Showing papers in "Canadian Journal of Public Health-revue Canadienne De Sante Publique in 1999"
TL;DR: The findings highlight the limited capacity of ad hoc, charitable food assistance programs to respond to problems of household food insecurity which arise in the context of severe and chronic poverty.
Abstract: Over the past two decades, the demand for charitable food assistance has steadily grown, and a massive ad hoc system of food banks has become established in Canada. To assess the food insecurity and nutritional vulnerability of one subgroup of food bank users, interviews were conducted with a sample of 153 women in families using emergency food relief programs in Metropolitan Toronto. Ninety percent reported household incomes which were less than two-thirds of the ‘poverty line’, and 94% reported some degree of food insecurity over the previous 12 months. Seventy percent reported some level of absolute food deprivation, despite using food banks. The findings highlight the limited capacity of ad hoc, charitable food assistance programs to respond to problems of household food insecurity which arise in the context of severe and chronic poverty.
171 citations
TL;DR: The evidence reviewed demonstrated that placing limits on both daily intake and cumulative intake over the typical week is justifiable for the prevention of important causes of morbidity and mortality.
Abstract: In 1997 the Addiction Research Foundation of Ontario and Canadian Centre on Substance Abuse released updated guidelines for low-risk alcohol consumption. This paper presents the scientific rationale behind this statement. Important comprehensive overviews on the consequences of alcohol use were studied. Formal meta-analyses on morbidity and mortality were examined wherever possible. Individual elements from similar guidelines were investigated for their scientific foundation. Limited original analyses defined risk levels by average weekly consumption. The evidence reviewed demonstrated that placing limits on both daily intake and cumulative intake over the typical week is justifiable for the prevention of important causes of morbidity and mortality. Gender-specific limits on weekly consumption were also indicated. In these updated guidelines intended for primary prevention, days of abstinence are not necessarily recommended. Intoxication should be avoided and abstinence is sometimes advisable. Available evidence does not strongly favour one alcoholic beverage over another for cardiovascular health benefits.
155 citations
TL;DR: The results suggest that length of time since immigration is an important risk factor for excess weight and further research is required to confirm these initial findings.
Abstract: Objective: To examine the relationship between time since immigration and excess body weight.
117 citations
TL;DR: If the information that is contained in the data of the indicator set is to be transformed into knowledge that can empower and emancipate the community, it has to be developed in consultation with the local community and local users of the information.
Abstract: We begin with a discussion of some vitally important conceptual and methodological issues. These issues concern our understanding of community, of health, of population health and its determinants, of the concept of 'measurement' and the values that underlie it, and our reasons for wishing to measure these constructs. We then present a framework for indicator categories, propose some criteria for indicator selection and suggest an initial set of core indicators. This indicator set reflects not simply health status--no matter how broadly defined--but also the environmental, social and economic determinants of health and the "healthfulness" of the community itself. Our most important conclusion is that if the information that is contained in the data of the indicator set is to be transformed into knowledge that can empower and emancipate the community, it has to be developed in consultation with the local community and local users of the information.
100 citations
TL;DR: The results indicate the incidence of FAS in northeastern Manitoba is very high and that much greater effort needs to be made in its prevention and early detection.
Abstract: The incidence of fetal alcohol syndrome (FAS) in northeastern Manitoba was investigated by examining all 745 live births occurring in Thompson General Hospital in 1994 Birth records were screened with criteria designed to capture all potential FAS cases Cases were then eliminated if follow-up records indicated the child was not developmentally delayed or no longer had the small head or body size identified at birth Cases still meeting criteria were personally examined Five cases of FAS were identified among the 46% of eligible children screened at age 2, roughly an incidence of 72/1,000 However, because only 46% of the high risk cases were personally examined, incidence could be as high as 148/1,000 Only 1/5 FAS cases had been identified prior to our investigation The results indicate the incidence of FAS in northeastern Manitoba is very high and that much greater effort needs to be made in its prevention and early detection
86 citations
TL;DR: The authors find the consistency of the overall pattern of associations with the respiratory infection hypothesis striking, but there were several other substantial associations, both positive and negative.
