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Access to primary care from the perspective of Aboriginal patients at an urban emergency department.

https://arctichealth.org/en/permalink/ahliterature139323
Source
Qual Health Res. 2011 Mar;21(3):333-48
Publication Type
Article
Date
Mar-2011
Author
Annette J Browne
Victoria L Smye
Patricia Rodney
Sannie Y Tang
Bill Mussell
John O'Neil
Author Affiliation
School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada. annette.browne@nursing.ubc.ca
Source
Qual Health Res. 2011 Mar;21(3):333-48
Date
Mar-2011
Language
English
Publication Type
Article
Keywords
Adult
Anthropology, Cultural
British Columbia
Canada
Emergency Service, Hospital - statistics & numerical data - utilization
Female
Health Knowledge, Attitudes, Practice
Health Services Accessibility - statistics & numerical data
Health services needs and demand
Health Status Disparities
Humans
Indians, North American - statistics & numerical data
Male
Middle Aged
Primary Health Care - statistics & numerical data
Time Factors
Triage
Urban Population - statistics & numerical data
Young Adult
Abstract
In this article, we discuss findings from an ethnographic study in which we explored experiences of access to primary care services from the perspective of Aboriginal people seeking care at an emergency department (ED) located in a large Canadian city. Data were collected over 20 months of immersion in the ED, and included participant observation and in-depth interviews with 44 patients triaged as stable and nonurgent, most of whom were living in poverty and residing in the inner city. Three themes in the findings are discussed: (a) anticipating providers' assumptions; (b) seeking help for chronic pain; and (c) use of the ED as a reflection of social suffering. Implications of these findings are discussed in relation to the role of the ED as well as the broader primary care sector in responding to the needs of patients affected by poverty, racialization, and other forms of disadvantage.
PubMed ID
21075979 View in PubMed
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An examination of stress among Aboriginal women and men with diabetes in Manitoba, Canada.

https://arctichealth.org/en/permalink/ahliterature179442
Source
Ethn Health. 2004 May;9(2):189-212
Publication Type
Article
Date
May-2004
Author
Yoshi Iwasaki
Judith Bartlett
John O'Neil
Author Affiliation
Health, Leisure and Human Performance Research Institute, 102 Frank Kennedy Centre, University of Manitoba, Winnipeg, Mannitoba, Canada. iwasakiy@ms.umanitoba.ca
Source
Ethn Health. 2004 May;9(2):189-212
Date
May-2004
Language
English
Publication Type
Article
Keywords
Adult
Aged
Attitude to Health - ethnology
Diabetes Mellitus - economics - ethnology - psychology - therapy
Female
Health Expenditures
Humans
Indians, North American - psychology
Male
Manitoba
Middle Aged
Poverty
Self Care - psychology
Socioeconomic Factors
Stress, Psychological - ethnology - etiology
Abstract
In this study, a series of focus groups were conducted to gain an understanding of the nature of stress among Canadian Aboriginal women and men living with diabetes. Specifically, attention was given to the meanings Aboriginal peoples with diabetes attach to their lived experiences of stress, and the major sources or causes of stress in their lives. The key common themes identified are concerned not only with health-related issues (i.e. physical stress of managing diabetes, psychological stress of managing diabetes, fears about the future, suffering the complications of diabetes, and financial aspects of living with diabetes), but also with marginal economic conditions (e.g. poverty, unemployment); trauma and violence (e.g. abuse, murder, suicide, missing children, bereavement); and cultural, historical, and political aspects linked to the identity of being Aboriginal (e.g. 'deep-rooted racism', identity problems). These themes are, in fact, acknowledged not as mutually exclusive, but as intertwined. Furthermore, the findings suggest that it is important to give attention to diversity in the Aboriginal population. Specifically, Métis-specific stressors, as well as female-specific stressors, were identified. An understanding of stress experienced by Aboriginal women and men with diabetes has important implications for policy and programme planning to help eliminate or reduce at-risk stress factors, prevent stress-related illnesses, and enhance their health and life quality.
PubMed ID
15223576 View in PubMed
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Best practices in intercultural health: five case studies in Latin America.

