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Health Status and Canadian Children

Overview
Obesity
Injuries
Childhood Cancer
Asthma
Communicable Diseases Prevalent Among Children
Ear Infections
Children and Disability
Health of Immigrant Children
    Mental Health
    Academic Achievement
Reports, References and Websites

Overview

Children under the age of 14 years, make up approximately 18% of the total Canadian population (Statistics Canada, 2006). Most of these children live in an urban setting. Approximately one in every five children (approximately 20%) live in poverty (National Council of Welfare, 1998).

Infant mortality has decline significantly in Canada over the past 100 years. In 1901, the infant mortality rate was 134 for every 1000 live births. In 2001, the rate declined to 5.2 per 1000 live births (Statistics Canada, 2005). The advancements in medical technology allows for medical professionals to save children they would have been unable to help a few decades ago. In addition, due to the enormous benefits of immunization, the prevalence of historically fatal childhood illness such as measles, pertussis, polio, diphtheria, rubella, mumps, tetanus and haemophilus influenzea type B, are at an extremely low prevalence among Canadian children. As long as immunization coverage remains high, it is not suspected that any of these conditions will resurface in serious numbers.

More children these days are living into adulthood compared to a few decades ago. Disease patterns and causes of death have changed. The top two leading causes of death among children are injuries and cancer. Obesity, ear infections, asthma are common conditions among Canadian children today (Statistics Canada, 2002). Canadian children are generally healthy, well nourished and experience little trauma. However, children in poverty, children with disabilities, immigrant children are subgroups of the Canadian child population that are disproportionately affected by certain health conditions.

The link between socioeconomic status and child’s health is very well known. Children who live in poverty experience more obstacles to healthy development and are at increased risk for a wide range of adverse health outcomes (Canadian Institute of Child Health, 2006). Children with disabilities are at increased risk of co-disability and chronic illness (Statistics Canada, 2002). Immigrant children are impacted physically and psychologically from the experiences pre and post immigration; in addition, they may experience discrimination, poor socioeconomic conditions and cultural and linguistic barriers that may negatively affect their health.

The health of Canadian children is an important issue as today’s children are Canada’s future. Therefore, it is essential that universal programs are available to meet the diverse needs of every child in Canada.

Currently, a Children’s Health Survey is underway at the Chinook Health Region. This survey is being conducted to measure the health needs of children between the ages of 1 to 11 in both rural and urban communities throughout the region. Stay tuned for the results of the survey. http://www.chr.ab.ca

For more information on Child health and development visit the following websites:

Health Canada. (2006). Children.
http://www.hc-sc.gc.ca

Measuring Up: A Health Surveillance Update on Canadian Children and Youth.
http://www.phac-aspc.gc.ca

Health Canada. (2004). Young People in Canada their health and well-being.
http://www.phac-aspc.gc.ca

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Obesity

Childhood overweight and obesity is a major public health issue in Canada, as well as in other industrialized countries around the world (Anderson, 2000). The overweight and obesity rates among Canadian children have increased dramatically over the past few decades. Data from the Canadian Community Health Survey indicates that the obesity rate among children and youth ages 12 to 17 years tripled from 1979-2004, from 3% to 9% respectively (Statistics Canada, 2005). Further, the rate of overweight children and youth between 12-17 years nearly doubled from 14% in 1979, to 29% in 2004. The survey also found that the rate of obesity and overweight was positively related to the amount of time spent on the computer, watching television and playing videogames.

The wide range of physical, psychological, and economic consequences of childhood overweight and obesity are well established. Childhood overweight and obesity has been found to have negative impact on cognition, self esteem, academic achievement and social development (Tremblay, Inman, & Willms, 2002). As the rates of overweight and obesity increase among children and youth, conditions such as type 2 diabetes, hypertension, sleep disorders and mental health issues are becoming more prevalent among this younger age group (Must, & Straus, 1999). In addition, overweight and obesity as a child may persist into adulthood thereby putting the child a risk for cardiovascular disease, arthritis and certain types of cancers in their adult years (Krassas, & Tzotzas, 2004; Canadian Food Information Council, 2003). Childhood overweight and obesity is related to a reduced life expectancy and significant health care costs.

