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Article. Perceived need for mental health care in Canada: Results from the 2012 Canadian Community Health Survey Mental Health

Article. Perceived need for mental health care in Canada: Results from the 2012 Canadian Community Health Survey Mental Health

Based on data from the 2012 Canadian Community Health Survey–Mental Health (CCHS-MH), this article describes the prevalence of four types of perceived MHC needs (information, medication, counsel- ling, and other) and the degree to which they are met in relation to risk factors for MHC needs, specifi cally, mental disor- ders, distress, or chronic physical health condition(s). Possible barriers to receiving MHC are also explored.

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An overview of the statistical methods reported by studies using the Canadian community health survey

An overview of the statistical methods reported by studies using the Canadian community health survey

The first step of our study was to define reasonable bound- aries for our search. The literature search was conducted for articles indexed in Ovid Embase, Ovid Medline, Web of Knowledge, and Scopus bibliographical databases. Our search strategy included the terms “Canadian Community Health Survey*” and “CCHS”. These terms were then com- bined with other keywords that could be associated with the survey including variations of the cycle (e.g. "Cycle 1.1", "Cycle 1.2", "Cycle 2.1" etc.), sub-cycle (e.g. "mental health and well-being", "Canadian Forces", "Healthy Aging", etc.) and the years of the survey (e.g. 2000, 2001, etc.) to identify potential references. References were restricted to articles published up to December 31, 2012. References were then retrieved and duplicates were removed. One reviewer (DWY) excluded any references that did not actually utilize the CCHS data. References were also excluded if they were missing the abstract, were a conference abstract or commentary, and in instances where an electronic readable Portable Document File (PDF) of the article was not available. Other than the exclusion of conference abstracts and commentaries, we did not put any restric- tion on types of publications we included such as papers classified as “original research” or “reviews”. Narrative re- views are increasingly being replaced by systematic re- views that often present statistical estimates and even statistical models (e.g. meta-regression). Given the goals of this project, reviews were considered eligible for this rea- son. The literature search was conducted on January 14, 2013.
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Daily smoking and lower back pain in adult Canadians: the Canadian Community Health Survey

Daily smoking and lower back pain in adult Canadians: the Canadian Community Health Survey

Objective: The primary objective of the study was to determine if daily smoking is associated with an increased risk of having LBP. The secondary objectives were to assess the risk for LBP among occasional smokers and to determine the prevalence of LBP in relation to different covariates. Data and study design: Using the Canadian Community Health Survey (cycle 3.1) data, 73,507 Canadians between the ages of 20 and 59 years were identified. LBP status, smoking level, sex, age, body mass index (BMI), level of activity and level of education were assessed in these subjects.
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Low concentrations of fine particle air pollution and mortality in the Canadian Community Health Survey cohort

Low concentrations of fine particle air pollution and mortality in the Canadian Community Health Survey cohort

death compared to a 10km 2 or 5km 2 grid indicating that exposure estimates that are more specific to a person’s residence are appropriate [54]. Gaps in postal code his- tory are imputed under the assumption that the person did not leave the country or community during that time. In assigning contextual covariates by postal code, misclassification may occur from taking the mode or mean when estimating a single value to represent mul- tiple points of latitude and longitude for a single postal code. Second, in contrast to the CanCHEC cohorts (Pap- pin AJ, Crouse DL, Christidis T, Pinault LL, Tjepkema M, Erickson A, Brauer M, Weichenthal S, van Donkelaar A, Martin RV, Brook J, Hystad P. Burnett RT. Associa- tions between low levels of fine particulate matter andmortality within Canadian cohorts. Environ Health Persp., under review), this cohort does not completely represent the full Canadian population; the Canadian Community Health Survey is not a census of the popula- tion and survey weights were not used in this analysis. Further, in creating this cohort persons were removed if they did not consent to data linkage or if they could not be linked to the SDLE. The CCHS over-samples rural communities [55] which results in a disproportionate sample in areas with low levels of PM 2.5 and higher rates
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THE RELATIONSHIP BETWEEN DIET QUALITY AND OBESITY IN CANADIAN ADULTS: EVIDENCE FROM THE 2004 CANADIAN COMMUNITY HEALTH SURVEY

