This study was designed to provide a representative description of the mental health of youth accessing homelessness services in Canada. It is the most extensive survey in this area to date and is intended to inform the development of mental health and addiction service and policy for this marginalized population.
This study reports mental health-related data from the 2015 "Leaving Home" national youth homelessness survey, which was administered through 57 agencies serving homeless youth in 42 communities across the country. This self-reported, point-in-time survey assessed a broad range of demographic information, pre-homelessness and homelessness variables, and mental health indicators.
Survey data were obtained from 1103 youth accessing Canadian homelessness services in the Nunavut territory and all Canadian provinces except for Prince Edward Island. Forty-two per cent of participants reported 1 or more suicide attempts, 85.4% fell in a high range of psychological distress, and key indicators of risk included an earlier age of the first episode of homelessness, female gender, and identifying as a sexual and/or gender minority (lesbian, gay, bisexual, transgender, queer, and 2 spirit [LGBTQ2S]).
This study provides clear and compelling evidence of a need for mental health support for these youth, particularly LGBTQ2S youth and female youth. The mental health concerns observed here, however, must be considered in the light of the tremendous adversity in all social determinants faced by these youth, with population-level interventions best leveraged in prevention and rapid response.
Cites: Lancet. 1998 Aug 29;352(9129):743 PMID 9729028
National data about acute care hospitalization of Aboriginal people are scarce. This study addresses that information gap by describing patterns of hospitalization by Aboriginal identity for leading diagnoses for all provinces and territories except Quebec.
The 2006 Census was linked to the 2006/2007-to-2008/2009 Discharge Abstract Database, which contains hospital records from all acute care facilities in Canada (excluding Quebec). With these linked data, hospital records could be examined by Aboriginal identity, as reported to the census. Hospitalizations were grouped by International Classification of Diseases (ICD-10) chapters based on "the most responsible diagnosis." Age-standardized hospitalization rates were calculated per 100,000 population, and rate ratios (RR) were calculated for Aboriginal groups relative to non-Aboriginal people.
Hospitalization rates were almost invariably higher for First Nations living on and off reserve, Métis, and Inuit living in Inuit Nunangat than for the non-Aboriginal population, regardless of ICD diagnostic chapter. The ranking of age-standardized hospitalization rates by frequency of diagnoses varied slightly by Aboriginal identity. RRs were highest among First Nations living on reserve, especially for endocrine, nutritional and metabolic diseases (RR = 4.9), mental and behavioural disorders (RR = 3.6), diseases of the respiratory system (RR = 3.3), and injuries (RR = 3.2). As well, the rate for endocrine, nutritional and metabolic diseases was high among First Nations living off reserve (RR = 2.7). RRs were also high among Inuit for mental and behavioural disorders (RR = 3.3) and for diseases of the respiratory system (RR = 2.7).
Hospitalization rates varied by Aboriginal identity, and were consistent with recognized health disparities between Aboriginal and non-Aboriginal people. Because many factors besides health affect hospital use, further research is required to understand differences in hospital use by Aboriginal identity. These national data are relevant to health policy formulation and service delivery planning.
Research that has examined Aboriginal children's hospitalization rates at the national level has been limited to analyses of areas with large percentages of Aboriginal residents, rather than of Aboriginal individuals. This study uses linked census and administrative data to describe hospitalization patterns among children and youth aged 0 to 19, by Aboriginal identity, for all provinces and territories except Quebec.
The 2006 Census was linked to the 2006/2007-to-2008/2009 Discharge Abstract Database, which contains hospital records from all acute care facilities (except Quebec). Hospital records were examined by Aboriginal identity, as reported to the census, according to International Classification of Diseases chapters based on "the most responsible diagnosis." Age-standardized hospitalization rates (ASHRs) were calculated per 100,000 population, and age-standardized rate ratios (RRs) were calculated for Aboriginal groups relative to non-Aboriginal people.
ASHRs were consistently higher among Aboriginal children and youth relative to their non-Aboriginal counterparts; rates for children aged 0 to 9 were 1.4 to 1.8 times higher; for youth aged 10 to 19, 2.0 to 3.8 times higher. For all children aged 0 to 9, the leading cause of hospitalization was "diseases of the respiratory system," but RRs for Aboriginal children ranged from 1.7 to 2.5, compared with non-Aboriginal children. Disparities between Aboriginal and non-Aboriginal 10- to 19-year-olds were pronounced for injuries due to assaults (RRs from 4.8 to 10.0), self-inflicted injuries (RRs from 2.7 to 14.2), and pregnancy, childbirth and the puerperium (RRs from 4.1 to 9.8).
Additional research is needed to examine reasons for the disparities in hospitalization rates between Aboriginal and non-Aboriginal children and youth.
