Factors associated with not seeking professional help or disclosing intent prior to suicide : A study of medical examiners' records in Nova Scotia

Individual-level data from clinical settings lack information on people who did not seek professional help prior to suicide. We used records of the Nova Scotia Medical Examiner Service (NSMES) to compare people who had contact with a health professional prior to suicide with those who did not.We linked data from the NSMES to routine administrative data of the province.The NSMES recorded 108 suicides in Nova Scotia from January 1, 2006, to December 31, 2006; there were 90 male and 18 female suicide deaths. Mean and median age at death were 44.73 (SD 13.33) and 44 years, respectively. Patients aged 40 to 49 years made up one-third of the cases (n = 35) and this was the decade of life with the highest number of suicides. This was also the group least likely to have suicidal intent recorded in the NSMES files (χ(2) = 3.86, df = 1, P = 0.05). Otherwise, there were no significant differences between people who sought help, or disclosed intent, prior to suicide and people who did not. The samples in all cases were predominately male and single.People aged 40 to 49 years were the age group with the highest absolute number of suicides, but were the least likely to have suicidal intent recorded in the NSMES files. This finding merits further investigation. Medical examiner or coroner data may provide additional information not obtained elsewhere for the surveillance of suicide

The epidemiology of travel-related Salmonella Enteritidis in Ontario, Canada, 2010–2011

<p>Abstract</p> <p>Background</p> <p>Increases in the number of salmonellosis cases due to <it>Salmonella</it> Enteritidis (SE) in 2010 and 2011 prompted a public health investigation in Ontario, Canada. In this report, we describe the current epidemiology of travel-related (TR) SE, compare demographics, symptoms and phage types (PTs) of TR and domestically-acquired (DA) cases, and estimate the odds of acquiring SE by region of the world visited.</p> <p>Methods</p> <p>All incident cases of culture confirmed SE in Ontario obtained from isolates and specimens submitted to public health laboratories were included in this study. Demographic and illness characteristics of TR and DA cases were compared. A national travel survey was used to provide estimates for the number of travellers to various destinations to approximate rates of SE in travellers. Multivariate logistic regression was used to estimate the odds of acquiring SE when travelling to various world regions.</p> <p>Results</p> <p>Overall, 51.9% of SE cases were TR during the study period. This ranged from 35.7% TR cases in the summer travel period to 65.1% TR cases in the winter travel period. Compared to DA cases, TR cases were older and were less likely to seek hospital care. For Ontario travellers, the adjusted odds of acquiring SE was the highest for the Caribbean (OR 37.29, 95% CI 17.87-77.82) when compared to Europe. Certain PTs were more commonly associated with travel (e.g., 1, 4, 5b, 7a, Atypical) than with domestic infection. Of the TR cases, 88.9% were associated with travel to the Caribbean and Mexico region, of whom 90.1% reported staying on a resort. Within this region, there were distinct associations between PTs and countries.</p> <p>Conclusions</p> <p>There is a large burden of TR illness from SE in Ontario. Accurate classification of cases by travel history is important to better understand the source of infections. The findings emphasize the need to make travellers, especially to the Caribbean, and health professionals who provide advice to travellers, aware of this risk. The findings may be generalized to other jurisdictions with travel behaviours in their residents similar to Ontario residents.</p

How Equity-Oriented Health Care Affects Health: Key Mechanisms and Implications for Primary Health Care Practice and Policy