THE RELATIONSHIP BETWEEN DIET QUALITY AND OBESITY IN CANADIAN ADULTS: EVIDENCE FROM THE 2004 CANADIAN COMMUNITY HEALTH SURVEY

No statistically significant relationship between dietary macronutrient composition and obesity has been found among Canadians [74]. Current nutritional guidelines from Health Canada emphasize the importance of eating less fat, advising diets of 20-35% of calories from fat (specifically, 5-10% from omega-6 polyunsaturated fat and 0.6-1.2% from omega-3 polyunsaturated fat), and 45-65% of calories from carbohydrates [21]. Canada’s Food Guide seemingly recommends that Canadians consume as little fat as possible: it provides suggestions to prepare foods using little or no added fat, use low-fat versions of dairy products, and choose lean meats and trim visible fat from meats before preparing them [20]. In fact, recent nutritional surveys have shown that in recent decades the percentage of calories Canadians consume from fat has been decreasing: the 1977 Food Consumption Patterns Report showed that Canadians consumed an average of 40% of calories from fat while the 2004 Canadian Community Health Survey showed that fat intake had fallen to an average of 31% [19]. However, the prevalence of obesity in Canada is clearly on the rise, implying that there may be other important factors causing obesity than dietary fat. Since reducing dietary fat often leads to a simultaneous increase in carbohydrate intake, it may be that one of these factors is the types of carbohydrates consumed.
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Are Canada’s Older Adults Aging Successfully? An Analysis of the Canadian Community Health Survey

Are Canada’s Older Adults Aging Successfully? An Analysis of the Canadian Community Health Survey

Defining successful aging (SA) has been a topic of debate amongst researchers since Rowe and Kahn introduced the topic of “usual” versus “successful” aging in the late 1980s. Researchers have criticized their biomedical model of successful aging, which has been used as an unofficial gold standard in determining whether one has aged usually or successfully. This perspective focuses on having high physical and mental functional capacities, being void of disease or disease-related disability, and having an active engagement with life, and is considered too narrow in its focus and lacking subjective interpretations of aging. Using the 2011-2012 version of the Canadian Community Health Survey with Canadian adults aged 60 years and older (N = 15,846), 15.9% of respondents were aging successfully, 81% were aging moderately successfully, and 3.1% were aging unsuccessfully with the biomedical model based on Rowe and Kahn’s (1987; 1997; 1998) three postulates of aging success. Using the psychosocial criteria based on a review of SA literature, 18.3% of respondents were aging successfully, 66.1% were aging moderately successfully, and 15.6% were aging unsuccessfully. Using the integrative criteria, which combined both the biomedical and psychosocial perspectives, 28.9% of respondents were aging successfully, 55.5% were aging moderately successfully, and 15.6% were aging unsuccessfully. Results from the integrated model are depicted on a continuum that illustrates the difference in aging success based on a combination of predictors unique to each perspective of SA. This model has the potential to demonstrate that those
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Dental care use in Ontario: the Canadian community health survey (CCHS)

Dental care use in Ontario: the Canadian community health survey (CCHS)

the past year than non-smokers [27]. Our results also suggested that those who smoked usually visited a den- tist for emergencies only compared to non-smokers. This could be due in part to the fact that smokers tend to engage in health-seeking behavior rather than pre- ventive care behavior, even though regular dental visits are highly recommended for averting future periodontal disease, tooth loss, and other oral health complexities [28]. Interestingly, our results revealed that those who consumed alcohol at least once per week were less likely to report having poor dental care use. This result was not in concordance with a longitudinal study in Sweden, which found that individuals with high alcohol use reported having more irregular dental visits than those with lower alcohol use In fact, previous studies have Table 1 Characteristics of the total sample and those with dental visits ≥ 1 year and emergency dental visits in Ontario, the Canadian Community Health Survey (CCHS), 2014 (Continued)
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Analysis of Added Sugar Intake of Canadian Children and Adolescents: Findings from the Canadian Community Health Survey on Nutrition