Despite extensive investigations, some patients have no identifiable cause for their cholestatic liver enzyme abnormalities. The aim of this study was to document the clinical, laboratory, radiologic and histologic features of adult patients with idiopathic cholestasis (AIC). A computerised database of referred patients to a tertiary care hospital outpatient department for assessment of hepatobiliary disorders between 2005 and 2015 was employed to identify and describe features associated with AIC. Of 6,560 patient referrals, sufficient documentation to warrant a diagnosis of AIC was present in 17 (0.26%) cases. Of the 17, a disproportionate number were Canadian Inuit (7/60, 12% Inuit referrals vs. 10/6,500, 0.16% non-Inuit referrals, p
Cites: World J Gastroenterol. 2008 Aug 7;14(29):4607-15 PMID 18698674
Frequency and quantity of alcohol consumed by women are two important indicators of the risks associated with drinking during pregnancy. Some studies have compared the validity of maternal alcohol report obtained during and after pregnancy. However, to date none have examined alcohol use in a Native Canadian population, such as the Inuit. Effective measurement methods are necessary to better understand why children from some communities seem at increased risk of alcohol-related neurodevelopmental disorders.
Prospective and retrospective drinking interviews were obtained from a sub-sample of 67 women included in the Nunavik Child Development Study (NCDS), Nunavik, Canada (1995-2010; N=248). Number of days of alcohol consumption and binge drinking (five drinks or more per episode) across pregnancy as well as ounces of absolute alcohol per day and per drinking day among users were collected using timeline follow-back interviews administered both during pregnancy and again 11years after delivery. Consistency of alcohol reports over time, as well as significant differences for alcohol quantities described by users between interviews were examined. Sociodemographic characteristics associated with alcohol use reports were also assessed.
The proportion of positive reports of alcohol and binge drinking during pregnancy was higher when women were interviewed prospectively during pregnancy than retrospectively. We observed a fair to moderate agreement of alcohol report between interview periods. By contrast, the number of binge drinking days during pregnancy was slightly higher among alcohol users when documented retrospectively.
Our findings endorse the conclusion that prospective alcohol measures provide more reliable ascertainment and likely generate more valid information about the proportion of children prenatally exposed to alcohol in the Inuit population.
First Nations, Inuit, and Métis are at higher risk of adverse birth outcomes than are non-Indigenous people. However, relatively little perinatal information is available at the national level for Indigenous people overall or for specific identity groups.
This analysis describes and compares rates of preterm birth, small-for-gestational-age birth, large-for-gestational-age birth, stillbirth, and infant mortality (neonatal, postneonatal, and cause-specific) in a nationally representative sample of First Nations, Inuit, Métis, and non-Indigenous births. The study cohort consisted of 17,547 births to Indigenous mothers and 112,112 births to non-Indigenous mothers from 2004 through 2006. The cohort was created by linking the Canadian Live Birth, Infant Death and Stillbirth Database to the long form of the 2006 Census, which contains a self-reported Indigenous identifier.
With the exception of small-for-gestational-age birth, adverse birth outcomes occurred more frequently among First Nations, Inuit, and Métis women than among non-Indigenous women. Inuit had the highest preterm birth rate (11.4 per 100 births; 95% CI: 9.7 to 13.1) among the three Indigenous groups. The large-for-gestational-age rate was highest for First Nations births (20.9 per 100 births; 95% CI: 19.9 to 21.8). Infant mortality rates were more than twice as high for each Indigenous group compared with the non-Indigenous population, and rates of sudden infant death syndrome were more than seven times higher among First Nations and Inuit.
The results confirm disparities in birth outcomes between Indigenous and non-Indigenous populations, and demonstrate differences among First Nations, Métis and Inuit.
Prevention and Cancer Control (Mazereeuw, Withrow, Nishri, Marrett), Cancer Care Ontario; Dalla Lana School of Public Health (Withrow, Marrett), University of Toronto, Toronto, Ont.; Health Analysis Division (Tjepkema), Statistics Canada; Métis National Council (Vides), Ottawa, Ont. firstname.lastname@example.org.
Métis people are 1 of 3 Aboriginal groups recognized by the Canadian constitution. We estimated site-specific incidence rates and survival for the most common cancers among Métis adults in Canada and compared these with rates among non-Aboriginal adults in Canada.
We examined responses to the 1991 long-form census, including self-reported Métis ancestry linked to national mortality and cancer databases for followup from 1992 to 2009. We estimated age-standardized incidence rates and 5-year relative survival. We determined relative risk (RR) of cancer among Métis and non-Aboriginal adults using Poisson regression, and estimated excess mortality rate ratios using ethnicity-specific life tables.
For all cancers and both sexes combined, cancer incidence was similar for Métis and non-Aboriginal adults. However, incidence was significantly higher among Métis adults than among non-Aboriginal adults for the following cancers: female breast (RR 1.18, 95% confidence interval [CI] 1.02-1.37), lung (RR 1.34, 95% CI 1.18-1.52), liver (RR 2.09, 95% CI 1.30-3.38), larynx (RR 1.60, 95% CI 1.03-2.48), gallbladder (RR 2.35, 95% CI 1.12-4.96) and cervix (RR 1.84, 95% CI 1.23-2.76). Métis people had poorer survival for prostate cancer (excess mortality rate ratio 2.60, 95% CI 1.52-4.46).
