Suicide and self-inflicted injury hospitalizations in Canada (1979 to 2014/15)

Introduction The purpose of this paper is to describe the trends and patterns of self-inflicted injuries, available from Canadian administrative data between 1979 and 2014/15, in order to inform and improve suicide prevention efforts. Methods Suicide mortality and hospital separation data were retrieved from the Public Health Agency of Canada (PHAC) holdings of Statistics Canada’s Canadian Vital Statistics: Death Database (CVS:D) (1979 to 2012); Canadian Socio-Economic Information Management System (CANSIM 2011, 2012); the Hospital Morbidity Database (HMDB) (1994/95 to 2010/11); and the Discharge Abstract Database (2011/12 to 2014/15). Mortality and hospitalization counts and rates were reported by sex, 5-year age groups and method. Results The Canadian suicide rate (males and females combined, all ages, age-sex standardized rate) has decreased from 14.4/100 000 (n = 3355) in 1979 to 10.4/100 000 (n = 3926) in 2012, with an annual percent change (APC) of –1.2% (95% CI: –1.3 to –1.0). However, this trend was not observed in both sexes: female suicide rates stabilized around 1990, while male rates continued declining over time—yet males still accounted for 75.7% of all suicides in 2012. Suffocation (hanging and strangulation) was the primary method of suicide (46.9%) among Canadians of all ages in 2012, followed by poisoning at 23.3%. In the 2014/15 fiscal year, there were 13 438 hospitalizations in Canada (excluding Quebec) associated with self-inflicted injuries—over 3 times the number of suicides. Over time females have displayed consistently higher rates of hospitalization for self-inflicted injury than males, with 63% of the total. Poisoning was reported as the most frequent means of self-inflicted harm in the fiscal year 2014/15, at 86% of all hospitalizations. Conclusion Suicides and self-inflicted injuries continue to be a serious—but preventable— public health problem that requires ongoing surveillance.

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Correctional Work: Reflections Regarding Suicide

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18084280 ◽

2021 ◽

Vol 18 (8) ◽

pp. 4280

Author(s):

Christine Genest ◽

Rosemary Ricciardelli ◽

R. Nicholas Carleton

Keyword(s):

Public Health ◽

Suicidal Ideation ◽

Family Doctor ◽

Public Health Problem ◽

Health Agency ◽

Life Time ◽

Psychological Theory ◽

Small Sample ◽

Employee Assistance Program ◽

Assistance Program

The Public Health Agency of Canada declared suicide a public health problem in Canada (2016). Employees working in correctional services, researchers find, experience high rates of life-time suicidal ideation in comparison to other public safety professionals and the general population. Suicide behaviours (i.e., ideation, planning, attempts, death) are a multifactorial phenomenon, explained in part by the Interpersonal-Psychological Theory of Suicide that suggests attempted suicide is facilitated by perceived burdensomeness, a lost sense of belonging, a feeling of hopelessness, and a progressively reduced fear of death, as well as capacity and planning to engage a lethal attempt. In the current study, we unpack the factors that can influence suicide behaviours as reported by correctional workers. Our intent is to make explicit the experiences of a small sample (n = 25) of correctional workers in relation to suicidal behaviours, highlighting stories of recovery and acknowledging the importance of facilitating psychologically safe workplaces. Analysis entailed an inductive semi-grounded emergent theme approach. Participants identified certain risk factors as being able to induce suicidal ideation, such as marital or family problems as well as difficulties at work (i.e., bullying or difficult working conditions). Having children and a partner may act as factors preventing suicide for those with ideation. Participants sought help from professionals, such as their family doctor, a psychologist, or the Employee Assistance Program (EAP); however, the lack of perceived organisational supports and recognition of the issue of suicide by the employer are two elements that can hinder the search for help.

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Epidemiological statistics of adolescent suicide during confinement due to the Covid-19 pandemic in Ecuador

Revista de la Facultad de Medicina Humana ◽

10.25176/rfmh.v21i4.3984 ◽

2021 ◽

Vol 21 (4) ◽

pp. 797-803

Author(s):

Andres Joaquin Guarnizo Chávez ◽

Nathaly Alejandra Romero Heredia

Keyword(s):

Public Health ◽

Mortality Rate ◽

Adolescent Suicide ◽

Public Health Problem ◽

The State ◽

Suicide Mortality ◽

Suicide Method ◽

Cross Sectional ◽

State Of Emergency ◽

Psychological Suffering

Introduction: Adolescent suicide is a public health problem that has been neglected due to the pandemic and confinement. Objective: To describe the characteristics of adolescent suicide, during the period of confinement due to pandemic in the year 2020 in Ecuador. Method: An observational, descriptive, cross-sectional, retrospective study was carried out, with the information from the database of violent deaths of the Ministry of Government, from March 17 to September 13, which lasted through the state of emergency. The analysis was carried out by province, sex, age, suicide method and frequency in days after the event occurred. The suicide mortality rate (per 100,000 inhabitants) was estimated for each province. Results: During confinement due to a state of emergency in 2020 in Ecuador, 97 suicides were registered among adolescents between 10 and 19 years of age. The highest number was estimated in males between 15 and 19 years of age, with the most frequent age being 19. The most frequent day of removal of corpses was on Mondays, and the preferred mode of suicide was by hanging with 81 reported cases. followed by intoxication and poisoning. Conclusions: No increases were found in the suicide mortality rate during the state of emergency in 2020. However, it must be considered that the context of COVID-19 has increased the burden of psychological suffering, which may lead adolescents to think about suicide.