Veugelers, & Fitzgerald (2005) conducted a survey to investigate the risk factors for childhood overweight and obesity among grade 5 students and their parents in Nova Scotia. A total of 4298 students from 292 schools across Nova Scotia participated in the study. The prevalence of overweight and obesity among these students was 32.9% and 9.9% respectively. Interestingly, the study found that those students who ate breakfast regularly were 1.5 times less likely to be overweight or obese. Students who reported increased physical activity and lower levels of sedentary activities were found less likely to be overweight and/or obese. Children who reported regularly eating together with their families were found to be less likely to be overweight or obese. This study concluded that the more physically active a child is, the less time the child spends doing sedentary activities, and the less likely the child will be overweight or obese. Therefore, preventative actions can occur at the home and school level to protect children from becoming overweight and obese. A complete review of the article is available at http://www.cmaj.ca

Tremblay & Wilmns (2000) investigated changes in body mass index (BMI) of children and youth over a 15 year period. After analyzing BMI data from four national surveys between 1981 through to 1996, a common trend was apparent. The number of children and youth classified as overweight or obese increased significantly from 1981 to 1996 among children between the ages of 7-13 years of age. For more information on this article, please refer to the following link - Secular trends in the Body Mass index of Canadian Children http://www.activehealthykids.ca

Childhood overweight and obesity within the Calgary Health Region has been recently researched and reported. The report on an environmental scan of childhood obesity in the Calgary Region was released in October 2005 and outlines an action plan for improving childhood obesity in the Calgary Region. According to the report, approximately 55,000 children living in the Calgary region are overweight or obese. This represents about 22% of the entire child population in the Calgary area. The report described various programs and services available in the Calgary region that are working to decrease the prevalence of childhood obesity. In addition, the report provides recommendations for action. Detail information about this report is available at: http://www.sacyhn.ca

Adopting a healthy lifestyle from childhood is important to an individuals overall health status. Physical activity, healthy eating and healthy lifestyle practices play an important role in maintaining a healthy body weight and limited disease burden. Health Canada has recognized the impact of childhood overweight and obesity on overall health status and the link to health in the adult years. The following documents from the Government of Canada contain helpful guidelines and ideas on how to promote healthy lifestyles in children and youth.

Public Health Agency of Canada. (2002). Canada’s physical activity guide for children and youth. http://www.phac-aspc.gc.ca

Health Canada. (2005). Canada’s Food Guide to Healthy eating.
http://www.hc-sc.gc.ca

The Government of Canada. (2006). Canada’s guide to healthy eating and Physical Activity. http://www.phac-aspc.gc.ca

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Injuries

Injuries are the leading cause of death among Canadian children and youth. In addition, injuries cause a substantial level of morbidity among children and youth in Canada and are the leading cause of hospitalizations among children between the ages of 10-19 years of age (Public Health Agency of Canada, 2000). Motor vehicle crashes are the leading cause of injury-related mortality among children over the age of one year. Second to motor vehicle crashes are suicides (Public Health Agency of Canada, 1999).

A study by Faelker, Pickett, Brison (2000) investigated whether risks for childhood injury vary based on socioeconomic status. 4909 children between the ages of 0-19 years were identified by an emergency system surveillance system. Findings from the study indicated a steady relationship between poverty and injury. Moreover, children living in extreme poverty were found to have injury rates 1.67 times higher than children with a high socioeconomic status. This relationship was evident regardless of the type or severity of the injury at hand. These results set forth the need for targeted injury prevention programs toward children from low socioeconomic populations.

For more information on childhood injuries and prevention review the documents available at the following websites:

Unintentional Injuries in Childhood: Results for Canadian Health Surveys.
http://www.phac-aspc.gc.ca

Systematic Review of the Relationship between Childhood Injury and Socioeconomic Status (1999). http://www.phac-aspc.gc.ca

Public Health Agency of Canada. (2006). Injury Prevention.
http://www.phac-aspc.gc.ca

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Childhood Cancer

Cancer incidence among Canadian children is fairly uncommon. Data from the Canadian Cancer Surveillance and Control Program stated that in 2002, Canada was made up of 8 million children and youth under the age of 20 years; of those children, an estimated 1300 were diagnosed with cancer. Cancer is second to injuries in the leading causes of death among children and youth between the ages of 1 to 20 years (Public Health Agency of Canada, 2005). An estimated 250 children died as a result of cancer in 2002. Over the years, the survival rates from childhood cancer have improved. Three and five – year survival rates for childhood cancer now exceed 80% and 70% respectively (Public Health Agency of Canada, 2005).