Abstract: Background: An apparent excess of teachers and healthcare workers among the Parkinson’s disease patients of a large tertiary care movement disorders clinic suggested the hypothesis that high exposure to viral (or other) respiratory infections in these occupations might be a risk factor for Parkinson’s disease. Methods: A case-control study of the association between occupation and Parkinson’s disease was conducted. Cases (414) were all Parkinson’s disease patients seen at the University of British Columbia Hospital Movement Disorders Clinic between 1986 and 1993, residing in Greater Vancouver, and under 65 in 1991. Controls (6,659) were randomly selected from the 1991 Canadian Census. Findings: Parkinson’s disease was associated with teaching (OR 2.50, 95% CI 1.67–3.74) and occupation in healthcare services (OR 2.07, 95% CI 1.34–3.20), but there were several other substantial associations, both positive and negative. Interpretation: While referral bias cannot be ruled out, the authors find the consistency of the overall pattern of associations with the respiratory infection hypothesis striking.
86 citations
85 citations
TL;DR: A lexicon for population health has been proposed in this paper, which distinguishes population health in its literal meaning from a population health perspective, population health research, a populationhealth framework, and a population-health approach to policy.
Abstract: Despite its undeniable currency in research and policy circles, there remains considerable confusion about what 'population health' is. We propose a lexicon for population health in the hope of clarifying issues and advancing this important research emphasis and policy agenda. It distinguishes population health in its literal meaning from a population health perspective, population health research, a population health framework, and a population health approach to policy. Population health is more than just thinking in aggregate terms or about identifying vulnerable or at-risk subpopulations. A population health perspective is fundamentally concerned with the social nature of health influences. The social structures that shape health experiences transcend the characteristics or actions of any one individual, providing population health with analytic advantages over individualistic-oriented approaches to health and to health policy.
80 citations
TL;DR: Factors influencing infant feeding choices of 434 mothers with 9-month-old infants in Vancouver are described and initiatives to facilitate further advances in breastfeeding promotion could address three areas: 1) prenatal intentions, 2) early postpartum concerns, and later issues surrounding returning to work and infant nutrition.
Abstract: This study describes factors influencing infant feeding choices of 434 mothers with 9-month-old infants in Vancouver. Consistent with Social Cognitive Theory, both internal personal and socio-environmental factors influence infant feeding choices. Mothers attributed the choice to breastfeed primarily to personal choice, whereas the choice to formula feed was attributed to socio-environmental factors. Among mothers who breastfed <3 months, the choice to wean was primarily attributed to concern for baby’s nutrition; compared to returning to work, concern about milk supply and concern for baby’s nutrition among those who breastfed ≥3 to <6 months; and returning to work and personal choice among those who breastfed ≥6 months. Among Caucasian mothers, the choice to wean was primarily attributed to returning to work, compared to concern for baby’s nutrition among non-Caucasian mothers. Initiatives to facilitate further advances in breastfeeding promotion could address three areas: 1) prenatal intentions, 2) early postpartum concerns, and 3) later issues surrounding returning to work and infant nutrition.
71 citations
TL;DR: The need to obtain more information on driving under the influence of cannabis (DUIC) in the general population is underscore, including a more complete understanding of any risks involved.
Abstract: While cannabis is the most frequently found illegal drug in drivers killed or injured in motor vehicle collisions, little is know about driving under the influence of cannabis (DUIC) in the general population We report information on the incidence of DUIC in a representative sample of the Ontario adult population Among all drivers, 19% reported DUIC in the previous 12 months Several factors influenced the likelihood of reported DUIC, including gender, age, marital status and education level Among cannabis users, DUIC appeared to be a relatively common behaviour; 228% reported DUIC, and the probability of the behaviour was significantly influenced by gender and education level As well, DUIC and drinking-driving were strongly related in this sample These data underscore the need to obtain more information on this behaviour, including a more complete understanding of any risks involved
70 citations
TL;DR: The relationship between adolescent self-rated health and personal and situation and situation at five different time intervals is examined to identify inter- and intra-cohort effects as well as concomitant changes in adolescent health compromising behaviour, specifically substance use.
