Interpersonal violence in a deprived Scottish urban area with aggregations of physical health risks and psychiatric morbidity: an ecological study

Abstract Background Glasgow, Scotland, has previously shown exceptional levels of violence among young men, shows aggregations of health conditions, with shortened life expectancy. Health conditions can be both causes and consequences of violence, of shared community-level socio-economic risk factors, and can result from large-scale social forces beyond the control of populations with high levels of violence. The aim of the study was to provide an in depth understanding of the Public Health problem of violence among young adult men in Glasgow East. Method Ecological investigation of violence and its associations with health conditions in areas of contrasting socioeconomic deprivation. National survey of 1916 British men aged 18–34 years, augmented by a sub-sample of 765 men in Glasgow East (GE). Participants completed questionnaires covering current physical and sexual health, psychiatric symptoms, substance misuse, lifestyle, and crime and violence. Results The 5-year prevalence of violence was similar in both surveys but fights involving weapons (AOR 3.32, 95% CI 2.29–4.79), gang fights (AOR 2.30, 95% CI 1.77–2.98), and instrumental violence supporting criminal lifestyles were more common in GE, where 1 in 9 men had been in prison. Violent men in both samples reported poorer physical and sexual health and all types of psychiatric morbidity except depression, with multiple high-risk behaviours for both future poor health and violence. Associations between drug and alcohol dependence and violence in GE could not be entirely explained by deprivation. Conclusion Violence in deprived urban areas is one among many high-risk behaviours and lifestyle factors leading to, as well as resulting from, aggregations of both psychiatric and physical health conditions. Poverty partly explained raised levels of violence in GE. Other factors such as drug and alcohol misuse and macho attitudes to violence, highly prevalent among men in this socially excluded community, also contributed. Multi-component preventive interventions may be needed in deprived areas and require future investigations into how multiple co-existing risk factors produce multimorbidity, including psychiatric disorders, substance misuse, poor physical health and violence.

Download Full-text

A syndemic of psychiatric morbidity, substance misuse, violence, and poor physical health among young men with reduced life expectancy

SSM - Population Health ◽

10.1016/j.ssmph.2021.100858 ◽

2021 ◽

pp. 100858

Author(s):

Jeremy Coid ◽

Yingzhe Zhang ◽

Paul Bebbington ◽

Simone Ullrich ◽

Bianca de Stavola ◽

...

Keyword(s):

Life Expectancy ◽

Physical Health ◽

Substance Misuse ◽

Psychiatric Morbidity ◽

Young Men ◽

Poor Physical Health

Download Full-text

Prevalence, Risk Factors, and Comorbidities of Obstructive Sleep Apnea Risk Among a Working Population in Kuwait: A Cross-Sectional Study

Frontiers in Neurology ◽

10.3389/fneur.2021.620799 ◽

2021 ◽

Vol 12 ◽

Author(s):

Husain Al-Qattan ◽

Hamad Al-Omairah ◽

Khaled Al-Hashash ◽

Fahad Al-Mutairi ◽

Mohammad Al-Mutairat ◽

...

Keyword(s):