https://arctichealth.org/en/permalink/ahliterature161535
Source
J Ethnobiol Ethnomed. 2007;3:31
Publication Type
Article
Date
2007
Author
Javier Mignone
Judith Bartlett
John O'Neil
Treena Orchard
Author Affiliation
Department of Family Social Sciences, Faculty of Human Ecology, University of Manitoba, 307 Human Ecology Bldg,, Winnipeg, Manitoba, R3T 2N2, Canada. mignonej@ms.umanitoba.ca
Source
J Ethnobiol Ethnomed. 2007;3:31
Date
2007
Language
English
Publication Type
Article
Keywords
Anthropology, Cultural
Benchmarking
Community Health Services - organization & administration
Delivery of Health Care - organization & administration
Female
Health Services, Indigenous - organization & administration
Humans
Interinstitutional Relations
Latin America
Medicine, Traditional
Midwifery - education - organization & administration
Models, organizational
Organizational Case Studies
Pregnancy
Primary Health Care
Quality of Health Care
Abstract
The practice of integrating western and traditional indigenous medicine is fast becoming an accepted and more widely used approach in health care systems throughout the world. However, debates about intercultural health approaches have raised significant concerns. This paper reports findings of five case studies on intercultural health in Chile, Colombia, Ecuador, Guatemala, and Suriname. It presents summary information on each case study, comparatively analyzes the initiatives following four main analytical themes, and examines the case studies against a series of the best practice criteria.
Notes
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PubMed ID
17803820 View in PubMed
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Biphasic fracture risk in diabetes: a population-based study.

https://arctichealth.org/en/permalink/ahliterature164405
Source
Bone. 2007 Jun;40(6):1595-601
Publication Type
Article
Date
Jun-2007
Author
William D Leslie
Lisa M Lix
Heather J Prior
Shelley Derksen
Colleen Metge
John O'Neil
Author Affiliation
Department of Medicine (C5121), University of Manitoba, 409 Tache Avenue, Winnipeg, Manitoba, Canada R2H 2A6. bleslie@sbgh.mb.ca
Source
Bone. 2007 Jun;40(6):1595-601
Date
Jun-2007
Language
English
Publication Type
Article
Keywords
Adult
Canada - epidemiology
Case-Control Studies
Cohort Studies
Comorbidity
Diabetes Complications - epidemiology
Female
Fractures, Bone - epidemiology
Hip Fractures
Humans
Male
Population Surveillance - methods
Regression Analysis
Retrospective Studies
Risk factors
Spinal Fractures
Time Factors
Wrist Injuries
Abstract
Diabetes is associated with increased fracture rates but the effect size, time course and modifying factors are poorly understood. This study was undertaken to assess the effect of diabetes on fracture rates and possible interactions with age, duration of diabetes and comorbidity. A retrospective, population-based matched cohort study (1984-2004) was performed using the Population Health Information System (POPULIS) for the Province of Manitoba, Canada. The study cohort consisted of 82,094 diabetic adults and 236,682 non-diabetic matched controls. Diabetes was subclassified as long term, short term, and newly diagnosed. Number of ambulatory diagnostic groups (ADGs) was an index of comorbidity. Poisson regression was used to study counts of combined hip, wrist and spine (osteoporotic) fractures (5691 with diabetes and 16,457 without diabetes) and hip fractures (1901 with diabetes and 5224 without diabetes). Independent effects of longer duration of diabetes (p-for-trend
Notes
Comment In: Bone. 2008 Jan;42(1):235; author reply 23617974519
PubMed ID
17392047 View in PubMed
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Building a health research relationship between First Nations and the University in Manitoba.