Abstract: Self-rated health is a commonly used measure of physical health status. While the development of one's perception of self-rated health likely occurs during childhood and adolescence, its development has been largely unexplored. This study addresses this issue by examining the relationship between adolescent self-rated health and personal (sex, age) and situation (family structure, family income) factors at five different time intervals to identify inter- and intra-cohort effects as well as concomitant changes in adolescent health compromising behaviour, specifically substance use. Five waves between 1989 and 1997 of the biennial Ontario Student Drug Use Survey (OSDUS) by the Addiction Research Foundation (ARF) consisting of 19,512 cases were examined. The results indicate the presence of both inter- and intra-cohort effects on self-rated health. In addition, health-compromising behaviours had a varied effect on self-rated health across grade. This analysis confirms some previous findings but also presents contradictory evidence by identifying the complexity of relationships among these factors and self-rated health.
TL;DR: Consumption of contaminated well-water is associated with gastrointestinal illness in family members and E. coli can be a useful marker for detecting wells that pose a potential public health problem in rural areas.
Abstract: Objectives: To determine the relationship between consumption of E. coli contaminated well-water and gastrointestinal illness in rural families. Methods: One hundred and eighty-one families with well-water as a drinking source participated in a one-year follow-up study. Water was tested for E. coli bacteria and health outcomes were monitored for household members. Results: E. coli in well-water was significantly associated with gastrointestinal illness in family members, however the relationship was modified by the distance from the septic tank to the well. E. coli had an odds ratio of 2.16 [95% CI 1.04, 4.42] if the septic tank was greater than 20 metres from the well and 0.46 [95% CI 0.07, 2.95] if the septic tank was within 20 metres. Conclusions: Consumption of contaminated well-water is associated with gastrointestinal illness. E. coli can be a useful marker for detecting wells that pose a potential public health problem in rural areas.
TL;DR: L’analyse des ingredients contenus dans ces desserts a demontre that des framboises fraiches provenant de the Bosnie etaient l’ingredient le plus susceptible d’etre contamine.
Abstract: Plusieurs intoxications alimentaires dont l’origine etait vraisemblablement commune sont survenues dans la region de Quebec en juillet et aout 1997. Lors des premiers episodes, l’analyse de deux cohortes (A et B) revelait que la consommation d’un gâteau aux framboises (framboisier) augmentait le risque de contracter une gastro-enterite (A, RR=2,6 p=0,001, B, RR=4,7 p=0,02). Par la suite, plus de 200 personnes ont declare avoir ete malades apres avoir consomme un dessert contenant des framboises. l’analyse des ingredients contenus dans ces desserts a demontre que des framboises fraiches provenant de la Bosnie etaient l’ingredient le plus susceptible d’etre contamine. Des tests d’amplification genomique par PCR realises sur des echantillons de framboises (2) et de selles (5) ont decele un virus de la famille des Calicivirides. Il est important de se doter de systemes de surveillance permettant de detecter rapidement et de limiter l’ampleur de telles eclosions.
TL;DR: Using a nationally representative sample, it is found that single mothers have almost double the 12-month prevalence rates of married mothers, and there are no significant differences in rates of depression between single and married mothers by region/province of the country.