The types of cancer prevalence among children are more diverse in comparison to adults. Children tend to experience a higher prevalence of hematopoietic cancers (blood and lymphatic) compared to adults who experience a high incidence of carcinomas.

The most common cancers occurring in children between the ages of one and four years of age are leukemia (43%), CNS tumors (16%). Similarly, leukemia (32%) and CNS tumors (30%) are the most common cancers among children between the ages of 5 and 9 years. Children aged 10-14 years have a high incidence of CNS tumors (25%), leukemia (23%) and lymphoma (20%). Lymphoma (29%), carcinoma (19%), and leukemia (11%) are the most common cancers among youth between the ages of 15-19 years (Public Health Agency of Canada, 2005).

The following documents outline specific cancer incidence statistics for children and youth across Canada:

Diagnosis and Initial Treatment of Cancer in Children 0-14 years. (2003).
http://www.phac-aspc.gc.ca

Diagnosis and Initial Treatment of Cancer in Children 15-19 years. (2004).
http://www.phac-aspc.gc.ca

National Cancer Institute of Canada. (2005). Canadian Cancer Statistics. http://www.ncic.cancer.ca

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Asthma

Asthma is a common respiratory disease that can develop at any age; however, it is highly prevalent among children and youth. The Canadian Lung association estimates that between 7-10% of Canadian children and youth have asthma. Every year, approximately 20 children die of asthma. However, in most cases, death from asthma can be prevented through proper asthma management.

Asthma is a chronic lung disease caused by a narrowing or obstruction in the airways. Individuals who experience asthma have sensitive airways, whereby inflammation or bronchocontriction occurs to narrow the airway, making it difficult to breath. Common triggers of bronchocontriction include but are not limited to cold air, dust, exercise, emotions, smoke. Respiratory viral infections and allergens are known to cause inflammation of the airways leading to asthma in some people (The Lung Association, 2005).

Asthma can occur at different severities. Individuals with mild asthma may experience asthmatic symptoms once in a while, when exposed to a certain trigger, infection or allergen. Asthma can also be quite severe whereby daily activities are restricted because asthma occurs easily and frequently. It is common that the severity of asthma in children often changes with time, which in some cases, children grow out of the disease.

A recent article in CBC News indicates that asthma rates in North American children are increasing at drastic rates. The report discusses exposure to air pollution as a major contributor to the increased asthma rates observed. An estimated 2.5 million Canadians are affected by asthma. Further, the report estimates that approximately 20% or boys and 15% of girls between the ages of 8 to 11 have been diagnosed with asthma. For more information about the recent report, view the article at the following link http://www.cbc.ca

For more information on Asthma in Canada review the British Columbia Lung Association Asthma and Canada document at http://www.bc.lung.ca

Article: Children with asthma more likely to have behavioural difficulties
http://www.sk.lung.ca

Statistics: Persons with Asthma by age and sex.
http://www40.statcan.ca

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Communicable Diseases Prevalence among Children

Hand, Foot and Mouth Disease

Hand, foot and mouth disease is a moderately contagious viral illness that is common among infants and children. It is characterized by sores in the mouth, a rash with blisters and fever. Hand, foot and mouth disease is more common among infants and children because they typically do not have the antibodies to fight it off. The infant or child builds immunity to the disease typically after the first exposure. There is essentially no treatment for hand, foot and mouth disease. Acetaminophen can be taken to reduce the fever. It is possible for an individual to have the infection but experience no symptoms. If an individual does experience symptoms, they typically reside after 7-10 days.

For more information about Hand, Foot and Mouth Disease refer to the following websites: Centre for Disease Control and Prevention.http://www.cdc.gov

BC Centre for Disease Control
http://www.bchealthguide.org

Chicken Pox
Chicken Pox, caused by the varisella- zoster virus, is a highly contagious viral disease very common among young children. It is characterized by an itchy rash covering the body. Typically, chicken pox is not a serious illness. However, if an individual scratches extensively, they are a risk of developing a bacterial infection. The incubation and symptomatic periods can last 10 to 21 days. For more information on chicken pox visit the following websites:

Ministry of Health, British Columbia
http://www.bchealthguide.org

Ministry of Health and Long Term Care, Ontario
http://www.health.gov.on.ca

Health Canada
http://www.hc-sc.gc.ca

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Ear Infections

Ear Infections are one of the most common childhood illnesses in Canada. The majority of children will have had a least one by the age of three years (Canadian Pediatric Society, 2006). Children may have fluid and infection in the middle ear, but show no signs and symptoms of an ear infection; this is termed otitis media with effusion (OME). Typically, OME heals on its own, without the use of antibiotics. However, they have the potential to develop into a more serious infection. Acute Otitis Media (AOM) is the inflammation of the middle ear accompanied by a number of signs and symptoms. It is extremely important that this type of ear infections be treated, as acute and persistent AOM infections can cause significant pain and discomfort and put the child at risk for hearing impairment. An ear infection can be caused by bacteria or virus and therefore, an individual should be seen by a physician to determine the cause and treatment regime.

Ear infections (Otitis Media) are the most common cause of short-term hearing impairment. Another common contributor to hearing impairment is perforation of the tympanic membrane. Scar tissue may form as a result of an ear infection. Persistent ear infections can result in the build up of scar tissue on the tympanic membrane. The presence of scar tissue on the tympanic membrane weakens it and makes it more susceptible to perforation. A hole in the eardrum can result in significant hearing loss. Treatment is available to repair the tympanic membrane.

Hearing assessments are an important component to a child’s complete academic and developmental assessment, as hearing can have a significant impact on learning. Even mild hearing loss can make a child miss a significant percentage of classroom learning.

A recent article in Canadian Living Online discusses the implications surrounding childhood ear infections. A pediatrician stated in the article that parents should not be running to the emergency room every time they sense their child has an ear infection. Providing the child with pain relieve and seeing the doctor the next day for antibiotics is appropriate. More information on this article is available at: http://www.canadianliving.com

For more detailed information on Otitis Media with Effusion and Acute Otitis Media, refer to the

BC Health Guide
http://www.bchealthguide.org

An ear infection guide for Clinicians and parents is available at http://www.healthservices.gov.bc.ca

Screening for Otitis Media with Effusion.
http://www.cmaj.ca

Article: Ear Infections- Niagara Health Region
http://www.niagarahealth.on.ca

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Children and Disability

It is at times difficult and sometimes impossible to identify specific types of disabilities before the age of five years considering the rate of physical, emotional and intellectual development. The Participation and Activities Limitation Survey (PALS) identified five types of disability in children: vision, hearing, chronic health condition, developmental delay, and unknown disability. The common types of disability reported among children aged 0-4 years with disability are hearing impairment (12.1%), vision impairment (8.0%), developmental delay (68.0%) and chronic disease/condition (62.6%). Common types of disability among children and youth aged 5-14 years of age with disability include hearing impairment (13%), vision impairment (9.4%), speech problems (43.3%), mobility (13.7%), developmental delay (29.8%), learning problems (64.9%), psychological condition (31.8%), chronic condition (65.3%) and unknown (3.2%). The degree of severity varied across the child and youth population. 57.4% of disability between the ages of 0-14 years was deemed mild to moderate and 42.6% was classified as severe to very severe depending on the level of limitation.

Chronic health conditions constitute the most widespread disability among disabled children aged 0 to 14 years, representing 65% of children with disabilities and approximately 118,000 Canadian children. Examples of chronic conditions include asthma, severe allergies, heart conditions, kidney disease, cancer, epilepsy, cerebral palsy, cystic fibrosis and Fetal Alcohol Spectrum Disorder. These chronic conditions are termed disability when children are limited in the amount or type of activities that one can do as a result of the presence of one or more chronic condition.

Developmental delay is the most common type of disability among children between the ages of 0 and 4 years. 68% of disabled children aged 0-4 years had a developmental delay. This represents 1.1% of all children aged 0-4 years, approximately 18,000 children.

Multiple disabilities

A large percentage of children identified as having some type of disability, have more than one disability. 50.9% of children aged 0-4 years have only one type of disability, 39.8% have two types and 9.3% have three of more disabilities. 28.1% of children aged 5-14 years have one disability, 36.5% have two or three disabilities, 24.8% have four or five and 10.5 % have six or more disabilities.

