palatability, but rather to health belief (r = 0.689, p less than 0.05). The results suggest that carbohydrate foods of potential use to the diabetic may be identified by their in vitro digestion characteristics but to a large extent their acceptance will depend on health belief and possibly ease of preparation.     

The 2011 and 2016 iterations of the Ontario Marginalization Index: updates,consistency and a cross-sectional study of health outcome associations

ObjectivesThe Ontario Marginalization Index (ON-Marg) is an area-based measure used widely to measure health inequalities in Ontario. Recently, the index was updated for 2011 and 2016. The loss of the 2011 long-form census required the use of alternative data sources for the 2011 version. This paper describes the update of ON-Marg, assesses consistency in the indices across census years using Dissemination Areas, and examines associations between ON-Marg 2016 and four health and social outcomes to demonstrate its potential to measure health inequalities.MethodsON-Marg was created using factor analysis. Differences in quintile assignment was compared over time to assess whether the use of taxfiler, immigration, property assessment, and health card address data in 2011 affected consistency in measurement of marginalization. Inequalities in rates of overall mortality, gonorrhea incidence, mental health emergency department visits, and alcohol retail locations across quintiles of ON-Marg 2016 were quantified using the Relative Index of Inequality.ResultsDepending on the dimension, between 81% and 96% of DAs showed limited or no changes in quintiles of marginalization between 2006, 2011 and 2016. Of the 45–64% of DAs that did not change quintile between 2006 and 2016, 1.8% to 8.8% of DAs in 2011 differed by two or more quintiles. Findings showed significant differences in rates of health and social outcomes across quintiles of ON-Marg 2016, with strength and directionality varying by dimension of ON-Marg.ConclusionAlternative data sources did not substantially affect the consistency of the 2011 version of ON-Marg. The updated ON-Marg is a comprehensive tool that can be used to study health inequalities in Ontario.     

Role of specific postingestional effects and medicinal context in the acquisition of liking for tastes

The role of positive postingestional effects in the acquisition of liking for tastes was explored. The purpose of the first study was to ask whether changes in liking are associated with the repeated ingestion in a medicinal context of a drug which produces positive consequences and which has a distinctive flavor. The results revealed no evidence for an acquired liking overall, and a more fine-grained analysis found no evidence that any type of positive effect which occurred was associated with an increase in liking. In a second study, using a retrospective questionnaire, an examination was made of the changes in liking for a wider range of medicines with tastes as well as for a number of foods. Again, none of the specific positive medicinal effects (types of symptom relief) examined were especially effective in enhancing liking. However, comparison of data for foods and medicines revealed that the latter are less likely to come to be liked than are the former. One possible explanation for these results is that when substances are ingested with the primary motivation of obtaining positive postingestional consequences, as in the case of medicines, this extrinsic motivation interferes with the acquisition of liking.