Abstract: While a number of studies have documented higher period prevalence rates of depression among single as compared to married mothers, all of the data have been based upon community surveys of mental illness. In Canada, all of the published work comes from Ontario. As a result, we do not know whether these results hold true for other regions of the country. Using a nationally representative sample, we find, consistent with previous work, that single mothers have almost double the 12-month prevalence rates of married mothers (15.4% versus 6.8%). As well, there are no significant differences in rates of depression between single and married mothers by region/province of the country. Our findings are compared with other epidemiologic data on the mental health of single mothers from Ontario.
TL;DR: In this article, the authors showed that the consumption of a raspberry mousse with raspberry sauce increased the risk of contracting gastroenteritis (A, RR = 2.6 p = 0.001; B, RR= 4.7 p =0.02), and the nucleotide sequences found in the raspberry sauce and in the stool samples were identical.
Abstract: Several episodes of food poisoning affected the region of Quebec City in July and August 1997. In the first two episodes, the analysis of two cohorts (A and B) demonstrated that the consumption of a raspberry mousse with raspberry sauce increased the risk of contracting gastroenteritis (A, RR = 2.6 p = 0.001; B, RR = 4.7 p = 0.02). More than 200 people were sick after eating a raspberry dessert. The common ingredient of all those desserts was raspberries imported from Bosnia. Viral studies on the raspberry sauce (2) and stool samples (5) using the genome amplification method by PCR indicated the presence of genomic material compatible with a virus of the Caliciviruses family. Southern hybridization and sequence analysis showed that the nucleotide sequences found in the raspberry sauce and in the stool samples were identical. It is important to maintain active surveillance to detect and limit the spread of this kind of outbreak.
TL;DR: It is projected that the Edmonton Streetworks needle exchange program has a cost-effectiveness of $9,500 (Canadian) per HIV infection delayed for one year, and continuing the program is a dominant strategy.
Abstract: Objective: To conduct a cost-effectiveness analysis of the Edmonton Streetworks needle exchange program, in terms of the additional cost per HIV infection averted. The main outcome measures were needle use with and without Streetworks, HIV cases averted, and program costs. Method: We conducted interviews and HIV saliva tests on a sample of street-involved intravenous drug users (IDU) who are regular Streetworks’ clients. Outcomes were used in a cost-effectiveness model. Results: It is projected that the program has a cost-effectiveness of $9,500 (Canadian) per HIV infection delayed for one year. Conclusions: The discounted cost per case averted is less than the cost of a case of AIDS. Continuing the program is a dominant strategy.
TL;DR: Results of the analysis indicate that social context appears to be an important influence on risk-related behaviour, and should be taken into account in approaches designed to promote health behaviours.
Abstract: This paper examines the individual and social determinants of physical inactivity, daily smoking, heavy drinking, and overall risk behaviour among 1,395 Canadians aged 20-24 in the 1994 National Population Health Survey. Logistic regression was used to estimate models of risk behaviour using the following variables: sex, mastery, self-esteem, sense of coherence, chronic stress, psychological distress, social support, income adequacy, education, and main activity (working, looking for work, attending school, other). Results of the analysis indicate that the most consistent predictors were chronic stress and main activity. Thus, social context appears to be an important influence on risk-related behaviour, and should be taken into account in approaches designed to promote health behaviours.
TL;DR: The social and cultural factors that influence the vulnerability of female exotic dancers to sexually transmitted infections and workplace policies and health and safety standards appear to be the most effective ways to decrease theulnerability of dancers.
Abstract: This article examines the social and cultural factors that influence the vulnerability of female exotic dancers to sexually transmitted infections. Results are based on a qualitative, exploratory study using observations in 10 clubs and in-depth interviews with 30 dancers in southern Ontario. The social and cultural context within which exotic dancing takes place contributes to a chronic state of sexual harassment and sexual assault in the strip clubs. Women are pressured by economics and by their customers to engage in sex for pay. The defence mechanisms that some women use to deal with these work conditions also contribute to women’s vulnerability. The social structure of strip clubs and their policies toward employees and customers can either reduce or exacerbate the vulnerability of dancers. Workplace policies and health and safety standards appear to be the most effective ways to decrease the vulnerability of dancers. Public health units can work with employers and dancers to establish workplace policies and programmes that contribute to the health and wellbeing of dancers.
