Abstinence Versus Harm Reduction: Considering Follow-up and Aftercare in First Nations Addictions Treatment

Excessive daytime sleepiness (EDS) is a common problem in general the Canadian population. It can effect day-to-day activities and is also associated with several health issues. This study aimed to investigate the association between co-morbidities and the prevalence of EDS over a four-year period in adults living in two First Nation communities. Data collected during the First Nations Lung Health Project (FNLHP) conducted in two Cree First Nation communities in Saskatchewan in 2012–2013 (Cycle 1) and 2016 (Cycle 2) were used for this analysis. There were 859 participants aged 18 years and older at baseline (Cycle 1) and 821 participants aged 18 years and older at follow-up (Cycle 2) who completed the interviewer-administered questionnaire. An Epworth Sleepiness Scale (ESS) score > 10 was considered to be abnormal and identified as a case of EDS at both time points. A multilevel logistic regression model using a generalized estimating equations approach was used to analyze the data. The prevalence of EDS at baseline (Cycle 1) was 11.2% (91/815) and 10.0% (80/803) at follow-up (Cycle 2). Based on the predicted model, longitudinal change in the prevalence of EDS was −0.11% for 358 individuals who participated in both cycles. There were 49% males at baseline and 48% males at follow-up. Multivariate regression model results revealed that crowding, shortness of breath, loud snoring, chronic lung disease, depression and gastric reflux were the main significant predictors of EDS. In addition, the interaction between sex and age was significant. Some of the co-morbid conditions were associated with EDS. Therefore, managing such conditions requires considerations in strategies to decrease the prevalence of daytime sleepiness.

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Tuberculous Lymphadenitis in Manitoba: Incidence, Clinical Characteristics and Treatment

Canadian Respiratory Journal ◽

10.1155/2004/826501 ◽

2004 ◽

Vol 11 (4) ◽

pp. 279-286 ◽

Cited By ~ 6

Author(s):

Victoria J Cook ◽

Jure Manfreda ◽

Earl S Hershfield

Keyword(s):

First Nations ◽

Extrapulmonary Tuberculosis ◽

Population Data ◽

Tuberculous Lymphadenitis ◽

Foreign Born ◽

Statistics Canada ◽

Cure Rates ◽

Health Canada ◽

Case Characteristics

BACKGROUND:Tuberculous lymphadenitis (TBL) is an important form of extrapulmonary tuberculosis (TB). Recent studies have shown an increase in TBL in Canada.OBJECTIVES:To determine the incidence of TBL in Manitoba and to identify the characteristics associated with its presentation, diagnosis and treatment.METHODS:Population data from the Manitoba Health Population Registry, the First Nations and Inuit Health Branch of Health Canada, and Statistics Canada were used to calculate incidence. Case characteristics and outcomes were determined by a systematic, retrospective review of all cases between January 1, 1990 and December 31, 2000.RESULTS:One-hundred forty seven cases of TBL were identified during the study period; 77% confirmed by culture; 68% women. TBL was found in Canadian-born/nonstatus Aboriginal (12%), status Aboriginal (29%) and foreign-born (59%) populations. Incidence of TBL was 1.17 per 100,000 person years (95% CI 0.98 to 1.36). The highest incidence was in status Aboriginals over 65 years (16.85 per 100,000 person years; 95% CI 3.37 to 30.33). TBL is seen most often in Western Pacific women. The most common presentation was a single, enlarged cervical node (80%). No atypical mycobacterium was found. Drug resistance occurred in 13% of cases and only in the foreign-born. Cure rates (81%) were influenced by comorbidity and burden of TB disease. Relapse occurred in 8.1 per 1000 person years of follow-up (95% CI 1.7 to 23.7).CONCLUSIONS:Respiratory physicians, who manage the majority of TB disease in Canada, need to remain aware that TB is an important and treatable cause of enlarged lymph nodes.

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CANCER INCIDENCE IN FIRST NATIONS AND MéTIS ADULTS IN CANADA: FOLLOW-UP OF THE 1991 CENSUS MORTALITY COHORT

Journal of Epidemiology & Community Health ◽

10.1136/jech-2013-203098.10 ◽

2013 ◽

Vol 67 (10) ◽

pp. e2.2-e2

Author(s):

Diana Withrow ◽

Loraine Marrett ◽

Michael Tjepkema ◽

Jason Pole

Keyword(s):

First Nations ◽

Cancer Incidence

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Liver Transplant Outcomes in a Canadian First Nations Population

Canadian Journal of Gastroenterology ◽

10.1155/2011/986945 ◽

2011 ◽

Vol 25 (6) ◽

pp. 307-310 ◽

Cited By ~ 2

Author(s):

M Zhang ◽

J Uhanova ◽

GY Minuk

Keyword(s):