Analysis of Added Sugar Intake of Canadian Children and Adolescents: Findings from the Canadian Community Health Survey on Nutrition

However, findings from the Canadian Community Health Survey (CCHS) on Nutrition from 2004, which measured diet by asking participants to report everything they consumed in the past 24-hour period, showed that children and adolescents between the ages of 9 and 18 attained 24% to 25% of their daily calories from total sugar, and the majority of this sugar came from the 'Other' food category, suggesting that added sugars were the main source of sugar, rather than the intrinsic sugars found in the rest of the food groups (fruit and vegetables, milk products, grain products, and meat and alternatives) (Langlois & Garriguet, 2011). Since the majority of daily calories are coming from the 'Other' food category, this suggests that children and adolescents are not meeting Health Canada's dietary recommendations. Additionally, since this study measured total sugar intake, it is also unclear whether Canadian children and adolescents are meeting added sugar intake guidelines that have been published by health organizations such as Diabetes Canada, which recommends that added sugar should be limited to less than 10% of daily energy intake (Diabetes Canada, 2016).
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Risk estimates of mortality attributed to low concentrations of ambient fine particulate matter in the Canadian community health survey cohort

Risk estimates of mortality attributed to low concentrations of ambient fine particulate matter in the Canadian community health survey cohort

Since the purpose of this analysis was to evaluate long-term effects of air pollution exposure, the study population was restricted to adults aged 25 to 90 years of age at enrollment (n = 72,000 respondents excluded). Adults older than 90 years of age were excluded from this study to ensure a sufficient sample size within all age strata. Similar to the CanCHEC study [3], immi- grants living in Canada for less than 20 years (i.e., those who had arrived in Canada less than 20 years before the start date), were excluded from this study (n = 13,200 additional respondents excluded) for the following rea- sons. Immigrants are known to have better health and live longer than the Canadian-born population [9]. Im- migrants also more frequently live in areas of greater ambient air pollution (unpublished data), and their exposure to air pollution prior to living in Canada is largely unknown. Cause-specific mortality analyses among recent immigrants were also not meaningful due to small sample sizes in the CCHS cohort (i.e., < 250 deaths). Therefore, the use of a larger cohort would be necessary to examine the health effects of air pollution on recent im- migrant populations. Finally, we excluded an additional 3,400 respondents who were not linked to air pollu- tion estimates since they live beyond the boundaries of the air pollution models (i.e., in the northern Ter- ritories) (Additional file 1). The final analytical sample was 299,500 respondents (note slight inconsistencies due to rounding). All research using human data was carried out at Statistics Canada in accordance with the Statistics Act to meet standards of privacy and confidentiality associated with the internal use of survey data. The record linkage project was approved by the Executive Management Board at Statistics Canada (ref. num. 003–2015).
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UNMET NEEDS REPORTED BY ADULTS WITH CHRONIC CONDITIONS: AN ANALYSIS OF DATA FROM THE CANADIAN COMMUNITY HEALTH SURVEY

UNMET NEEDS REPORTED BY ADULTS WITH CHRONIC CONDITIONS: AN ANALYSIS OF DATA FROM THE CANADIAN COMMUNITY HEALTH SURVEY

The regression analyses in this study also identified signif- icant associations between age and sex and each of avail- ability, affordability, and acceptability dependent variables. Specifically, the results from this study indicated women were more likely than men, and older persons were less likely than persons 40 – 45 years, to report a physical un- met need due to any of the three dimensions of access to care.These findings are consistent with the existing litera- ture. For example, multiple studies have demonstrated that in Canada women report more unmet need for health care than men,[42,43,47,49] despite accessing health services more frequently than men [48]. Levesque et al (2008) [48] identified that a higher proportion of women (53.2%, 95% CI 50.3 – 56.0) compared to men (46.8%, 95% CI 44.0 – 49.7) reported an unmet need for health services in a sur- vey of 9,206 adults who resided in Montreal or Monteregie, Quebec, Canada in 2005. However, Bryant et al (2009) [50] have also identified that women tend to assume the re- sponsibility of primary care giving of family members, and women who work outside the house may have increased responsibilities that threaten their own health [50]. These responsibilities may affect women’s health directly through the stress of greater responsibilities, or indirectly through difficulties with scheduling and meeting medical appoint- ments [50]. Despite the volume of research document- ing disparities in women’s access to health services, most services are neither funded nor delivered with gender or
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Dental care use by immigrant Canadians in Ontario: a cross-sectional analysis of the 2014 Canadian Community Health Survey (CCHS)