TL;DR: This study examined the sociodemographic predictors of smoking cessation attempts among pregnant women, and compared the characteristics of women who successfully quit smoking during pregnancy with those who relapsed before their child was born.
Abstract: This study examined the sociodemographic predictors of smoking cessation attempts among pregnant women, and compared the characteristics of women who successfully quit smoking during pregnancy with those who relapsed before their child was born. Data, which were derived from the National Longitudinal Survey of Children and Youth, indicate that 23.7% of Canadian mothers smoked at some point during their pregnancies, of whom only 15.8% attempted to quit. Maternal and paternal education were the strongest predictors of successful cessation, whereas women pregnant with their first child, those who drank during pregnancy, and those who immigrated to Canada were the most likely to relapse. This study represents an important first step in identifying Canadian women at highest risk of sustained smoking during pregnancy, and is useful for the design of effective interventions, tailored to meet their needs.
TL;DR: It is found that the professionalization of food and nutrition, a desire for an expanded client base, and dependency creation through the provision of other material goods, permit programs to exert increasing institutional control over recipients, a process the authors, following Illich, call the dragnet.
Abstract: This study analyzed, through case studies of day-to-day observations and interviews with recipients and operators, the operations of nine children’s feeding programs in Nova Scotia, New Brunswick, and Newfoundland. We found that children’s feeding programs result in the stigmatization of participants and families, despite an ideology of equality. Most programs adopt a family substitution role in the lives of children they serve and function in a way that excludes parental participation. Programs also transmit a hidden curriculum to children that teaches them how to behave and how a ‘proper’ family functions. We found that the professionalization of food and nutrition, a desire for an expanded client base, and dependency creation through the provision of other material goods, permit programs to exert increasing institutional control over recipients, a process we, following Illich, call the dragnet. While these programs may be meeting some nutritional needs in a few poverty-stricken children, they ultimately reproduce, rather than reduce, inequities.
TL;DR: The findings indicate that participating in traditional ways — committee meetings, public fora, completing surveys — was not relevant to the realities of these individuals and argue for a new understanding of, and appreciation for what actually constitutes participation.
Abstract: This article describes partial results from a case study of community participation in “New Directions for a Healthy B.C.”, a now-abandoned health reform policy. For this study, focus groups were conducted to explore the perspectives of traditionally under-represented citizens in understanding reasons for nonparticipation and to identify strategies for fostering participation in the health reform process. The findings indicate that participating in traditional ways — committee meetings, public fora, completing surveys — was not relevant to the realities of these individuals. Yet, rather than merely refusing to be involved, focus group members extended an invitation for health planning group members to experience their daily lives; an idea that is referred to in the literature as ‘experiential participation’. In order to foster broad-based participation in community health initiatives, the findings from this study argue for a new understanding of, and appreciation for what actually constitutes participation.
TL;DR: The risk of testicular cancer has increased over time and changing exposure to environmental factors early in life may be responsible for this.
Abstract: Purpose To examine the pattern of testicular cancer incidence by age, time period and birth cohort since 1969 in Canada. Methods In addition to analyses of the secular trends by age group and birth cohort separately, an age-period-cohort model and the submodels with standard Poisson assumptions were fitted to the data. Results The overall age-adjusted incidence of testicular cancer increased in Canada, from 2.8 per 100,000 males in 1969-71 to 4.2 in 1991-93. The younger age groups showed much higher absolute incidence rates in the recent period compared with those in the early period. Age-period-cohort modelling of data restricted to males aged 20-84 years suggested that the observed increase in testicular cancer could be largely attributed to a birth cohort effect. A steady increase in risk was observed among men born since 1945; those born between 1959 and 1968 were 2.0 (95% CI, 1.5-2.6) times as likely to develop testicular cancer as those born between 1904 and 1913. Conclusion The risk of testicular cancer has increased over time and changing exposure to environmental factors early in life may be responsible for this.