Risk Factors ◽

Obstructive Sleep Apnea ◽

High Risk ◽

Cross Sectional Study ◽

Health Conditions ◽

Sectional Study ◽

Working Population ◽

Cross Sectional ◽

Working Adults ◽

Obstructive Sleep

Background: Obstructive sleep apnea (OSA) affects a considerable proportion of adults globally and is associated with elevated morbidity and mortality. Given the lack of epidemiologic data on the burden of OSA in Kuwait, this study sought to estimate its prevalence, associated risk factors, and comorbid conditions among a working population in Kuwait.Methods: This was a cross-sectional study of a sample of working adults (n = 651) from public institutions in Kuwait. High/low risk for OSA was ascertained according to the Berlin Questionnaire criteria. Participants self-reported their coexisting health conditions. Associations were assessed using Poisson regression with robust variance estimation; adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) were estimated.Results: Overall, 20.0% (130/651) of participants were classified as being at high risk for OSA, with more male than female subjects being at high risk (24.0% [56/233] vs. 17.7% [74/418], P = 0.053), though this difference did not gain statistical significance. Moreover, a high risk for OSA was more common among older and obese subjects. Factors associated with increased prevalence of a high risk for OSA included current smoking status (aPR = 1.58, 95% CI: 1.02–2.06), longer hours spent watching television (1.76, 1.10–2.81), and lower self-perceived physical health (2.11, 1.15–3.87). However, decreasing trends in the prevalence of high risk for OSA were observed with frequent engagement in vigorous physical activity and longer nightly sleep duration. Compared to those at a low risk for OSA, the subjects at high risk for OSA were more likely to have insomnia disorder (2.83, 1.81–4.41), diabetes (1.94, 1.15–3.27), hypertension (3.00, 1.75–5.16), and depression (4.47, 1.80–11.08).Conclusion: This study estimated that 1/5 of working adults in Kuwait were at high risk for OSA, and the prevalence varied according to personal characteristics and lifestyle factors. Also, a high risk for OSA classification was associated with multiple comorbid health conditions.

Download Full-text

Erratum to

SSM - Population Health ◽

10.1016/j.ssmph.2021.100940 ◽

2021 ◽

pp. 100940

Author(s):

Jeremy Coid ◽

Yingzhe Zhang ◽

Paul Bebbington ◽

Simone Ullrich ◽

Bianca de Stavola ◽

...

Keyword(s):

Life Expectancy ◽

Physical Health ◽

Substance Misuse ◽

Psychiatric Morbidity ◽

Poor Physical Health

Download Full-text

COVID-19 risk: Adult Medicaid beneficiaries with autism, intellectual disability, and mental health conditions

Autism ◽

10.1177/13623613211039662 ◽

2021 ◽

pp. 136236132110396

Author(s):

Whitney Schott ◽

Sha Tao ◽

Lindsay Shea

Keyword(s):

Mental Health ◽

Risk Factors ◽

Intellectual Disability ◽

High Risk ◽

Autism Spectrum ◽

Health Conditions ◽

Residential Facility ◽

Severe Illness ◽

Mental Health Conditions ◽

Autistic Adults

Adults on the autism spectrum and those with intellectual disability or mental health conditions may be at increased risk of contracting COVID-19 or experiencing more severe illness if infected. We identified risk factors for COVID-19 among adults enrolled in Medicaid with an autism spectrum disorder diagnosis, intellectual disability, or mental health conditions. We examined adults ages 20–64 years with 9-month continuous enrollment over 2008–2012 using Medicaid Analytic eXtract data. There were 83,150 autistic adults and 615,607 adults with intellectual disability meeting inclusion criteria; of a random sample of 1 million beneficiaries without autism spectrum disorder or intellectual disability, 35.3% had any mental health condition. Beneficiaries on the spectrum, those with intellectual disability, and those with mental health conditions all had higher odds of risk factors for becoming infected with COVID-19 (living in a residential facility, receiving services in the home from outside caregivers, having had a long hospitalization, and having had avoidable hospitalizations) and higher odds of comorbidities associated with severe illness from COVID-19. Clinicians should anticipate high prevalence of comorbidities and risk factors for severe illness from COVID-19 among these populations. Health officials and non-governmental organizations should target these groups with outreach for the COVID-19 vaccine and support continued efforts for appropriate mitigation measures. Lay abstract Autistic adults, adults with intellectual disability, and adults with other mental health conditions may have higher risk of contracting COVID-19 or experiencing more severe illness from COVID-19 if infected. We used data from Medicaid to look at whether autistic adults and other adults with intellectual disability and other mental health conditions were more likely to have risk factors for COVID-19, such as living in a residential facility, receiving services regularly in the home from outside caregivers, having had a long hospitalization, having had avoidable hospitalizations, and having high-risk health conditions. We found that autistic adults had higher odds of living in a residential facility, receiving in-home services from outside caregivers, having had an avoidable hospitalization, and having a high-risk health condition, compared to neurotypical adults without mental health conditions. Adults with intellectual disability had similar odds of having these conditions. Adults with other mental health conditions were also more likely to live in a residential facility, receive services from outside caregivers, and have had avoidable hospitalizations compared to the neurotypical population without mental health conditions. They had three times higher odds of having a high-risk health condition. High risk of COVID-19 among autistic adults and adults with intellectual disability and mental health conditions should be recognized by clinicians, and these groups should be prioritized for vaccine outreach.