Policy Points A consensus regarding the need to orient health systems to address inequities is emerging, with much of this discussion targeting population health interventions and indicators. We know less about applying these approaches to primary health care. This study empirically demonstrates that providing more equity-oriented health care (EOHC) in primary health care, including trauma- and violence-informed, culturally safe, and contextually tailored care, predicts improved health outcomes across time for people living in marginalizing conditions. This is achieved by enhancing patients’ comfort and confidence in their care and their own confidence in preventing and managing health problems. This promising new evidence suggests that equity-oriented interventions at the point of care can begin to shift inequities in health outcomes for those with the greatest need. Context: Significant attention has been directed toward addressing health inequities at the population health and systems levels, yet little progress has been made in identifying approaches to reduce health inequities through clinical care, particularly in a primary health care context. Although the provision of equity-oriented health care (EOHC) is widely assumed to lead to improvements in patients’ health outcomes, little empirical evidence supports this claim. To remedy this, we tested whether more EOHC predicts more positive patient health outcomes and identified selected mediators of this relationship. Methods: Our analysis uses longitudinal data from 395 patients recruited from 4 primary health care clinics serving people living in marginalizing conditions. The participants completed 4 structured interviews composed of self-report measures and survey questions over a 2-year period. Using path analysis techniques, we tested a hypothesized model of the process through which patients’ perceptions of EOHC led to improvements in self-reported health outcomes (quality of life, chronic pain disability, and posttraumatic stress [PTSD] and depressive symptoms), including particular covariates of health outcomes (age, gender, financial strain, experiences of discrimination). Findings: Over a 24-month period, higher levels of EOHC predicted greater patient comfort and confidence in the health care patients received, leading to increased confidence to prevent and manage their health problems, which, in turn, improved health outcomes (depressive symptoms, PTSD symptoms, chronic pain, and quality of life). In addition, financial strain and experiences of discrimination had significant negative effects on all health outcomes. Conclusions: This study is among the first to demonstrate empirically that providing more EOHC predicts better patient health outcomes over time. At a policy level, this research supports investments in equity-focused organizational and provider-level processes in primary health care as a means of improving patients’ health, particularly for those living in marginalizing conditions. Whether these results are robust in different patient groups and across a broader range of health care contexts requires further study

Modelling the impact of compliance with dietary recommendations on cancer and cardiovascular disease mortality in Canada

Abstract: Objectives: Despite strong evidence indicating that unbalanced diets relate to chronic diseases and mortality, most adults do not comply with dietary recommendations. To help determine which recommendations could yield the most benefits, we estimated the number of deaths attributable to cardiovascular diseases and cancer that could be delayed or averted in Canada if adults changed their diet to adhere to recommendations. Study Design: Macrosimulation based on national population-based survey and vital statistics data. Methods: We used a macrosimulation model to draw age- and sex-specific changes in relative risks based on the results of meta-analyses of relationship between food components and risk of cardiovascular disease and diet-related cancers. Inputs in the model included Canadian recommendations (fruit and vegetable, fiber, salt, and total-, monounsaturated-, polyunsaturated-, saturated-, and trans-fats), average dietary intake (from 35 107 participants with 24-h recall), and mortality from specific causes (from Canadian Vital Statistics). Monte Carlo analyses were used to compute 95% credible intervals (CI). Results: Our estimates suggest that 30 540 deaths (95% CI: 24 953, 34 989) per year could be averted or delayed if Canadians adhered to their dietary recommendations. By itself, the recommendation for fruit and vegetable intake could save as many as 72% (55-87%) of these deaths. It is followed by recommendations for fibers (29%, 13-43%) and salt (10%, 9-12%). Conclusions: A considerable number of lives could be saved if Canadians adhered to the national dietary intake recommendations. Given the scarce resources available to promote guideline adhesion, priority should be given to recommendations for fruit and vegetable intake

Canadian infants' nutrient intakes from complementary foods during the first year of life