TL;DR: Differences were found with respect to illegal income generation, illicit opiate and other drug use, illicit drug market activities and emergency care and aspects of socio-economic integration, but no major effects on health and criminal justice status could be shown.
Abstract: Untreated opiate use is correlated with major social harms and costs in Canada. While methadone treatment has existed in Canada since the 1960s, there is little specific Canadian research on its effects. This paper reports on the one-year follow-up results of a Toronto cohort study of opiate users (N = 114) who were not in treatment at baseline. Sixty-nine people were recruited for re-interviewing. A number of these individuals (N = 29) had entered methadone treatment during the year between baseline and follow-up interviews. Comparisons with respect to social functioning, health status and health care utilization, drug use and related risks, and criminal justice system involvement were made between the follow-up subsample who remained untreated, and the subjects who entered methadone treatment. Differences were found with respect to illegal income generation, illicit opiate and other drug use, illicit drug market activities and emergency care and aspects of socio-economic integration, but no major effects on health and criminal justice status could be shown. Research and policy implications are discussed.
TL;DR: Cancer coverage in 309 issues of Canadian women's magazines for the period 1991-1997 argued for greater partnerships between the media and health educators to enhance balanced dissemination of cancer control information to Canadian women.
Abstract: Mass media can inform health beliefs and shape cancer control behaviours. This study surveyed cancer coverage in 309 issues of Canadian women’s magazines for the period 1991–1997. Magazines were selected if 1996 revenue >$10 million and circulation >500,000; Canadian Living, Chatelaine, Flare and Homemaker’s met these criteria. The volume of cancer coverage varied significantly by year and by magazine. However, coverage of specific cancers did not reflect their contribution as a cause of cancer death in Canadian women. The percentage of articles on lung cancer was lower and on breast cancer was higher than the percentage of deaths due to these cancers. All magazines had decreased coverage of lung cancer in 1997 compared to 1991. National cancer resource agencies and research initiatives on breast cancer were infrequently mentioned. These results argue for greater partnerships between the media and health educators to enhance balanced dissemination of cancer control information to Canadian women.
TL;DR: Results of the multiple regression analysis show that adolescents who have been exposed to more violence, either as a victim or as a witness, report more psychiatric symptoms, higher levels of depression, and more problems of self-esteem.
Abstract: This study explores the impact of violence exposure on the mental health of the adolescents in a rural small town. A structured questionnaire was used to survey 347 adolescents. Violence experienced and witnessed by the adolescents at school, in the neighbourhood, and at home was measured. Mental health was represented by the psychiatric symptoms, depression level, and self-esteem. The level of violence perpetrated by the adolescents was also explored. Results of the multiple regression analysis show that adolescents who have been exposed to more violence, either as a victim or as a witness, report more psychiatric symptoms, higher levels of depression, and more problems of self-esteem. Being a witness of violence also contributes significantly to the variance of violence committed by the adolescents. The implications of the findings to violence prevention are discussed in the conclusion.
TL;DR: The notion of collective lifestyles as a heuristic for understanding the interaction between social conditions and behaviour in shaping health is proposed, and whether lifestyle is an individual or a collective attribute is proposed.
Abstract: The last five years have witnessed intense debate among health researchers in Canada regarding the overlap of the health promotion and population health discourses Meanwhile, strong currents within health promotion have attempted to move the field beyond a focus on individual behaviour towards the influence of social environments on health, although the tendency is often to fall back on individual behaviour modification as the primary lever for change The Population Health research agenda bypasses behavioural determinants of health and explores instead social determinants This body of knowledge provides useful insight for addressing some of the tensions in the health promotion discourse This paper explores two of these tensions: whether individuals at risk or general populations should be targeted for change; and whether lifestyle is an individual or a collective attribute We propose the notion of collective lifestyles as a heuristic for understanding the interaction between social conditions and behaviour in shaping health
TL;DR: Elderly suicide rates appear to be affected by deviations of monthly mean temperature from values expected for that time of year, and increased support by service agencies at times of predicted high risk is suggested.