We found higher incidence for several cancers and poorer survival after prostate cancer among Métis adults. Several of these disparities may be related to lifestyle factors (including tobacco use, obesity and lack of cancer screening), providing evidence to support development of public health policy and health care to address cancer burden in the Métis people of Canada.
Although cancer is the leading cause of death in Canada, cancer in the North has been incompletely described.
To determine cancer mortality rates in the Yukon Territory, compare them with Canadian rates, and identify major causes of cancer mortality.
The Yukon Vital Statistics Registry provided all cancer deaths for Yukon residents between 1999-2013. Age-standardised mortality rates (ASMRs) were calculated using direct standardisation and compared with Canadian rates. Standardised mortality ratios (SMRs) were calculated using indirect standardisation relative to age-specific rates from Canada, British Columbia (BC), and three sub-provincial BC administrative health regions : Interior Health (IH), Northern Health (NH) and Vancouver Coastal Health (VCH). Trends in smoothed ASMRs were examined with graphical methods.
Yukon's all-cancer ASMRs were elevated compared with national and provincial rates for the entire period. Disparities were greatest compared with the urban VCH: prostate (SMRVCH=246.3, 95% CI 140.9-351.6), female lung (SMRVCH=221.2, 95% CI 154.3-288.1), female breast (SMRVCH=169.0 95% CI, 101.4-236.7), and total colorectal (SMRVCH=149.3, 95% CI 101.8-196.8) cancers were significantly elevated. Total stomach cancer mortality was significantly elevated compared with all comparators.
Yukon cancer mortality rates were elevated compared with national, provincial, urban, and southern-rural jurisdictions. More research is required to elucidate these differences.
Limited understanding of Indigenous adults' cardiovascular structure and function exists despite high rates of cardiovascular disease. This investigation characterised cardiovascular structure and function among young Indigenous adults and compared to age- and sex-matched European descendants. Echocardiographic assessments included apical two- and four-chamber images, parasternal short-axis images and Doppler. Analyses included cardiac volumes, dimensions, velocities and strains. Cardiovascular structure and function were similar between Indigenous (n=10, 25 ± 3 years, 4 women) and European-descendant (n=10, 24 ± 4 years, 4 women,) adults, though European descendants demonstrated greater systemic vascular resistance (18.19 ± 3.94 mmHg·min-1·L-1 vs. 15.36 ± 2.97 mmHg·min-1·L-1, p=0.03). Among Indigenous adults, women demonstrated greater arterial elastance (0.80 ± 0.15 mmHg·mL-1·m-2 vs. 0.55 ± 0.17 mmHg·mL-1·m-2, p=0.02) and possibly greater systemic vascular resistance (17.51 ± 2.20 mmHg·min-1·L-1 vs. 13.93 ± 2.61 mmHg·min-1·L-1, p=0.07). Indigenous men had greater cardiac size, dimensions and output, though body size differences accounted for cardiac size differences. Similar cardiac rotation and strains were observed across sexes. Arterial elastance and cardiac size were different between Indigenous men and women while cardiovascular structure and function may be similar between Indigenous and European descendants.
Excessive daytime sleepiness may be determined by a number of factors including personal characteristics, co-morbidities and socio-economic conditions. In this study we identified factors associated with excessive daytime sleepiness in 2 First Nation communities in rural Saskatchewan.
Data for this study were from a 2012-13 baseline assessment of the First Nations Lung Health Project, in collaboration between two Cree First Nation reserve communities in Saskatchewan and researchers at the University of Saskatchewan. Community research assistants conducted the assessments in two stages. In the first stage, brochures describing the purpose and nature of the project were distributed on a house by house basis. In the second stage, all individuals age 17 years and older not attending school in the participating communities were invited to the local health care center to participate in interviewer-administered questionnaires and clinical assessments. Excessive daytime sleepiness was defined as Epworth Sleepiness Scale score?>?10.
Of 874 persons studied, 829 had valid Epworth Sleepiness Scale scores. Of these, 91(11.0%) had excessive daytime sleepiness; 12.4% in women and 9.6% in men. Multivariate logistic regression analysis indicated that respiratory comorbidities, environmental exposures and loud snoring were significantly associated with excessive daytime sleepiness.
Excessive daytime sleepiness in First Nations peoples living on reserves in rural Saskatchewan is associated with factors related to respiratory co-morbidities, conditions of poverty, and loud snoring.
Cites: Am J Respir Crit Care Med. 2010 Sep 15;182(6):819-25 PMID 20508218
Cites: J Korean Med Sci. 2005 Oct;20(5):784-9 PMID 16224152
Cites: J Forensic Leg Med. 2016 Nov;44:183-187 PMID 27821309