Early identification and intervention of childhood disability is key to a child’s future success. Sometimes specified screening is required to identify certain disabilities at a young age. However, it is essential that disabilities be recognized and diagnosed early so that accommodations and modifications can be made to maximize a child’s learning potential.

A more comprehensive report of the 2001 Participation and Activity Limitation Survey (PALS) is available in A profile of Disability in Canada, 2001 http://www.statcan.ca

A profile of Disability among Canadian Children
http://www.statcan.ca

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Health of Immigrant Children

Among the 1.8 million immigrants and refugees who came to Canada during the 1990’s, approximately 17% of them were children between the ages of 5 and 16 years (Statistics Canada, 2004). Therefore, immigrant children represent a significant proportion of the Canadian population; making their health issues important and in need of attention. Immigrant children are particularly vulnerably in regards to their health. The medical examinations that take place during the recommendation process provide medical screening that can optimize their health care as they make the transition to life in Canada. Research suggests that immigrant and refugee children experience a wide range of mental health problems. Furthermore, physical health and psychopathology among immigrant children is impacted by the child’s experiences both prior and post immigration.

When immigrant children arrive in a new country, they may be exposed to local pathogens they have not built immunity for. In addition, dietary changes can lead to food allergies (Hull, 1979). Children coming from a foreign country may be faced with unfamiliar substances and their body may react adversely. It is common that new food and environmental allergies arise when a child relocates to a new country. In addition, various foreign pathogens may present as an illness until the child has built immunity.  

A study by Oxman-Martinex, Gravel, Gagnon, Lacroix, & Lefebvre (2005) investigated the mental and physical health, social functioning and school performance of immigrant and refugee children in Montreal, Quebec. A total of 459 immigrant children between the ages of 11-13 years were involved in the study. 85% of these children reported living in a two-parent family. A total of 66% of the immigrant children were living in families where the income was below the poverty line. Findings indicated that 25% of immigrant children had never accessed health care services in the past 12 months. The immigrant children were generally very healthy and very few showed long term health conditions. The prevalence of asthma was low (5%) among the group. 71% of the immigrant children reported having six or more close friends. 26% received an overall A in their academic performance, 51% obtained a B, 19% a C and 4% a D or less. For more information on this study, please review the full document located at the following link.
Immigrant Children’s Health: A snapshot from Montreal. (2005). http://www.toronto.ca

Research shows that immigrant children are relatively healthy when they arrive in Canada (Beiser, 2001). However, over time their health status may deteriorate as their health and behaviours converge with the Canadian society. IT is therefore extremely important that cultural and linguistically appropriate health education be provided to immigrant children so that they have every opportunity to live and grow to meet their ultimate potential.

An outstanding review of the Health of Immigrant Children is available at the following link:

Immigrant Children in Focus: A map of needs, strengths and resources.
http://www.calgaryunitedway.org

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Mental Health

Children who have experiences psychological stress as a result of natural disasters, war, repression, and witnessing violence may consequently produce adverse mental health problems such as depression, anger, post traumatic stress disorder and anxiety (Beiser, Hou, Hyman, & Tousignant, 2002). In addition, poverty creates an additional mental health risk for a child. Poverty is a reality for many immigrant families after their arrival in Canada. According to the Longitudinal Study of Children and Youth, immigrant Children are more likely to live in poverty compared to their non-immigrant counterparts. Furthermore, 36.4% of immigrant children live in families where annual income is below the poverty line compared to 13.3% of non-immigrant children (Beiser, Hou, Hyman, Tousignant, 2002). However, a study by Beiser, Hou, Hyman, & Tousignant (2002) investigated the effects of poverty on mental health status of immigrant children, children of immigrant parents and children of non-immigrant parents. Interestingly, despite the increased rate of poverty among immigrant children, they have better mental health compared to their non-immigrant counterparts. It is suggested that the immigrant mental health advantage may be a result of the immigration selection process.

