The social context and epidemiology of suicide in Labrador

In Canada, many Inuit and First Nations populations have elevated rates of suicide, though there is substantial variation at the community level. The factors that contribute to suicide are complex and entrenched in colonization. Labrador is a circumpolar region in eastern Canada where suicide has been a persistent social problem in Inuit and Innu communities since the 1970’s. As a result, suicide prevention has become a policy and program priority. Indigenous leaders and health system stakeholders in Labrador identified a need for local evidence on suicide to inform community programs and services. The aim of this thesis was to examine the social context and epidemiology of suicide in the region. To this end, we established research partnerships with community members, Indigenous governments, and the regional health authority. Within a population health approach founded on the principles for ethical research involving Indigenous peoples, we integrated community-based methods with qualitative and epidemiological study designs. This work began with a series of community consultations which engaged health and social service providers to better understand research priorities related to suicide. In a qualitative study, we then used focus groups to gather information about local risk and protective factors for suicide. Participants viewed suicidal behaviour, problematic alcohol and substance use, and mental disorders as the downstream outcomes of social inequity and historical trauma. To build on this knowledge, we conducted a population-based observational study to investigate disparities in suicide mortality between Innu and Inuit communities and the general population of the province. The results showed that the suicide rate was higher in Labrador (31.8 per 100,000 person-years) than in Newfoundland (8 per 100,000 person-years); at the subregional level, suicide rates were elevated in Inuit and Innu communities, at 165.6 and 114.0 suicide deaths per 100,000 person-years. To put the data from Labrador in a global context, we undertook a systematic review on the incidence of suicide among Indigenous peoples worldwide. Suicide rates were elevated in many Indigenous populations, though rate variation was common. Strikingly, rate disparities in Labrador were among the highest globally. Recognizing challenges related to monitoring suicide, we analyzed the public health approach to suicide surveillance in Canada. To improve surveillance capacity, we proposed strategies such as integrating Indigenous identifiers into national data sets and building an inclusive data governance model to better track progress in suicide prevention in Indigenous communities. This thesis concludes with a discussion of the scholarly contributions of this work and identifies opportunities for future research

Global incidence of suicide among Indigenous peoples: a systematic review

Background Suicide is the second leading cause of death among adolescents worldwide, and is a major driver of health inequity among Indigenous people in high-income countries. However, little is known about the burden of suicide among Indigenous populations in low- and middle-income nations, and no synthesis of the global data is currently available. Our objective was to examine the global incidence of suicide among Indigenous peoples and assess disparities through comparisons with non-Indigenous populations. Methods We conducted a systematic review of suicide rates among Indigenous peoples worldwide and assessed disparities between Indigenous and non-Indigenous populations. We performed text word and Medical Subject Headings searches in PubMed, MEDLINE, Embase, Cumulative Index of Nursing and Allied Health (CINAHL), PsycINFO, Latin American and Caribbean Health Sciences Literature (LILACS), and Scientific Electronic Library Online (SciELO) for observational studies in any language, indexed from database inception until June 1, 2017. Eligible studies examined crude or standardized suicide rates in Indigenous populations at national, regional, or local levels, and examined rate ratios for comparisons to non-Indigenous populations. Results The search identified 13,736 papers and we included 99. Eligible studies examined suicide rates among Indigenous peoples in 30 countries and territories, though the majority focused on populations in high-income nations. Results showed that suicide rates are elevated in many Indigenous populations worldwide, though rate variation is common, and suicide incidence ranges from 0 to 187.5 suicide deaths per 100,000 population. We found evidence of suicide rate parity between Indigenous and non-Indigenous populations in some contexts, while elsewhere rates were more than 20 times higher among Indigenous peoples. Conclusions This review showed that suicide rates in Indigenous populations vary globally, and that suicide rate disparities between Indigenous and non-Indigenous populations are substantial in some settings but not universal. Including Indigenous identifiers and disaggregating national suicide mortality data by geography and ethnicity will improve the quality and relevance of evidence that informs community, clinical, and public health practice in Indigenous suicide prevention

