Previous publications indicated an emerging issue with community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA), particularly skin and soft tissue infections (SSTIs), in Indigenous communities in Canada. The objectives of this analysis were to explore the prevalence of SSTIs due to CA-MRSA and patterns of antimicrobial use in the community setting.
A retrospective chart review was conducted as part of an environmental scan to assess antibiotic prescriptions in 12 First Nations communities across five provinces in Canada including Alberta, Saskatchewan, Manitoba, Ontario, and Québec. Charts were randomly selected from nursing stations and patients who had accessed care in the previous 12?months and were?=?18?years were included in the review. Data was collected from September to December, 2013 on antibiotic prescriptions, including SSTIs, clinical symptoms, diagnostic information including presence of CA-MRSA infection, and treatment.
A total of 372 charts were reviewed, 60 from Alberta, 70 from Saskatchewan, 120 from Manitoba, 100 from Ontario, and 22 from Québec. Among 372 patients, 224 (60.2%) patients had at least one antibiotic prescription in the previous 12?months and 569 prescriptions were written in total. The prevalence of SSTIs was estimated at 36.8% (137 cases of SSTIs in 372 charts reviewed). In 137 cases of SSTIs, 34 (24.8%) were purulent infections, and 55 (40.2%) were due to CA-MRSA.
This study has identified a high prevalence of antibiotic use and SSTIs due to CA-MRSA in remote and isolated Indigenous communities across Canada. This population is currently hard to reach and under-represented in standard surveillance system and randomized retrospective chart reviews can offer complimentary methodology for monitoring disease burden, treatment and prevention.
Information on arthritis and other musculoskeletal disorders among Aboriginal people is sparse. Survey data show that arthritis and rheumatism are among the most commonly reported chronic conditions and their prevalence is higher than among non-Aboriginal people.
To describe the burden of arthritis among Aboriginal people in northern Canada and demonstrate the public health significance and social impact of the disease.
Using cross-sectional data from more than 29,000 Aboriginal people aged 15 years and over who participated in the Aboriginal Peoples Survey 2006, we assessed regional differences in the prevalence of arthritis and its association with other risk factors, co-morbidity and health care use.
The prevalence of arthritis in the three northern territories ("North") is 12.7% compared to 20.1% in the provinces ("South") and is higher among females than males in both the North and South. The prevalence among Inuit is lower than among other Aboriginal groups. Individuals with arthritis are more likely to smoke, be obese, have concurrent chronic diseases, and are less likely to be employed. Aboriginal people with arthritis utilized the health care system more often than those without the disease.
Aboriginal-specific findings on arthritis and other chronic diseases as well as recognition of regional differences between North and South will enhance program planning and help identify new priorities in health promotion.
OBJECTIVE: To examine the extent to which differences in individual- and regional-level socioeconomic status and racial/cultural origin account for geographic variations in the prevalence of self-reported arthritis, and to determine whether regional characteristics modify the effect of individual characteristics associated with reporting arthritis. METHODS: Analyses were based on the 2000-2001 Canadian Community Health Survey (>15 years, n = 127,513). Arthritis was self-reported as a long-term condition diagnosed by a health professional. A 2-level logistic regression model was used to identify predictors of reporting arthritis. Individual-level variables included age, sex, income, education, immigration status, racial/cultural origin, smoking, physical activity, and body mass index. Regional-level variables included the proportion of low-income families, low education, unemployment, recent immigrants, Aboriginals, and Asians. RESULTS: At the individual level, age, sex, low income, low education, Aboriginal origin, current smoking, and overweight/obesity were positively associated with reporting arthritis; recent immigration and Asian origin were negatively associated with reporting arthritis. At the regional level, percentages of low-income families and the Aboriginal population were independently associated with reporting arthritis. Regional income and racial/cultural origin moderated the effects of individual income and racial/cultural origin; low-income individuals residing in regions with a higher proportion of low-income families reported arthritis more than low-income individuals living in better-income regions. CONCLUSION: Both individual and regional factors were found to contribute to variations in the prevalence of arthritis, although significant unexplained variation remained. Further research is required to better understand the mechanisms that underlie these regional effects and to identify other contributing factors to the remaining variation.
In Canada, First Nations women are far less likely to breastfeed than other women. First Nations people have been subjected to massive health and social disparities and are at the lowest end of the scale on every measure of well-being. The purpose of this study is to understand the experiences, strengths, and challenges of breastfeeding for First Nations women. Central to the current research is the notion of an embodiment within indigenous women's health and, more specifically, breastfeeding perspectives.
Guided by an indigenous feminist standpoint, our research study evolved through honest discussions and is informed by relevant public health literature on breastfeeding. We collected quantitative data through a survey on demographics and feeding practices, and we conducted focus groups in three Canadian provinces (British Columbia, Manitoba, and Ontario) over a period of 1 year (2010) from 65 women in seven First Nation communities.
Three overarching themes are discussed: social factors, including perceptions of self; breastfeeding environments; and intimacy, including the contribution of fathers. The main findings are that breastfeeding is conducive to bed sharing, whereas a history of residential school attendance, physical and psychological trauma, evacuations for childbirth, and teen pregnancy are obstacles to breastfeeding. Also, fathers play a pivotal role in a woman's decision to breastfeed.