Dental care use by immigrant Canadians in Ontario: a cross-sectional analysis of the 2014 Canadian Community Health Survey (CCHS)

This study is the first to highlight oral health care use patterns among immigrants in Ontario. The estimate of not visiting the dentist within the past year was over 30%, while 25% reported visiting for emergency purposes only. Males, new immigrants, those with low household income, low educational level, no dental insurance, and poor health of teeth and mouth were at an increased odds of poor dental care use. It is vital that the provin- cial government and its stakeholders modify policies to support this population with their oral health care needs. Given the importance of immigration-specific factors, strategies and interventions to provide individuals with access to dental care at an early stage of immigration should be sought. This can be achieved via educational and outreach programs informing incoming immigrants of the importance of preventative dental care and where to find dental services in their region. Furthermore, appropriate use of language assistance and navigation services can be helpful in improving accessibility and use of these services. Lastly, publicly funded financial support programs for immigrants without dental insur- ance should be implemented. Doing so will not only improve dental care seeking behaviors, but also help create a healthier nation by preventing chronic condi- tions that often follow dental diseases.
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Masters or pawns? Examining injury and chronic disease in male Masters Athletes and chess players compared to population norms from the Canadian Community Health Survey

Masters or pawns? Examining injury and chronic disease in male Masters Athletes and chess players compared to population norms from the Canadian Community Health Survey

relatively unique groups (e.g., greater involvement in preventive health activities). These studies will extend our knowledge of the level and type of activity required to optimize health and function, as well as confirm whether participation in an intense cognitive activity alone can mitigate chronic disease amongst older adults. Given that chess players reported lower incident of in- juries than Masters Athletes as well as a lower preva- lence of chronic diseases compared to moderately active and inactive groups, it begs the question ‘why is the gold standard for successful aging only associated with those who participate in competitive sport?’ as suggested by Hawkins et al. [27]. Perhaps this label could be expanded to include other forms of competitive activity. Moreover, our lack of understanding regarding the consequences of competitive sport [24, 60], highlights the need to refrain from labeling Masters Athletes as the ideal model for suc- cessful aging, at least until additional work has been con- ducted. Furthermore, from a health promotion standpoint, advocating sport as a preventive health strategy may be problematic, particularly for individuals who have a) debili- tating chronic diseases and/or socio-demographic barriers that can limit participation in sport [7, 61] or b) internal- ized the pervasive old age stereotypes in North American society and likely avoid participation in competitive sport [22]. Our study suggests older adults may have other op- tions, such as competitive chess, to gain similar health ben- efits to sport participation. Moreover, it is possible older adults who participate in a variety of activities (e.g., chess and sport) may gain a combination of physical and cogni- tive health benefits [13, 62]. For that reason, advocating programs designed to cognitively and physically engage older persons may be a pragmatic response from both a health and an economic standpoint.
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Capacity development in health systems and policy research: a survey of the Canadian context

Capacity development in health systems and policy research: a survey of the Canadian context

Data on graduate employment would be useful to uni- versity departments and training programs as a tool for evaluating the quality of their programs and identifying opportunities for improvement. More specifically, these data could provide information on whether programs equip trainees with core competencies that match future career requirements [18]. Commenting on the scientific community more broadly, Kennedy et al. [6] suggest university departments give applicants a detailed account of the placement histories of recent graduates. As our results show, no departments surveyed currently possess this information. More careful tracking of graduates is a necessary first step. Research funders also have a role to play, ensuring that investments in human resource cap- acity are matched with support for research infrastruc- ture, and ensuring that available support is balanced over the course of research careers. Support for new in- vestigators has been identified as one possible gap in current career support funding [12]. While academic in- stitutions are responsible for hiring faculty positions, models to support research infrastructure outside of the academic environment should also be explored.
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Physical health in a Canadian Old Order Mennonite community