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Academic Achievement

Children of Immigrants: How well do they do in School?
http://www.statcan.ca

Data from the National Longitudinal Survey of Children and Youth was analyzed to determine how children of immigrant parents perform in school compared to the general population. A child’s ability in reading, writing, math and overall aptitude was measured. Overall, children of immigrants perform just as well in school compared to children of Canadian-born parents. However, children from immigrant parents whose first language is either French or English performed better in reading and writing compared to children from parents whose first language is neither French nor English; there was no difference in math outcomes. To review the entire document, please visit the following website School Performance of the Children of Immigrants in Canada. (2001)
http://www.statcan.ca

Related Reports:

Immigrant Youth in Canada. (2000). Canadian Council on Social Development. Available at http://www.ccsd.ca

The Health and Well-Being of Young Children of Immigrants. (2004). http://www.urban.org

Government of Canada. Healthy Immigrant Children : A demographic and Geographic Analysis 1998. Available at http://www.hrsdc.gc.ca

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Reports, References and Websites

Reports:

Immigrant Youth in Canada. (2000). Canadian Council on Social Development. Available at http://www.ccsd.ca

The Health and Well-Being of Young Children of Immigrants. (2004). http://www.urban.org

Government of Canada. Healthy Immigrant Children : A demographic and Geographic Analysis 1998. Available at http://www.hrsdc.gc.ca

References:

1.  Canada. (2005). Canadian Community Health Survey: Obesity among children and adults. http://www.statcan.ca

2. Anderson, (2000). The spread of the childhood obesity epidemic. Available at http://www.cmaj.ca

3. Canadian Food Information Council. (2003). Childhood Obesity. http://www.ccfn.ca

4. G., Tzotzas, T. (2004). Do obese children become obese adults: childhood predictors of adult disease. Pediatr Endocrinol Rev., 1(Supp 1), 455-459.

5. Veugelers, P., & Fitzgerald, A. (2005). Prevalence of and risk factors for childhood overweight and obesity. Canadian Medical Association Journal, 173(6), 607-613. http://www.cmaj.ca

6. Tremblay, M., Inman, J., Willms, J. (2000). Relationships between physical activity, self esteem, and academic achievements in ten- and eleven-year-old children. Pediatr Exer Sci. 11:312-23.

7. Must, A., Strauss, R. (1999). Risks and consequences of childhood and adolescent obesity. Int J Obes Relat Metab Disord. 23(Suppl 2):S2-11.

8. Public Health Agency of Canada. (2005). Centre for Chronic Disease Prevention and Control: Surveillance. http://www.phac-aspc.gc.ca

9. Statistics Canada. (2006). Population by sex and age group. Available at http://www40.statcan.ca

10. Statistics Canada. (2005). Infant mortality rates. http://www40.statcan.ca

11. The Lung Association. (2005). Asthma. http://www.lung.ca

12. National Council of Welfare. (1998). Poverty Profile, 1996.

13. Public Health Agency of Canada. (2000). Leading cause of death and hospitalization in Canada. http://www.phac-aspc.gc.ca

14. Faelker, T., Pickett, W., Brison, R. (2000). Socioeconomic differences in childhood injury: a population based epidemiologic study in Ontario, Canada. Injury Prevention, 6(3), 203-208.

15. Public Health Agency of Canada. (1999). Measuring up: A health surveillance update for Canadian Children and Youth. http://www.phac-aspc.gc.ca

16. Trumper, R. (2004). Aboriginal Children and Youth. Available at http://www.sacyhn.ca

17. Health Canada.(2006). Children. Available at
http://www.hc-sc.gc.ca

18. Canadian Partnership for Children’s Health and Environment. (2003). Overview of the Health Status of Children in Canada. Available at
http://www.healthyenvironmentforkids.ca

19. Canadian Heritage. (2001). Canadian Children and Youth Study. Available at
http://www.canadianheritage.gc.ca

20. Statistics Canada. (2005). National Longitudinal Study of Children and Youth. Available at http://www.statcan.ca

21. Beiser, M. (2001). The Health of Immigrants and Refugees in Canada. Available at http://www.ualberta.ca

22. Beiser, M., Hou, F., Hyman, I., Tousignant. M. (2002). Poverty, Family process and the mental health of Immigrant Children in Canada. American Journal of Public Health. 92(2), 220-228.

23. Canadian Institute of Child Health. (2006). The Health of Canada’s Children: Income Inequity. Available at http://www.cich.ca

Websites:

Canadian Institute of Child Health. http://www.cich.ca

Healthy Child Development Links http://www.cich.ca

Stress in Children http://www.cfc-efc.ca

Canadian Pediatric Society. (2006). http://www.caringforkids.cps.ca

Canadian Pediatric Society Adolescent Health http://www.cps.ca

Child Health Links
http://www.cps.ca/

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