https://arctichealth.org/en/permalink/ahliterature176361
Source
Can J Public Health. 2005 Jan-Feb;96 Suppl 1:S9-12
Publication Type
Article
Author
John O'Neil
Brenda Elias
Jennie Wastesicoot
Author Affiliation
Centre for Aboriginal Health Research, Suite 715 Buhler Research Centre, Department of Community Health Sciences, The University of Manitoba, 715 McDermot Avenue, Winnipeg, MB R3E 3P4. oneilj@ms.umanitoba.ca
Source
Can J Public Health. 2005 Jan-Feb;96 Suppl 1:S9-12
Language
English
Publication Type
Article
Keywords
Consumer Participation
Health Policy
Health Services, Indigenous - organization & administration - trends
Humans
Indians, North American
Manitoba
Universities - organization & administration
Abstract
This paper describes the emergence of a formal partnership between Manitoba First Nations and researchers in the Department of Community Health Sciences at the University of Manitoba. This partnership reflects two decades of a working relationship in Manitoba involving university researchers and First Nations communities, as well as new and innovative approaches to developing organizations, training initiatives and projects that strengthen First Nations principles of governance. The emerging trust that has developed between the Manitoba First Nations and the University has made it possible to extend this partnership into building further research capacity and evidence-based decision-making among First Nations. Discussions between the Assembly of Manitoba Chiefs and the Northern Health Research Unit resulted in the development of a Manitoba First Nations Centre for Aboriginal Health Research. Its mission is to initiate, coordinate and support research activities designed to assist First Nations and Aboriginal communities and organizations in their efforts to promote healing, wellness and improved health services in their communities. Much of the health research described in this journal was facilitated through this partnership, which demonstrated the value of partnerships and new funding opportunities to better address the health information needs of First Nations communities, particularly at a time when Aboriginal communities were highly skeptical of the value of academic research.
PubMed ID
15686146 View in PubMed
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Closing the health equity gap: evidence-based strategies for primary health care organizations.

https://arctichealth.org/en/permalink/ahliterature119912
Source
Int J Equity Health. 2012;11:59
Publication Type
Article
Date
2012
Author
Annette J Browne
Colleen M Varcoe
Sabrina T Wong
Victoria L Smye
Josée Lavoie
Doreen Littlejohn
David Tu
Olive Godwin
Murry Krause
Koushambhi B Khan
Alycia Fridkin
Patricia Rodney
John O'Neil
Scott Lennox
Author Affiliation
University of British Columbia, School of Nursing, Vancouver, British Columbia, Canada. annette.browne@nursing.ubc.ca
Source
Int J Equity Health. 2012;11:59
Date
2012
Language
English
Publication Type
Article
Keywords
Adult
Aged
Canada
Evidence-Based Practice
Female
Health Policy
Health Status Disparities
Healthcare Disparities
Humans
Male
Middle Aged
Primary Health Care - organization & administration
Qualitative Research
Vulnerable Populations - statistics & numerical data
Young Adult
Abstract
International evidence shows that enhancement of primary health care (PHC) services for disadvantaged populations is essential to reducing health and health care inequities. However, little is known about how to enhance equity at the organizational level within the PHC sector. Drawing on research conducted at two PHC Centres in Canada whose explicit mandates are to provide services to marginalized populations, the purpose of this paper is to discuss (a) the key dimensions of equity-oriented services to guide PHC organizations, and (b) strategies for operationalizing equity-oriented PHC services, particularly for marginalized populations.
The PHC Centres are located in two cities within urban neighborhoods recognized as among the poorest in Canada. Using a mixed methods ethnographic design, data were collected through intensive immersion in the Centres, and included: (a) in-depth interviews with a total of 114 participants (73 patients; 41 staff), (b) over 900 hours of participant observation, and (c) an analysis of key organizational documents, which shed light on the policy and funding environments.
Through our analysis, we identified four key dimensions of equity-oriented PHC services: inequity-responsive care; trauma- and violence-informed care; contextually-tailored care; and culturally-competent care. The operationalization of these key dimensions are identified as 10 strategies that intersect to optimize the effectiveness of PHC services, particularly through improvements in the quality of care, an improved 'fit' between people's needs and services, enhanced trust and engagement by patients, and a shift from crisis-oriented care to continuity of care. Using illustrative examples from the data, these strategies are discussed to illuminate their relevance at three inter-related levels: organizational, clinical programming, and patient-provider interactions.
These evidence- and theoretically-informed key dimensions and strategies provide direction for PHC organizations aiming to redress the increasing levels of health and health care inequities across population groups. The findings provide a framework for conceptualizing and operationalizing the essential elements of equity-oriented PHC services when working with marginalized populations, and will have broad application to a wide range of settings, contexts and jurisdictions. Future research is needed to link these strategies to quantifiable process and outcome measures, and to test their impact in diverse PHC settings.
Notes
Cites: J Health Polit Policy Law. 2006 Feb;31(1):11-3216484666
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PubMed ID
23061433 View in PubMed
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Coping with stress among Aboriginal women and men with diabetes in Winnipeg, Canada.