A scoping review of Indigenous suicide prevention in circumpolar regions

Background. Suicide is a serious public health challenge in circumpolar regions, especially among Indigenous youth. Indigenous communities, government agencies and health care providers are making concerted efforts to reduce the burden of suicide and strengthen protective factors for individuals, families and communities. The persistence of suicide has made it clear that more needs to be done. Objective. Our aim was to undertake a scoping review of the peer-reviewed literature on suicide prevention and interventions in Indigenous communities across the circumpolar north. Our objective was to determine the extent and types of interventions that have been reported during past decade. We want to use this knowledge to support community initiative and inform intervention development and evaluation. Design. We conducted a scoping review of online databases to identify studies published between 2004 and 2014. We included articles that described interventions in differentiated circumpolar Indigenous populations and provided evaluation data. We retained grey literature publications for comparative reference. Results. Our search identified 95 articles that focused on suicide in distinct circumpolar Indigenous populations; 19 articles discussed specific suicide-related interventions and 7 of these described program evaluation methods and results in detail. The majority of publications on specific interventions were found in North American countries. The majority of prevention or intervention documentation was found in supporting grey literature sources. Conclusion. Despite widespread concern about suicide in the circumpolar world and active community efforts to promote resilience and mental well-being, we found few recorded programs or initiatives documented in the peer-reviewed literature, and even fewer focusing specifically on youth intervention. The interventions described in the studies we found had diverse program designs and content, and used varied evaluation methods and outcomes. The studies we included consistently reported that it was important to use communitybased and culturally guided interventions and evaluations. This article summarizes the current climate of Indigenous circumpolar suicide research in the context of intervention and highlights how intervention-based outcomes have largely remained outside of peer-reviewed sources in this region of the world

Suicide in Newfoundland and Labrador, Canada: a time trend analysis from 1981 to 2018

Background: The suicide rate in Canada decreased by 24% during the past four decades. However, rates vary between provinces and territories, and not all jurisdictions experienced the same changes. This study examined suicide rates over time in the province of Newfoundland and Labrador. Methods: We used cross-sectional surveillance data from the Canadian Vital Statistics Death Database to examine suicide rates in Newfoundland and Labrador from 1981 to 2018. We calculated annual age-standardized suicide mortality rates and used joinpoint regression to estimate the average annual percent change (AAPC) in suicide rates overall and by sex, age group, and means of suicide. Results: From 1981 to 2018, 1759 deaths by suicide were recorded among people in Newfoundland and Labrador. The age-standardized suicide mortality rate increased more than threefold over the study period, from 4.6 to 15.4 deaths per 100,000. The suicide rate was higher among males than females, and accounted for 83.1% of suicide deaths (n = 1462); the male-to-female ratio of suicide deaths was 4.9 to 1. The average annual percent change in suicide rates was higher among females than males (6.3% versus 2.0%). Age-specific suicide rates increased significantly for all age groups, except seniors (aged 65 or older); the largest increase was among youth aged 10 to 24 years old (AAPC 3.5; 95% CI, 1.6 to 5.5). The predominant means of suicide was hanging/strangulation/ suffocation, which accounted for 43.8% of all deaths by suicide. Conclusions: The suicide rate in Newfoundland and Labrador increased steadily between 1981 and 2018, which was in contrast to the national rate decline. The disparity between the provincial and national suicide rates and the variations by sex and age underscore the need for a public health approach to prevention that accounts for geographic and demographic differences in the epidemiology of suicide

A collection of INDEL markers for map-based cloning in seven Arabidopsis accessions

The availability of a comprehensive set of resources including an entire annotated reference genome, sequenced alternative accessions, and a multitude of marker systems makes Arabidopsis thaliana an ideal platform for genetic mapping. PCR markers based on INsertions/DELetions (INDELs) are currently the most frequently used polymorphisms. For the most commonly used mapping combination, Columbia×Landsberg erecta (Col-0×Ler-0), the Cereon polymorphism database is a valuable resource for the generation of polymorphic markers. However, because the number of markers available in public databases for accessions other than Col-0 and Ler-0 is extremely low, mapping using other accessions is far from straightforward. This issue arose while cloning mutations in the Wassilewskija (Ws-4) background. In this work, approaches are described for marker generation in Ws-4 x Col-0. Complementary strategies were employed to generate 229 INDEL markers. Firstly, existing Col-0/Ler-0 Cereon predicted polymorphisms were mined for transferability to Ws-4. Secondly, Ws-0 ecotype Illumina sequence data were analyzed to identify INDELs that could be used for the development of PCR-based markers for Col-0 and Ws-4. Finally, shotgun sequencing allowed the identification of INDELs directly between Col-0 and Ws-4. The polymorphism of the 229 markers was assessed in seven widely used Arabidopsis accessions, and PCR markers that allow a clear distinction between the diverged Ws-0 and Ws-4 accessions are detailed. The utility of the markers was demonstrated by mapping more than 35 mutations in a Col-0×Ws-4 combination, an example of which is presented here. The potential contribution of next generation sequencing technologies to more traditional map-based cloning is discussed