Download Full-text

M82. GROWING BURDEN OF DISEASE: THE PREVALENCE OF CHRONIC HEALTH CONDITIONS AFTER A FIRST EPISODE OF PSYCHOSIS

Schizophrenia Bulletin ◽

10.1093/schbul/sbaa030.394 ◽

2020 ◽

Vol 46 (Supplement_1) ◽

pp. S165-S166

Author(s):

Myanca Rodrigues ◽

Saverio Stranges ◽

Bridget Ryan ◽

Kelly Anderson

Keyword(s):

Risk Factors ◽

Physical Health ◽

Administrative Data ◽

Burden Of Disease ◽

Intervention Program ◽

Psychotic Disorders ◽

Premature Mortality ◽

Health Conditions ◽

First Episode ◽

Health Administrative Data

Abstract Background Over 12% of Canadians live with two or more (2+) co-occurring chronic physical health conditions or multimorbidity. This proportion is expected to rise with increased exposure to risk factors for these diseases. People with psychotic disorders often have co-occurring chronic physical health conditions; however, to date there has been a paucity of research on the prevalence of multimorbidity among people with psychosis. The objective of our study was to examine the prevalence of multimorbidity ten years after a first episode of psychosis (FEP) utilizing data from a retrospective cohort study based on health administrative data. Methods The health administrative dataset has been linked to data from the Prevention and Early Intervention Program for Psychoses in London, Canada to enable identification of FEP patients (n=455). FEP patients were compared to a randomly selected comparison group from the general population (n=1,783), matched on age, gender, and neighbourhood. This cohort has been followed for a 10-year period in the health administrative data to ascertain the prevalence of physical comorbidities. Results Preliminary analyses on 2,238 patients (557 females, 1,681 males) at 10-year follow-up, reveals that 32.1% (95% CI 28.0%, 36.5%) of FEP patients have 2+ conditions, as compared to 15.1% (95% CI 13.6%, 16.9%) of people without psychosis. Full results on risk factors for multimorbidity will be presented. Discussion The findings from this study will facilitate increased surveillance and recognition of the common physical health conditions faced by people with psychosis, including those contributing to premature mortality of this patient population. This information aims to assist decision-makers in creating tailored intervention plans to improve the physical health of patients with psychotic disorders, and integrate care across multiple specialties to reduce the growing burden of disease to the Canadian health system.

Download Full-text

Prevention of Suicidal Behavior in Prisons

Crisis ◽

10.1027/0227-5910/a000394 ◽

2016 ◽

Vol 37 (5) ◽

pp. 323-334 ◽

Cited By ~ 38

Author(s):

Lisa Marzano ◽

Keith Hawton ◽

Adrienne Rivlin ◽

E. Naomi Smith ◽

Mary Piper ◽

...

Keyword(s):

Risk Factors ◽

High Risk ◽

Suicide Prevention ◽

Suicide Risk ◽

Suicide Attempts ◽

Psychiatric Morbidity ◽

Clinical Factors ◽

Factors Associated ◽

Self Harm ◽

Specific Factors

Abstract. Background: Worldwide, prisoners are at high risk of suicide. Research on near-lethal suicide attempts can provide important insights into risk and protective factors, and inform suicide prevention initiatives in prison. Aims: To synthesize findings of research on near-lethal attempts in prisons, and consider their implications for suicide prevention policies and practice, in the context of other research in custody and other settings. Method: We searched two bibliographic indexes for studies in any language on near-lethal and severe self-harm in prisoners, supplemented by targeted searches over the period 2000–2014. We extracted information on risk factors descriptively. Data were not meta-analyzed owing to heterogeneity of samples and methods. Results: We identified eight studies reporting associations between prisoner near-lethal attempts and specific factors. The latter included historical, prison-related, and clinical factors, including psychiatric morbidity and comorbidity, trauma, social isolation, and bullying. These factors were also identified as important in prisoners' own accounts of what may have contributed to their attempts (presented in four studies). Conclusion: Factors associated with prisoners' severe suicide attempts include a range of potentially modifiable clinical, psychosocial, and environmental factors. We make recommendations to address these factors in order to improve detection, management, and prevention of suicide risk in prisoners.