Findings from this study contribute to informing public health by reconsidering simplistic health promotion and public health policies and, instead, educating First Nations communities about the complexity of factors associated with multiple breastfeeding environments.
Canadian Aboriginal women are at increased risk of fracture compared with the general population.
There is disproportionately reduced bone density in Aboriginal women as compared to white females of similar age.
A random age-stratified (25-39, 40-59 and 60-75) sample of Aboriginal women (n=258) and white women (n=181) was recruited. All subjects had calcaneus and distal forearm bone density measurements, and urban participants (n=397 [90.4%]) also had measurements of the lumbar spine, hip and total body.
Unadjusted measurements were similar in the two groups apart from the distal forearm which showed a significantly lower mean Z-score in the Aboriginal women (p=0.03). Aboriginal women were heavier than white women (81.0+/-18.0 kg vs. 76.0+/-18.0 kg, p=0.02). Weight was directly associated with BMD at all measurement sites (p0.2).
We identified significant site-specific differences in age-and weight-adjusted bone density for Aboriginal and white women. Larger bone area, rather than a reduction in BMC, appeared to be primarily responsible. Further work is needed to define how these differences in bone density and geometry affect indices of bone strength.
Breast cancer was studied over a 20-year period in Inuit populations in the Circumpolar region. A total of 193 breast cancers were observed in women. The incidence increased from 28.2 per 100 000 in 1969-1973 to 34.3 per 100 000 in 1984-1988. However, the incidence is low, about half what could be expected based on the rates in Denmark, Canada and Connecticut (USA). The low incidence could be explained by the Inuit diet and other lifestyle factors. These benefits should be preserved, in particular in the young, to maintain a low breast cancer incidence.
Canadian Aboriginal women have high rates of bone fractures, which is possibly due to low dietary intake of minerals or vitamin D. This study was undertaken to estimate dietary intake of calcium and vitamin D by designing a culturally appropriate dietary survey instrument and to determine whether disparities exist between Aboriginal and white women. After validation of a FFQ, 183 urban-dwelling and 26 rural-dwelling Aboriginal women and 146 urban white women completed the validated FFQ and had serum 25-hydroxyvitamin D [25(OH)D] measured. Urban Aboriginal women had lower (P=0.0004) intakes of total dietary calcium than urban white women; there was no difference in rural Aboriginal women. Only a minority of all women met the adequate intake (AI) for calcium intake. Ethnicity did not affect total vitamin D intake; however, rural Aboriginal women consumed all of their dietary vitamin D from food sources, which was more (P
Cancer incidence data for Circumpolar Inuit populations were developed and compiled from Greenland, Canada and Alaska from 1969 to 1988 to provide the largest possible base of data for documenting the unusual patterns of cancer previously reported for these populations. Cancer incidence and population data were transferred to the Danish Cancer Registry. Coded information from various ICD-classifications and codes for the basis of diagnosis were transformed to one format, enabling joint analysis. Standard descriptive analysis was carried out with presentation of number of cases, crude incidence rates (CR), age-standardized rates (world) (ASR), cumulative rates to age 64 years, and indirectly standardized ratios (SIR) to the populations of Connecticut (USA), Canada and Denmark. The resulting database can be used to support collaborative international research among the Inuit populations.
The results of an international, collaborative study of cancer in Circumpolar Inuit in Greenland, Canada, Alaska and Russia are summarized. A total of 3 255 incident cancers were diagnosed from 1969 to 1988 among 85 000-110 000 individuals. Indirect standardization (SIR) based on comparison populations in Connecticut (USA), Canada and Denmark showed excess risk of cancer of the lung, nasopharynx, salivary glands, gallbladder and extrahepatic bile ducts in both sexes, of liver and stomach cancer in men, and renal and cervical cancer in women. Low risk was observed for cancer of the bladder, breast, endometrium and prostate, and for non-Hodgkin lymphoma, Hodgkin's disease, leukaemia, multiple myeloma and melanoma. Age-standardized incidence rates (ASRs) of cancer of lung, cervix, nasopharynx and salivary glands among Inuit were among the world's highest as were rates in women of oesophageal and renal cancer. Regional differences in ASRs within the Circumpolar area were observed for cancer of the cervix, lung, colon and rectum, liver, gallbladder and breast. The differences in the Inuit cancer incidence pattern to some extent reflect known variations in lifestyle, diet and other exposures, as well as implementation of cancer control measures. Future research addressing possible individual differences are needed to evaluate environmental and genetic factors in etiology and evaluate intervention studies.
Cancer of the oesophagus, stomach, small intestine, colon, rectum, liver, gallbladder, biliary tract and pancreas was studied in the Inuit populations of Alaska, Canada and Greenland. Indirect standardization to the populations in Canada, Connecticut (USA) and Denmark was used. High risk of oesophageal cancer was observed in both sexes with standardized incidence ratios (SIRs) of up to 7. An increased risk of colon and rectum cancer occurred among Alaskan Inuit compared with the Inuit populations in Canada and Greenland, which had lower rates. Liver and gallbladder cancer rates were high, with SIRs of 1.5 to 4.1, whereas there were no differences in pancreatic cancer in the populations compared. Dietary habits, alcohol and tobacco consumption are believed to play an important role in most of the observed cancer patterns, but for liver cancer hepatitis B virus infection is also believed to have a causal role.