A framework for the extraction and modeling of fact-finding reasoning from legal decisions: lessons from the Vaccine/Injury Project Corpus

This article describes the Vaccine/Injury Project Corpus, a collection of legal decisions awarding or denying compensation for health injuries allegedly due to vaccinations, together with models of the logical structure of the reasoning of the factfinders in those cases. This unique corpus provides useful data for formal and informal logic theory, for natural-language research in linguistics, and for artificial intelligence research. More importantly, the article discusses lessons learned from developing protocols for manually extracting the logical structure and generating the logic models. It identifies sub-tasks in the extraction process, discusses challenges to automation, and provides insights into possible solutions for automation. In particular, the framework and strategies developed here, together with the corpus data, should allow top-down and contextual approaches to automation, which can supplement bottom-up linguistic approaches. Illustrations throughout the article use examples drawn from the Corpus

AVONET: morphological, ecological and geographical data for all birds

Functional traits offer a rich quantitative framework for developing and testing theories in evolutionary biology, ecology and ecosystem science. However, the potential of functional traits to drive theoretical advances and refine models of global change can only be fully realised when species‐level information is complete. Here we present the AVONET dataset containing comprehensive functional trait data for all birds, including six ecological variables, 11 continuous morphological traits, and information on range size and location. Raw morphological measurements are presented from 90,020 individuals of 11,009 extant bird species sampled from 181 countries. These data are also summarised as species averages in three taxonomic formats, allowing integration with a global phylogeny, geographical range maps, IUCN Red List data and the eBird citizen science database. The AVONET dataset provides the most detailed picture of continuous trait variation for any major radiation of organisms, offering a global template for testing hypotheses and exploring the evolutionary origins, structure and functioning of biodiversity

Genomic investigations of unexplained acute hepatitis in children

Since its first identification in Scotland, over 1,000 cases of unexplained paediatric hepatitis in children have been reported worldwide, including 278 cases in the UK1. Here we report an investigation of 38 cases, 66 age-matched immunocompetent controls and 21 immunocompromised comparator participants, using a combination of genomic, transcriptomic, proteomic and immunohistochemical methods. We detected high levels of adeno-associated virus 2 (AAV2) DNA in the liver, blood, plasma or stool from 27 of 28 cases. We found low levels of adenovirus (HAdV) and human herpesvirus 6B (HHV-6B) in 23 of 31 and 16 of 23, respectively, of the cases tested. By contrast, AAV2 was infrequently detected and at low titre in the blood or the liver from control children with HAdV, even when profoundly immunosuppressed. AAV2, HAdV and HHV-6 phylogeny excluded the emergence of novel strains in cases. Histological analyses of explanted livers showed enrichment for T cells and B lineage cells. Proteomic comparison of liver tissue from cases and healthy controls identified increased expression of HLA class 2, immunoglobulin variable regions and complement proteins. HAdV and AAV2 proteins were not detected in the livers. Instead, we identified AAV2 DNA complexes reflecting both HAdV-mediated and HHV-6B-mediated replication. We hypothesize that high levels of abnormal AAV2 replication products aided by HAdV and, in severe cases, HHV-6B may have triggered immune-mediated hepatic disease in genetically and immunologically predisposed children

Place, the Built Environment, and Means Restriction in Suicide Prevention

Restricting access to lethal means is a key public health intervention for preventing suicide. Means restriction research has often focused on suicide methods that are modifiable through legislation or policy interventions. However, some of the most common methods such as hanging may not be sensitive to regulation. The aims of this paper are to examine built environment and place-based approaches to means restriction in suicide prevention, and further consider the connections between place, the environment, and suicide methods. To increase knowledge about specific methods and mechanisms of injury in suicide deaths, higher resolution data for surveillance and epidemiology is required. Data that can be used to better discern patterns about specific locations and materials used in suicide and self-harm will support efforts to uncover new directions for prevention