Download Full-text

Prevention and management of physical health conditions in adults with severe mental disorders: WHO recommendations

International Journal of Mental Health Systems ◽

10.1186/s13033-021-00444-4 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Petra C. Gronholm ◽

Neerja Chowdhary ◽

Corrado Barbui ◽

Jayati Das-Munshi ◽

Kavitha Kolappa ◽

...

Keyword(s):

Risk Factors ◽

Mental Disorders ◽

Physical Health ◽

Best Practice ◽

Guideline Development ◽

Premature Mortality ◽

World Health ◽

Health Conditions ◽

Severe Mental Disorders

Abstract Background People with severe mental disorders (SMD) experience premature mortality mostly from preventable physical causes. The World Health Organization (WHO) have recently produced guidelines on the prevention and management of physical health conditions in SMD. This paper presents the evidence which led to the recommendations presented in the guidelines. Methods The work followed the methodological principles for WHO guideline development. Systematic reviews in relation to the treatment of seven key priority physical health conditions and associated risk factors in persons with SMD were systematically sourced. The quality of this evidence was assessed, and compiled into evidence profiles. Existing guidelines and treatment recommendations were also considered. Based on this information, specific recommendations were developed on the prevention and management of physical health conditions and their risk factors amongst people with SMD. Results Nineteen recommendations were made in relation to the seven key priority physical health conditions and risk factors, alongside best practice statements for each condition. A mixture of conditional and strong recommendations were made, the quality of evidence underpinning these was generally low or very low. This is owing to the dearth of direct evidence relating to people living with SMD and comorbidities. Conclusions This paper presents evidence-based recommendations to prevent and manage physical health conditions in people with SMD. The recommendations are designed to inform policy makers, healthcare providers as well as other stakeholders about what they can do to improve the management of physical health conditions in adults with SMD and support the promotion of individual health behaviors to reduce the risk factors for these conditions. If implemented, these recommendations can improve the care that people with SMD receive for their physical health conditions in an equitable and person-centered manner, so that in future in relation to premature mortality ‘no-one is left behind’.

Download Full-text

Prevalence of physical health conditions and health risk behaviours in people with severe mental illness in South Asia: protocol for a cross-sectional study (IMPACT SMI survey)

BMJ Open ◽

10.1136/bmjopen-2020-037869 ◽

2020 ◽

Vol 10 (10) ◽

pp. e037869 ◽

Cited By ~ 1

Author(s):

Gerardo A Zavala ◽

Krishna Prasad-Muliyala ◽

Faiza Aslam ◽

Deepa Barua ◽

Asiful Haidar ◽

...

Keyword(s):

Health Risk ◽

Physical Health ◽

Cross Sectional Study ◽

Health Conditions ◽

Risk Behaviours ◽

Cross Sectional ◽

Health Risk Behaviours ◽

Related Quality ◽

Health Related

IntroductionPeople with severe mental illness (SMI) die on average 10–20 years earlier than the general population. Most of these deaths are due to physical health conditions. The aim of this cross-sectional study is to determine the prevalence of physical health conditions and their associations with health-risk behaviours, health-related quality of life and various demographic, behavioural, cognitive, psychological and social variables in people with SMI attending specialist mental health facilities in South Asia.Methods and analysisWe will conduct a survey of patients with SMI attending specialist mental health facilities in Bangladesh, India and Pakistan (n=4500). Diagnosis of SMI will be confirmed using the Mini-international neuropsychiatric interview V.6.0. We will collect information about physical health and related health-risk behaviours (WHO STEPwise approach to Surveillance (STEPS)); severity of common mental disorders (Patient Health Questionnaire-9 (PHQ-9) and General Anxiety Disorder scale (GAD-7)) and health-related quality of life (EQ-5D-5L). We will measure blood pressure, height, weight and waist circumference according to WHO guidelines. We will also measure glycated haemoglobin, lipid profile, thyroid function, liver function, creatinine and haemoglobin. Prevalence rates of physical health conditions and health-risk behaviours will be presented and compared with the WHO STEPS survey findings in the general population. Regression analyses will explore the association between health-risk behaviours, mental and physical health conditions.Ethics and disseminationThe study has been approved by the ethics committees of the Department of Health Sciences University of York (UK), Centre for Injury Prevention and Rehabilitation (Bangladesh), Health Ministry Screening Committee and Indian Council of Medical Research (India) and National Bioethics Committee (Pakistan). Findings will be disseminated in peer-reviewed articles, in local and international conferences and as reports for policymakers and stakeholders in the countries involved.Trial registration numberISRCTN88485933; 3 June 2019.