Liver Transplantation ◽

Liver Disease ◽

First Nations ◽

Patient Survival ◽

Graft Loss ◽

Underlying Disease ◽

Advanced Liver Disease ◽

Demographic Profiles ◽

Long Term Follow Up

BACKGROUND: A higher incidence of autoimmune disorders may predispose First Nations (FN) individuals to higher rates and more severe episodes of rejection, graft loss and mortality following liver transplantation for advanced liver disease.METHODS: A retrospective review of patient outcomes in a single centre providing long-term follow-up care for FN and non-FN patients transplanted for advanced liver disease was conducted.RESULTS: A total of 20 FN and 129 non-FN charts were available for review. FN subjects were younger at transplantation (mean [± SD] age 32.4±4.1 years versus 46.3±1.4 years; P=0.00005), less often male (35% versus 58%; P=0.05), more commonly transplanted for autoimmune hepatitis (30% versus 4.7%; P=0.006), less often from urban residences (25% versus 74%; P=0.0001) and less compliant with medical care (20% versus 80%; P=0.007). After a mean follow-up period of 11.0±1.5 years and 8.4±0.5 years in FN and non-FN subjects, respectively, the incidence and severity of rejection, graft and patient survival were similar between cohorts.CONCLUSION: Although demographic profiles, nature of the underlying disease and compliance differed, the rates and severity of rejection, graft and patient survival were similar in FN and non-FN patients who underwent liver transplantation for advanced liver disease.

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Emergency Health Care Use among Sociodemographic Groups of Children Presenting to Emergency Departments for Self-Harm in Alberta

CJEM ◽

10.1017/cem.2015.1 ◽

2015 ◽

Vol 17 (5) ◽

pp. 497-506

Author(s):

Amanda S. Newton ◽

Conrad I. Tsang ◽

Rhonda J. Rosychuk

Keyword(s):

Health Care ◽

First Nations ◽

Emergency Departments ◽

Population Based ◽

Health Care Use ◽

Administrative Databases ◽

Sociodemographic Differences ◽

Kaplan Meier ◽

Self Harm

AbstractObjectiveTo examine sociodemographic variations among children <18 years in (1) rates of self-harm visits to emergency departments (EDs) and (2) physician follow-up after the self-harm visit in Alberta.MethodsA retrospective, population-based cohort (2002–2011) of ED visits for self-harm by individuals <18 years was conducted using administrative databases from Alberta, Canada. Individuals were grouped by First Nations status or type of health care premium subsidy (family receipt of government subsidy, human services program subsidy, no subsidy received). Visits from 104 EDs were summarized by crude and directly standardized visit rates (DSVRs) per 100,000 individuals. Kaplan-Meier estimates for median estimated time to physician follow-up were calculated with 95% confidence intervals (CIs).ResultsDuring the study period, visit rates decreased with the exception of children from families receiving government-sponsored program subsidy (DSVRs 163/100,000 to 250/100,000;p=0.032). First Nations children had disproportionately fewer follow-up visits compared to other children. The median time to follow-up for First Nations children was 39 days (95% CI: 32, 48) compared to 16 days for children from families receiving no subsidy (95% CI: 14, 19), who had the shortest follow-up time after an ED visit.ConclusionsSociodemographic differences were evident in ED visit rates as well as the number of and time to physician follow-up visit. The disparities experienced by First Nations children in the follow-up period highlight an opportunity for culturally-grounded risk and needs assessment in the ED to determine and facilitate timely and appropriate follow-up care.

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E-Cigarette Use and Future Cigarette Initiation Among Never Smokers and Relapse Among Former Smokers in the PATH Study

Public Health Reports ◽

10.1177/0033354919864369 ◽

2019 ◽

Vol 134 (5) ◽

pp. 528-536 ◽

Cited By ~ 14

Author(s):

Robert McMillen ◽

Jonathan D. Klein ◽

Karen Wilson ◽

Jonathan P. Winickoff ◽

Susanne Tanski

Keyword(s):