Physical health in a Canadian Old Order Mennonite community

consistently found in most large population studies. Second, results may be limited by the ways in which various determinants were measured. Since all the determinants were being measured, there were restrictions on the number of measures that could be included in the survey. Third, the non-OOM sample size (344) is below the 500 recommended by the SF-12 developers (for consistency with SF-36 results), with the small sample size potentially contributing to the lack of significance among variables in the non-OOM regression. However, tests conducted for the non-OOMs indicate that the instrument shows acceptable internal consistency, distinguishes between socio-demographic classes of respondents in the expected manner, and exceeds the small convenience samples often used in SF-12 validity studies 55 .
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The role of natural health products (NHPs) in dietetic practice: results from a survey of Canadian dietitians

The role of natural health products (NHPs) in dietetic practice: results from a survey of Canadian dietitians

Additionally, RDs who experienced a greater demand for their services/expertise with respect to NS and HP, and per- sonally use FF/N were more likely to respond. This was de- termined by comparing results of the full survey with a secondary follow-up survey conducted several weeks later to capture data from non-responders. Although knowledge was not assessed in the follow-up survey, it is also possible that RDs with minimal or no knowledge of NHPs may not have felt comfortable responding to the survey, thus con- tributing to the low response rate. There were no signifi- cant differences between RDs responding to the full survey and those responding to the secondary follow-up survey with respect to primary practice setting, size of community where practicing, age, years in practice, and involvement in counselling or health promotion.
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The burden of multiple sclerosis: A community health survey

The burden of multiple sclerosis: A community health survey

over- or under-report any medical condition, including MS. Likewise, no disease specific health measure for MS or indicator for disease course was included in the CCHS 1.1. Another limitation of this study concerned the number of respondents who were missing data on covariates and were excluded from the analysis. While this was less than 10.0% of MS respondents, generalizability of these results to the respondents with missing data may be limited. Despite over 98% of the Canadian community dwelling population being represented in the survey, the generaliz- ability of the results to the entire Canadian population with MS is limited by the fact that the sampling frame would not capture those individuals who reside in institu- tions or on reserve lands. That being said, the true HRQL burden of the entire Canadian population with MS would be under-estimated by these results given that individuals with MS who resided in institutions were more likely to have greater impairment than those residing in the com- munity. Although the impact of MS appears to be more severe in First Nations People, the prevalence rates of MS are relatively low [34] and would likely have a small impact on the overall HRQL of this sample population. Conclusion
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Community health nurses’ learning needs in relation to the Canadian community health nursing standards of practice: results from a Canadian survey

Community health nurses’ learning needs in relation to the Canadian community health nursing standards of practice: results from a Canadian survey

Due to fiscal constraints now recognized within Canada and elsewhere and the escalating costs of hospital-based curative care [43,44] decision makers within our health systems are more primed than ever before to acknow- ledge the value of health promotion, disease prevention. To ensure a strong nursing presence within the forefront of community health, it is imperative that decision- makers advocate for policies and allocation of resources to support the learning needs of CHNs to enable their continued response to the changing health needs of Canadians. The results of this study also need to be ser- iously considered by curriculum planners within schools of nursing to ensure a future nursing workforce pre- pared for the realignment of our health care system. In addition, CHN practice leaders and educators need to consider these results in determining where to strengthen content in professional development programs. For prac- ticing CHNs, educational content needs to be tailored based on learner’s years of experience working in the com- munity and their employment sector. Given ongoing cur- riculum revisions in undergraduate educational nursing programs, changing work contexts, as well as continued renewal of standards and competencies, future research should repeat such surveys to track changes in learning needs. Using the validated tool used in this study [20], modified to address any new competencies, will allow tracking of changes over time and help ensure that cur- riculum content is current and meeting CHNs’ learning needs in the future. Lastly, nurses need to take responsi- bility to identify and address their own learning needs through performance reviews.
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Mental health in a Canadian Old Order  Mennonite community