Download Full-text

Socioeconomic and Psychosocial Adversity in Inuit Mothers from Nunavik during the First Postpartum Year / ᐃᓄᓕᕆᓂᕐᒧᑦ ᐱᕙᓪᓕᐊᔪᓕᕆᓂᕐᒧᓪᓗ ᐊᒻᒪᓗ ᐃᓄᓕᕆᓂᒃᑯᑦ ᐃᓱᒪᑎᒍᓪᓗ ᐅᓇᒻᒥᓇᖅᑐᑦ ᓄᓇᕕᒻᒥᑦ ᐃᓄᓐᓄᑦ ᐊᓈᓇᐅᔪᓄᑦ ᐊᕐᕌᒎᑉ ᓯᕗᓪᓕᖅᐹᖓᓂᑦ ᐃᕐᓂᓯᒪᓕᖅᑎᓪᓗᒋᑦ

International Journal of Indigenous Health ◽

10.18357/ijih92201214363 ◽

2015 ◽

Vol 9 (2) ◽

pp. 63

Author(s):

Stéphanie Fortin ◽

Sandra W. Jacobson ◽

Jocelyne Gagnon ◽

Nadine Forget-Dubois ◽

Ginette Dionne ◽

...

Keyword(s):

Risk Factors ◽

High Risk ◽

Well Being ◽

Spousal Abuse ◽

Single Women ◽

Psychosocial Risk Factors ◽

Psychosocial Risk ◽

Public Health Programs ◽

Financial Difficulties ◽

Drug And Alcohol

The postpartum year is a crucial period for child development and mother-child attachment. In a young and prolific population such as the Inuit from Nunavik (northern Quebec, Canada), postpartum maternal well-being is even more concerning. This study aims to document the prevalence and co-occurrence of socioeconomic and psychosocial risk factors in this population, and to use these factors to identify specific profiles of women. Data collection involved 176 mothers recruited during pregnancy and interviewed 12 months after delivery. Socioeconomic (age, education, single parenting, unemployment, welfare) and psychosocial (psychological distress, suicidal thoughts and attempts, spousal abuse, drug and alcohol use) risk factors were documented. Four high-risk conditions (socioeconomic precariousness, distress, domestic abuse, and substance use) were computed and considered in the analysis. Adversity was salient because most of the women (58%) simultaneously experience many high-risk conditions, with socioeconomic difficulties, distress, and spousal abuse being the most prevalent. Distinct profiles were identified: those without socioeconomic and psychosocial risk factors (30.8%) and those experiencing distress (69.2%). From the latter category, two specific profiles of distressed mothers emerged: single women coping with socioeconomic stressors (40.1%), and women with fewer financial difficulties but in an abusive relationship and more likely to use drugs or binge drink (29.1%). Our results support the need for preventive and public health programs in this population to improve maternal as well as infant wellbeing. ᐊᕐᕌᒍ ᓯᕗᓪᓕᖅᐹᖅ ᐃᕐᓂᓯᒪᓕᖅᑐᓂ ᐱᓪᓗᕆᓐᓂᖅᐸᐅᕗᖅ ᐊᓈᓇᐅᔪᖅ ᕿᑐᕐᖓᖓᓗ ᐊᑕᐅᓯᐅᖃᑎᒌᓐᓂᖏᓐᓄᑦ. ᓄᓇᕕᒻᒥᐅᑦ ᐃᓄᐃᑦ ᐃᓅᓱᑦᑎᓪᓗᒋᑦ ᐊᒻᒪᓗ ᓇᓗᓇᐃᔭᐃᑦᑎᐊᖅᑐᑎᒃ ᑭᒃᑰᓂᖏᓐᓂᒃ ᐃᓱᒫᓗᓇᖅᐳᖅ ᐊᓈᓇᐅᔪᑦ ᖃᓄᐃᓐᖏᓐᓂᖏᑦ ᐃᕐᓂᕋᑖᖅᑐᒥᓂᐅᑎᓪᓗᒋᑦ. ᐅᓇ ᖃᐅᔨᓴᕐᓂᖅ ᑐᕌᒐᖃᖅᑯᖅ ᑎᑎᖅᑐᐃᔾᔪᑕᐅᓪᓗᓂ ᐃᓄᓕᕆᓂᕐᒧᑦ ᐱᕙᓪᓕᐊᓂᕐᒧᓪᓗ ᐊᒻᒪᓗ ᐃᓄᓕᕆᓂᕐᒧᑦ ᐃᓱᒪᒃᑯᓪᓗ ᐊᑦᑕᕐᓇᕈᑕᐅᔪᓂᒃ ᐃᓄᓐᓄᑦ ᐊᒻᒪᓗ ᑖᒃᑯᐊ ᐊᖅᑯᑎᒋᓗᒋᑦ ᐊᕐᓇᐃᑦ ᖃᓄᐃᑦᑑᓂᖏᑦ ᐃᓕᓴᕐᓇᕈᑎᒋᓕᕐᓗᒋᑦ. ᖃᐅᔨᒪᔾᔪᑎᓂᒃ ᑲᑎᖅᓱᐃᓂᖅ ᐃᓚᓕᐅᔾᔨᔪᕗᖅ 176−ᓂᒃ ᐊᓈᓇᐅᔪᓂᒃ ᐃᓚᓕᐅᑦᑐᒋᑦ ᓇᔾᔨᔪᑦ ᐊᒻᒪᓗ ᐊᐱᖅᓱᖅᑕᐅᓯᒪᓪᓗᑎ ᑕᖅᑮᑦ ᖁᓕᑦ ᒪᕐᕉᓪᓗ (12) ᐊᓂᒍᖅᓯᒪᓕᖅᑎᓪᓗᒋᑦ. ᐃᓄᓕᕆᓂᖅ ᐱᕙᓪᓕᐊᓂᒃᑯᑦ (ᐊᕐᕌᒍᒋᔭᖏᑦ, ᐃᓕᓐᓂᐊᕐᓂᖏᑦ, ᐃᓄᑑᔾᔨᓂᖅ, ᐃᖅᑲᓇᐃᔮᖃᕐᓂᖅ, ᓱᒃᑯᐊᕿᖃᑦᑕᕐᓂᖅ) ᐊᒻᒪᓗ ᐃᓱᒪᑎᒍᑦ ᐃᓄᓕᕆᓂᒃᑯᑦ (ᐃᓱᒫᓘᑕᐅᔪᑦ, ᐃᒻᒥᓃᕈᒪᓂᖅ ᐊᒻᒪᓗ ᐃᒻᒥᓃᕋᓱᓐᓂᖅ, ᓂᖓᕐᓂᖅ, ᐋᖓᔮᕐᓇᑐᑦ ᐊᒻᒪᓗ ᐃᒥᐊᓗᒻᒥᒃ ᐊᑐᕐᓗᕐᓂᖅ) ᑕᐃᒪᐃᑦᑐᑦ ᐊᑦᑕᕐᓇᕈᑕᐅᔪᑦ ᑎᑎᖅᑐᖅᑕᐅᓯᒪᕗᑦ. ᑎᓴᒪᑦ ᖁᑦᑎᓂᖅᐹᑦ ᐊᑦᑕᕐᓇᕈᑕᐅᔪᑦ ᐊᑐᖅᑕᐅᔪᑦ (ᐃᓄᓕᕆᓂᕐᒧᑦ ᐱᕙᓪᓕᐊᔪᓕᕆᓂᕐᒧᑦ ᐊᑦᑐᐃᓗᖅᑯᑏᑦ, ᐃᓱᒫᓗᒍᑎᑦ, ᓂᖓᕐᓂᖅ ᐊᒻᒪᓗ ᓇᕐᓚᒍᑎᓂᒃ ᐊᑐᕐᓂᕐᓗᒃ) ᕿᒥᕐᕈᔭᐅᔪᔪᑦ ᐊᒻᒪᓗ ᐃᓱᒻᒥᕆᐊᕈᑕᐅᔪᔪᑦ ᕿᒥᕐᕈᓂᒃᑯᑎᒍᑦ. ᐊᑲᕐᕆᓐᖏᒍᑕᐅᔪᑦ ᓲᔪᕐᓇᑦᑎᐊᔪᕗᑦ ᐅᐱᓐᓇᕋᓂ ᐃᓄᒋᐊᓐᓂᖅᓴᐃᑦ ᐊᕐᓇᐃᑦ (58%) ᖁᑦᑎᓂᖅᐹᖑᔪᓂᑦ ᐊᑦᑕᕐᓇᕈᑎᓂᑦ ᐊᑐᖅᓯᒪᔪᑦ ᐊᑲᐃᓪᓕᐅᕈᑎᖃᖅᑐᑎ ᐃᓄᓕᕆᓂᕐᒧᑦ ᐱᕙᓪᓕᐊᔾᔪᑎᒃᑯᑦ, ᐃᓱᒫᓘᑎᖃᐅᖅᑐᑎ ᐊᒻᒪᓗ ᓂᖓᖅᑕᐅᓂᒃᑯᑦ ᓲᔪᕐᓇᓛᖑᔪᓪᓗᑎ. ᐊᔾᔨᒌᓐᖏᒍᑕᐅᔪᓪᓗ ᓲᔪᕐᓇᖅᓯᔪᕗᑦ: ᑕᐃᒃᑯᐊ ᐃᓄᓕᕆᓂᒃᑯᑦ ᐱᕙᓪᓕᐊᔪᓕᕆᓂᒃᑯᑦ ᐊᒻᒪᓗ ᐃᓱᒪᒃᑯᑦ ᐃᓄᓕᕆᓂᒃᑯᑦ ᐊᑦᑕᕐᓇᕈᑎᖃᓐᖏᑦᑐᑦ (30.8%) ᐊᒻᒪᓗ ᐅᖁᒪᐃᓪᓕᐅᖅᑐᑦ (69.2%). ᑭᖑᓪᓕᐅᔪᒥᒃ ᖃᐅᔨᔾᔪᑎᒥᒃ, ᒪᕐᕈᐃᓕᖅᑲᖓᔫᒃ ᐃᓕᓴᕐᓇᖅᓯᔪᕘᒃ ᐊᓈᓇᐅᔪᓄᑦ ᐅᖁᒪᐃᓪᓕᐅᕈᑕᐅᔪᑦ: ᐃᓄᑑᔾᔨᔪᑦ ᐊᕐᓇᐃᑦ ᐃᓄᓕᕆᓂᒃᑯᑦ ᐱᕙᓪᓕᐊᓂᒃᑯᑦ ᐃᓱᒫᓘᑎᓖᑦ (40.1%) ᐊᒻᒪᓗ ᐊᕐᓇᐃᑦ ᐃᓱᒫᓘᑎᖃᓐᖏᓂᔅᓴᐃᑦ ᑮᓇᐅᔭᑎᒍᑦ ᑭᓯᐊᓂᓕ ᓂᖓᖅᑕᐅᕙᑦᑐᑦ ᐊᒻᒪᓗ ᐋᖓᔮᕐᓇᑐᖅᑐᐸᑦᑐᑦ ᐅᕝᕙᓗᑭᐊᖅ ᐃᒥᕋᓚᑉᐸᑦᑐᑦ (29.1%). ᖃᐅᔨᔾᔪᑎᕗᑦ ᐃᑲᔪᖅᑐᐃᕗᑦ ᑭᓐᖒᒪᔭᐅᔪᓂᒃ ᓄᖅᑲᐅᒥᔾᔪᑎᔅᓴᑦ ᐊᒻᒪᓗ ᐃᓄᓐᓅᓕᖓᔪᓂᒃ ᐃᓗᓯᓕᕆᓂᕐᒧᑦ ᐃᖏᕐᕋᑎᑕᒐᕐᓂᒃ ᐱᕚᓪᓕᐊᓂᒃᑯᑦ ᐊᓈᓇᐅᔪᓄᑦ ᐊᒻᒪᓗ ᓄᑕᕋᖏᑕ ᐃᓅᑦᑎᐊᕐᓂᖏᓐᓄᑦ.

Download Full-text