https://arctichealth.org/en/permalink/ahliterature177030
Source
Soc Sci Med. 2005 Mar;60(5):977-88
Publication Type
Article
Date
Mar-2005
Author
Yoshi Iwasaki
Judith Bartlett
John O'Neil
Author Affiliation
Faculty of Physical Education and Recreation Studies, Health, Leisure and Human Performance Research Institute, 102 Frank Kennedy Centre, University of Manitoba, Winnipeg, Manitoba, R3T 2N2, Canada. iwasakiy@ms.umanitoba.ca
Source
Soc Sci Med. 2005 Mar;60(5):977-88
Date
Mar-2005
Language
English
Publication Type
Article
Keywords
Adaptation, Psychological
Diabetes Mellitus - psychology
Focus Groups
Humans
Indians, North American
Manitoba
Social Support
Stress, Psychological - psychology
Abstract
Many Aboriginal peoples are widely exposed to stress in their lives. This exposure to stress appears linked not only to their contemporary and immediate life circumstances (e.g., marginal economic and at-risk living conditions) but also to their historical, cultural, and political contexts. Recently, diabetes has become prevalent in many Aboriginal communities worldwide. The purpose of the present study was to gain a better understanding of the ways in which Aboriginal peoples with diabetes cope with stress. The study used a series of focus groups among First Nations and Metis women and men with diabetes in Winnipeg, Manitoba, Canada. Based on our cross-thematic analyses of the data, three overarching themes were identified: (1) individual and collective strengths of Aboriginal peoples with diabetes must be recognized and utilized to facilitate healing from or coping with the experience of stress and trauma; (2) healing must be accomplished holistically by maintaining balance or harmony among mind, body, and spirit; and (3) effective ways of coping with stress and healing from trauma potentially promote positive transformations for Aboriginal peoples and communities at both individual and collective levels. Also, sub-themes of stress-coping and healing that underlie and further describe the above three overarching themes emerged from the data. These include: (a) interdependence/connectedness, (b) spirituality/transcendence, (c) enculturation/facilitation of Aboriginal cultural identity, (d) self-control/self-determination/self-expression, and (e) the role of leisure as a means of coping with stress and healing from trauma. Accordingly, our deeper analyses resulted in the development of an emergent model of stress-coping and healing among Aboriginal peoples with diabetes, which is presented as a dynamic system in which the three overarching themes are embedded in the five specific themes of coping/healing. This evidence-based emergent model appears to provide some important insights into health policy and program planning for Aboriginal peoples with diabetes and their communities.
PubMed ID
15589668 View in PubMed
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The growing Canadian energy gap: more the can than the couch?

https://arctichealth.org/en/permalink/ahliterature150261
Source
Public Health Nutr. 2009 Nov;12(11):2216-24
Publication Type
Article
Date
Nov-2009
Author
Joyce Slater
Christopher G Green
Gustaaf Sevenhuysen
Barry Edginton
John O'Neil
Michael Heasman
Author Affiliation
Department of Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada, R3T 2N2. slater@cc.umanitoba.ca
Source
Public Health Nutr. 2009 Nov;12(11):2216-24
Date
Nov-2009
Language
English
Publication Type
Article
Keywords
Adult
Body mass index
Canada - epidemiology
Diet - standards
Energy intake
Energy Metabolism
Exercise
Food Supply - standards - statistics & numerical data
Health Surveys
Humans
Middle Aged
Obesity - epidemiology - etiology
Prevalence
Young Adult
Abstract
The present study describes the trajectory of the energy gap (energy imbalance) in the Canadian population from 1976 to 2003, its temporal relationship to adult obesity, and estimates the relative contribution of energy availability and expenditure to the energy gap. It also assesses which foods contributed the most to changes in available energy over the study period.
Annual estimates of the energy gap were derived by subtracting population-adjusted per capita daily estimated energy requirements (derived from Dietary Reference Intakes) from per capita daily estimated energy available (obtained from food balance sheets). Food balance sheets were used to assess which foods contributed to changes in energy availability. Adult obesity rates were derived from six national surveys. The relationship to the energy gap was assessed through regression analysis.
Between 1976 and 2003, per capita daily estimated energy availability increased by 18 % (1744 kJ), and increased energy availability was the major driver of the increased energy gap. Salad oils, wheat flour, soft drinks and shortening accounted for the majority of the net increase in energy availability. Adult obesity was significantly correlated with the energy gap over the study period.
The widening energy gap is being driven primarily by increased energy availability. The food commodities driving the widening energy gap are major ingredients in many energy-dense convenience foods, which are being consumed with increasing frequency in Canada. Policies to address population obesity must have a strong nutritional focus with the objective of decreasing energy consumption at the population level.
PubMed ID
19531279 View in PubMed
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A new approach to eliciting meaning in the context of breast cancer.