<p>Abstract</p> <p>Background</p> <p>Complementary feeding is currently recommended after six months of age, when the nutrients in breast milk alone are no longer adequate to support growth. Few studies have examined macro- and micro-nutrient intakes from complementary foods (CF) only. Our purpose was to assess the sources and nutritional contribution of CF over the first year of life.</p> <p>Methods</p> <p>In July 2003, a cross-sectional survey was conducted on a nationally representative sample of mothers with infants aged three to 12 months. The survey was administered evenly across all regions of the country and included a four-day dietary record to assess infants' CF intakes in household (tablespoon) measures (breast milk and formula intakes excluded). Records from 2,663 infants were analyzed for nutrient and CF food intake according to 12 categories. Mean daily intakes for infants at each month of age from CF were pooled and compared to the Dietary Reference Intakes for the respective age range.</p> <p>Results</p> <p>At three months of age, 83% of infants were already consuming infant cereals. Fruits and vegetables were among the most common foods consumed by infants at all ages, while meats were least common at all ages except 12 months. Macro- and micro-nutrient intakes from CF generally increased with age. All mean nutrient intakes, except vitamin D and iron, met CF recommendations at seven to 12 months.</p> <p>Conclusions</p> <p>Complementary foods were introduced earlier than recommended. Although mean nutrient intakes from CF at six to 12 months appear to be adequate among Canadian infants, further attention to iron and vitamin D intakes and sources may be warranted.</p

Anxiety and depression in Canada during the COVID-19 pandemic: A national survey.

Depression and anxiety are the most prevalent mental health problems in Canada. The COVID-19 pandemic will likely result in a large increase in the incidence and prevalence of anxiety and depression and experts are already warning of an “echo pandemic” of mental health problems. The objective is this research was to explore how Canadians are managing with the COVID-19 outbreak and determine the impact of the pandemic on levels of anxiety and depression. A nationally representative sample of 1,803 participants completed an online survey that was offered in both official languages. The percentage of respondents who indicated that their anxiety was high to extremely high quadrupled (from 5% to 20%) and the number of participants with high self-reported depression more than doubled (from 4% to 10%) since the onset of COVID-19. Although current anxiety levels are expected to remain the same, respondents predicted that depression would worsen if physical distancing and self-isolation continue for another 2 months. One-third of Canadians with anxiety and depression also report an increase in alcohol and cannabis use during the pandemic. Canadians with depression and anxiety also indicate that the quantity and quality of mental health support systems has decreased. Finally, a sizable proportion of Canadians believe that the federal and provincial governments should do more to support the mental health of Canadians. Recommendations for psychologists responding to mental health needs during and following the pandemic are provided

A European union and Canadian review of public health nursing preparation and practice.

This study explores the preparation and role of the public health nurse (PHN) across European Union (EU) countries (Finland, Sweden, and the United Kingdom) and Canadian provinces (Alberta, New Brunswick, and Prince Edward Island)

Unmet need for the treatment of depression in Atlantic Canada

Objective: Most people with depression do not receive treatment, even though effective interventions are available. Population-based data can assist health service planners to improve access to mental health services. This study aimed to examine the determinants of untreated depression in Canada's Atlantic provinces

Colonialism of Mind: Deterrent of Social Transformation --The Experiences of Oromo People in Ethiopia Begna F. Dugassa

An educational system and its curricula are shaped by the culture and epistemology in which it is embedded. It is influenced by the societal knowledge, but it also instrumental in shaping the knowledge of the society. Culture influences learning style. Based on cultural diversities and social needs, different societies have distinct curricula. As such, Oromo students ought to be taught now to interrogate the colonial epistemology and ideology as well schooled in the ways of dismantling the hegemony. However, in many cases, they are simply taught to reproduce the knowledge, culture, power structure, thinking and the worldview of colonizers. This means that education, which is supposed to be about critical inquiry and social transformation has been used to indoctrinate or brainwash some students. Such colonial educational curricula have invalidated the knowledge of indigenous Oromo people and compromised their needs. This type of education system, instead of empowering the students and their society, has incapacitated them. For the Oromo people, such curricula have distorted their history, image, identity, and damaged their social fabric. In this paper I argue that, colonial knowledge and education system is not in a position to bring about social transformation among Oromo people; on the contrary it disrupts their peace (nagaa), health (fayya) and (tasgabii) social order