Mental health in a Canadian Old Order Mennonite community

the two main types of social capital (bonding and bridg- ing), OOM trust would arise from bonding relations given their closed nature and emphasis on family values [29,103]. However, their mutual aid program, care for the elderly/disabled, legendary “barn raisings” etc. have an international reach that provide OOMs with bridg- ing-like benefits normally acquired by members of main- stream populations through participation in volunteer organizations (e.g., information, advice, work opportuni- ties). Other evidence suggests that OOM trust may be more generalized and include bridging relations. For example, the research team received an extremely posi- tive response from the OOMs, including endorsement of the research agenda and unsolicited offers of help that facilitated community engagement and enabled analyses not otherwise possible. Also, OOMs reported higher lev- els of trust in our survey for both 1) family/friends, and 2) strangers and first time acquaintances (who would be mainly non-OOMs). These results are consistent with studies finding that informal network trust is a prototype for generalized trust [105]. High levels of generalized trust among OOMs may seem surprising, given their cultural separation and resistance to change because of a fear it will disrupt group unity [47]. However, the local context is also recognized as uniquely supportive, with the OOMs held in high regard by Waterloo’s secular community and its many Mennonite groups [47,61]. This supportive environment is thought to contribute to the high degree of tolerance of outsiders demonstrated by Waterloo OOMs, a feature rarely seen in Gemeinschaft cultures [61]. High trust levels among OOMs may also originate from religious doctrine. Reference [91, p. 145] notes that OOMs “believe in loving others as ourselves, even our enemies. It is our conviction that by living in this manner, we are only doing what is expected of Christians”. Such unconditional love would be difficult to sustain without generalized trust. Regarding the mechanisms underlying the protective effect of high trust on mental health, it has been postulated that social influ- ence and social support impact health through behav- ioural and psychological pathways such as stress reduc- tion and promotion of a strong sense-of-place [33,103, 106]. Reference [32] theorizes that the psychological pathway is particularly relevant to trust. The low stress levels, high trust and sense-of-place levels, and health linkages of these in OOMs do not contradict the theory of a psychological pathway linking trust with health.
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Health and Safety in Canadian Workplaces

Health and Safety in Canadian Workplaces

Others suggest that harassment and bullying are instances of individual misconduct best resolved through human resources processes such as better selection, training, and disciplinary practices. The authors of this text argue, without intending to reduce the significance of the human rights dimensions of harassment, that harassment and bullying are also health and safety issues. The reason harassment and bullying are OHS issues is that they can be con- trolled by the employer and have clear health effects for the targeted worker(s). The psychological effects of harassment and bullying can be extensive and include anxiety, panic attacks, depression, shame, and anger. The physical effects mirror those of stress and can include inability to sleep, stomach pain or headaches, high blood pressure, heart palpitations, and loss of concen- tration/memory, as well as eating and digestive disorders. Further, workers exposed to harassment are found to be more at risk of illness, injury, and assault. 21 The negative health outcomes and increased risk of illness and injury
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Health practices of Canadian physicians

Health practices of Canadian physicians

Complying with the Canadian Task Force on Preventive Health Care’s (CTFPHC’s) recommendations, 75% of Canadian physicians had received influenza vac- cines in the past year, while only 34% of other Canadians did so. Per CTFPHC recommendations, 86% of women physicians had had Papanicolaou smears in the past 3 years or less (vs 75% of other Canadian women). Two- thirds of those younger than age 45 years had received mammograms, suggesting room for improved compli- ance with CTFPHC mammography guidelines (every 1 to 2 years for women 40 to 49 years of age and yearly for women 50 years or older). All but 15% of men and 22% of women physicians had had their cholesterol levels checked in the past 5 years, again showing good com- pliance with CTFPHC recommendations to establish a cholesterol baseline. Both Canadian physicians and non- physicians 19 were very likely to have had their blood pres-
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