https://arctichealth.org/en/permalink/ahliterature184733
Source
Cancer Nurs. 2003 Jun;26(3):169-78
Publication Type
Article
Date
Jun-2003
Author
Lesley F Degner
Thomas Hack
John O'Neil
Linda J Kristjanson
Author Affiliation
Helen Glass Centre for Nursing, University of Manitoba, 89 Curry Place, Winnipeg, Manitoba R3T 2N2, Canada. Lesley_Degner@umanitoba.ca
Source
Cancer Nurs. 2003 Jun;26(3):169-78
Date
Jun-2003
Language
English
Publication Type
Article
Keywords
Adaptation, Psychological
Aged
Attitude to Health
Breast Neoplasms - nursing - psychology
Canada
Cross-Sectional Studies
Female
Follow-Up Studies
Humans
Metaphor
Middle Aged
Motivation
Questionnaires
Survivors - psychology
Abstract
A semistructured measure was developed from early descriptive work by Lipowski to elicit the meaning of breast cancer using eight preset categories: challenge, enemy, punishment, weakness, relief, strategy, irreparable loss, and value. This measure was applied in two studies: a cross-sectional survey of 1012 Canadian women at various points after diagnosis and a follow-up study 3 years later of 205 women from the previous study who were close to the time of diagnosis at the first testing. The majority of the 1012 women chose "challenge" (57.4%) or "value" (27.6%) to describe the meaning of breast cancer, whereas fewer chose the more negative "enemy" (7.8%) or "irreparable loss" (3.9%). At the 3-year follow-up assessment, 78.9% of the women who had indicated positive meaning by their choices of "challenge" or "value" did so again. Verbal descriptions provided by the women were congruent with those reported in previous qualitative studies of meaning in breast cancer with respect to the two most prevalent categories: challenge and value. At follow-up assessment, women who ascribed a negative meaning of illness with choices such as "enemy," "loss," or "punishment" had significantly higher levels of depression and anxiety and poorer quality of life than women who indicated a more positive meaning. The meaning-of-illness measure provides an approach that can be applied in large surveys to detect women who ascribe less positive meaning to the breast cancer experience, women who may be difficult to identify in the context of small, qualitative studies.
PubMed ID
12832949 View in PubMed
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Social capital and youth suicide risk factors in First Nations communities.

https://arctichealth.org/en/permalink/ahliterature176355
Source
Can J Public Health. 2005 Jan-Feb;96 Suppl 1:S51-4
Publication Type
Article
Author
Javier Mignone
John O'Neil
Author Affiliation
Centre for Aboriginal Health Research, Department of Community Health Sciences, Faculty of Medicine, University of Manitoba, 715-715 McDermot Ave., Winnipeg, MB R3E 3P4. mignonej@ms.umanitoba.ca
Source
Can J Public Health. 2005 Jan-Feb;96 Suppl 1:S51-4
Language
English
Publication Type
Article
Keywords
Adolescent
Canada
Humans
Indians, North American
Risk factors
Social Class
Social Support
Suicide - ethnology - statistics & numerical data
Abstract
The paper presents a model of plausible mechanisms linking social capital to suicide risk factors among First Nations youth, informed by a study that explored the concept of social capital in First Nations communities, and by a study on mental health services in First Nations communities in Manitoba. The model incorporates several components of social capital. The plausible impact of social capital on protective and risk factors of suicide among youth is explored.
PubMed ID
15686154 View in PubMed
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11 records – page 1 of 2.