Cigarette Smoking ◽

Harm Reduction ◽

Electronic Cigarettes ◽

Computer Assisted ◽

Cigarette Use ◽

Cigarette Smokers ◽

Potential Harm ◽

Increased Risk ◽

Never Smokers

Objectives: Any potential harm-reduction benefit of electronic cigarettes (e-cigarettes) could be offset by nonsmokers who initiate e-cigarette use and then smoke combustible cigarettes. We examined correlates of e-cigarette use at baseline with combustible cigarette smoking at 1-year follow-up among adult distant former combustible cigarette smokers (ie, quit smoking ≥5 years ago) and never smokers. Methods: The Population Assessment of Tobacco and Health Study, a nationally representative, longitudinal study, surveyed 26 446 US adults during 2 waves: 2013-2014 (baseline) and 2014-2015 (1-year follow-up). Participants completed an audio computer-assisted interview in English or Spanish. We compared combustible cigarette smoking at 1-year follow-up by e-cigarette use at baseline among distant former combustible cigarette smokers and never smokers. Results: Distant former combustible cigarette smokers who reported e-cigarette past 30-day use (9.3%) and ever use (6.7%) were significantly more likely than those who had never used e-cigarettes (1.3%) to have relapsed to current combustible cigarette smoking at follow-up ( P < .001). Never smokers who reported e-cigarette past 30-day use (25.6%) and ever use (13.9%) were significantly more likely than those who had never used e-cigarettes (2.1%) to have initiated combustible cigarette smoking ( P < .001). Adults who reported past 30-day e-cigarette use (7.0%) and ever e-cigarette use (1.7%) were more likely than those who had never used e-cigarettes (0.3%) to have transitioned from never smokers to current combustible cigarette smokers ( P < .001). E-cigarette use predicted combustible cigarette smoking in multivariable analyses controlling for covariates. Conclusions: Policies and counseling should consider the increased risk for nonsmokers of future combustible cigarette smoking use as a result of using e-cigarettes and any potential harm-reduction benefits e-cigarettes might bring to current combustible cigarette smokers.

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Cancer incidence among First Nations adults in Canada: follow-up of the 1991 Census Mortality Cohort (1992–2009)

Can J Public Health ◽

10.17269/s41997-018-0091-0 ◽

2018 ◽

Vol 109 (5-6) ◽

pp. 700-709 ◽

Cited By ~ 5

Author(s):

Maegan V. Mazereeuw ◽

Diana R. Withrow ◽

E. Diane Nishri ◽

Michael Tjepkema ◽

Loraine D. Marrett

Keyword(s):

First Nations ◽

Cancer Incidence

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Long-term effectiveness of smoking cessation courses for Turkish-speaking migrants in Switzerland

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.268 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

R Paz Castro ◽

C Salis Gross ◽

S Haug

Keyword(s):

Smoking Cessation ◽

Harm Reduction ◽

Cox Regression ◽

Health Inequity ◽

Cox Regression Analysis ◽

Migrant Populations ◽

Culturally Adapted ◽

One Year

Abstract Background Migrant populations usually report higher smoking rates. Among those migrant populations, Turkish- and Kurdish-speaking migrants are often overrepresented. Providing equal access to health services is one of major challenges of our time. The need for adapted smoking-cessation treatments for Turkish-speaking populations to achieve equity in health led, in 2006, to the development and implementation of the Tiryaki-Kukla smoking-cessation program in Switzerland. Since 2006, 5'305 Turkish-speaking migrants in Switzerland were reached with tobacco-related information and the offer of tailored treatment. In short, the treatment was grounded in behavioral therapy and was adapted from the weekly group-counseling sessions applied by the Cancer League Zurich. The adaptation focused on language, cultural and health literacy issues. The aims of the study were to evaluate one-year quit rates for smoking-cessation courses held from 2006 to 2018 and investigate whether certain characteristics predict long-term abstinence. Methods Evaluation of the program included a pre/post questionnaire (session 1/ 3 months after the quit day) and a follow-up telephone call twelve months after the quit day. To elucidate factors associated with long-term abstinence, Cox regression analysis and Weighted Generalized Equation Models were used. Results Of the 478 who participated in smoking-cessation courses, 45.4% declared themselves non-smokers at one-year follow-up. Characteristics associated with long-term abstinence were length of the course (eight vs. six sessions), adherence to the course, use of pharmacotherapy or NRT products, and baseline level of dependence. Conclusions Our findings are consistent with existing evidence supporting culturally-adapted smoking cessation interventions to reduce health inequity in migrant populations. However, achieving harm reduction in smokers with higher dependence scores remains challenging. Key messages A culturally-adapted smoking cessation course showed effective to reduce health inequity. One challenge remains: Achieving harm reduction in migrants with higher dependence scores.

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Cultural Centrality and Information and Communication Technology among Canadian Youth

The Canadian Journal of Sociology ◽

10.29173/cjs891 ◽

2008 ◽

Vol 33 (2) ◽

Cited By ~ 2

Author(s):

Victor Thiessen ◽

Dianne E Looker

Keyword(s):

First Nations ◽

Information And Communication Technology ◽

Communication Technology ◽

Aboriginal Peoples ◽

Data Sets ◽

Canadian Youth ◽

Visible Minorities ◽

European Culture ◽

Information And Communication

This paper examines the positions of First Nations, Inuit and Métis (FNIM) peoples and visible minorities as distances from the cultural “centre” of White European culture. It then assesses the relation of information and communication technology (ICT) to these locations among Canadian youth using three data sets: the 2001 Aboriginal Peoples Survey, the 2000 Youth in Transition Survey (older cohort) and its 2002 follow–up, and a 2004/2005 survey collected by the authors. Findings indicate that the idea of cultural centrality is useful in locating FNIM groups and visible minorities vis-à-vis the cultural centre and each other and highlighting the stratified heterogeneity of these groups. Access to, use of, and development of ICT skills tend to mirror the relative positions of these groups in terms of cultural centrality. Further, youth who retain close ties with traditional culture are less unlikely to develop facility with ICT.

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