Abstract: Objectives: The authors examined the relationship of suicide in the elderly (65 years and older) to season and weather and compared it to that in the younger population (10–64 years). Methods: Information on suicides and on weather was obtained for British Columbia for the period 1981 to 1991. The association of suicide with season and weather was assessed using Poisson regression. Results: Whereas younger suicides were associated with season, showing a springsummer peak, elderly suicides were associated with actual weather. They increased with higher mean daily temperature for the current month (RR=1.16, 95% CI 1.05–1.28 for each 2.5° C change in mean temperature), and with lower mean daily temperature for the preceding three months (RR=1.12, 95% CI 1.01–1.23). Conclusions: Elderly suicide rates appear to be affected by deviations of monthly mean temperature from values expected for that time of year. Increased support by service agencies at times of predicted high risk is suggested.
TL;DR: Demographic variables (sex, age, education, occupation, income, residence, conservatism) explained less than 10% of the variance for each of the four explanations, with conservatism the most consistent predictor.
Abstract: The public’s view on how poverty and health are related will influence support for different policies and programs. The purpose of this study was to examine public perceptions of the relationship between poverty and health and to identify demographic variables that predict support for the four explanations of the relationship between poverty and health (artifact, drift, behavioural, and structural) first identified in the Black Report in the United Kingdom. A telephone survey of a representative sample of Albertans (N=1,216) was conducted. The majority of respondents believed that poverty leads to poor health. The explanation that health is influenced by the context in which individuals live (structural) received the most support. Demographic variables (sex, age, education, occupation, income, residence, conservatism) explained less than 10% of the variance for each of the four explanations, with conservatism the most consistent predictor.
TL;DR: Weight gain between pregnancies is an independent risk factor for gestational diabetes and is not associated with the other outcomes.
Abstract: Objective: Weight change between pregnancies was examined to determine if there were an association between weight gain (or loss) and delivery by cesarean section, gestational diabetes or pregnancy-induced hypertension. Methods: A cohort study was conducted which included Nova Scotia residents with two or more singleton deliveries between 1988 and 1996. Weight change between pregnancies was calculated as the difference in weight from a woman’s initial pre-pregnancy weight and the pre-pregnancy weight recorded from her final recorded pregnancy. Results: Weight change between pregnancies was examined in 19,932 women. Women in the highest weight gain category were at an increased risk for developing gestational diabetes (RR = 1.59, 95% CI 1.22 – 2.08), independent of their weight prior to the final pregnancy, and other confounders. Weight gain (or loss) between pregnancies was not associated with the other outcomes. Interpretation: Weight gain between pregnancy is an independent risk factor for gestational diabetes.
TL;DR: The historical evolution of health impact assessments as part of the environmental assessment process is examined, finding that sustainable development with its social objectives of empowerment, participation, equity, poverty alleviation, social cohesion, population stability and institutional development is an appropriate framework for conducting health impact assessment.
Abstract: The present paper examines the historical evolution of health impact assessments as part of the environmental assessment process. The development of a coherent public health framework must be based on the model of determinants of health, integrating toxic and infectious risks and social impacts of projects. The integration of common concepts, processes and methodologies from the area of public health and social impact assessment challenges the quantitative model approach to risk assessment. The expert-driven risk assessment is transformed into a social learning process where local knowledge and scientific input foster a dialogue among stakeholders. The issue-oriented, iterative and participative assessment process may be applied to the health impact assessment of public policies. Sustainable development with its social objectives of empowerment, participation, equity, poverty alleviation, social cohesion, population stability and institutional development is an appropriate framework for conducting health impact assessments.