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Metabolic disturbances in non-alcoholic fatty liver disease

Clinical Science ◽

10.1042/cs20080253 ◽

2009 ◽

Vol 116 (7) ◽

pp. 539-564 ◽

Cited By ~ 154

Author(s):

Christopher D. Byrne ◽

Rasaq Olufadi ◽

Kimberley D. Bruce ◽

Felino R. Cagampang ◽

Mohamed H. Ahmed

Keyword(s):

Public Health ◽

Liver Disease ◽

Fatty Liver ◽

Health Problem ◽

Fatty Liver Disease ◽

Public Health Problem ◽

Alcoholic Fatty Liver ◽

Increased Risk ◽

Alcoholic Fatty Liver Disease ◽

Over Time

NAFLD (non-alcoholic fatty liver disease) refers to a wide spectrum of liver damage, ranging from simple steatosis to NASH (non-alcoholic steatohepatitis), advanced fibrosis and cirrhosis. NAFLD is strongly associated with insulin resistance and is defined by accumulation of liver fat >5% per liver weight in the presence of <10 g of daily alcohol consumption. The exact prevalence of NAFLD is uncertain because of the absence of simple non-invasive diagnostic tests to facilitate an estimate of prevalence. In certain subgroups of patients, such as those with Type 2 diabetes, the prevalence of NAFLD, defined by ultrasound, may be as high as 70%. NASH is an important subgroup within the spectrum of NAFLD that progresses over time with worsening fibrosis and cirrhosis, and is associated with increased risk for cardiovascular disease. It is, therefore, important to understand the pathogenesis of NASH and, in particular, to develop strategies for interventions to treat this condition. Currently, the ‘gold standard’ for the diagnosis of NASH is liver biopsy, and the need to undertake a biopsy has impeded research in subjects in this field. Limited results suggest that the prevalence of NASH could be as high as 11% in the general population, suggesting there is a worsening future public health problem in this field of medicine. With a burgeoning epidemic of diabetes in an aging population, it is likely that the prevalence of NASH will continue to increase over time as both factors are important risk factors for liver fibrosis. The purpose of this review is to: (i) briefly discuss the epidemiology of NAFLD to describe the magnitude of the future potential public health problem; and (ii) to discuss extra- and intra-hepatic mechanisms contributing to the pathogenesis of NAFLD, a better understanding of which may help in the development of novel treatments for this condition.

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Developing and Testing the Populi Needle Exchange Point Finder: An App to Reduce Harm Associated With Intravenous Drug Consumption Among Homeless and Non-homeless Drug Users

Frontiers in Public Health ◽

10.3389/fpubh.2020.493321 ◽

2020 ◽

Vol 8 ◽

Author(s):

Fran Calvo ◽

Xavier Carbonell ◽

Carles Mundet

Keyword(s):

Public Health ◽

Drug Users ◽

People Who Inject Drugs ◽

Homeless People ◽

Public Health Problem ◽

Health Agency ◽

Needle Exchange ◽

Needle Exchange Program ◽

Exchange Program ◽

Use Of Technology

The spread of viral infections remains a serious public health problem. People who inject drugs represent one of the highest-risk groups. eHealth and mHealth have been shown to be effective in improving individuals' management of their own health and their access to health care and to contribute to reducing the costs associated with certain medical interventions. People who inject drugs, including homeless people, tend to have access to technology. Young homeless people in particular are likely to use smartphones and social networking sites in ways that are similar to the general population. Despite this widespread use of technology, there are no apps designed specifically to reduce harm in people who inject drugs. The objective of this study is to analyze the development and usability testing process for an application for mobile devices, designed to complement the Needle Exchange Program. This app—the first of its kind—was developed by a public health agency, specialized professionals and people who inject drugs. We analyzed the differences in how health providers and drug users experienced the usability of the app. The participants were 61 members of multidisciplinary professional group and 16 people who inject drugs. We used a cross-sectional quantitative, observational design. First, we created and administered a questionnaire to collect the sociodemographic characteristics that could mediate the use of technology. Next participants tried the app and filled out a second questionnaire in which they rated their experience on a Likert scale from 1 to 7 in the following dimensions: overall attractiveness of the app, ease/difficulty of use, the extent to which they believed the app could improve access to injection materials, the extent to which they thought it would improve PWID's participation in the needle exchange program, overall utility, the degree to which they thought PWID would use the app, and the need for the app. To analyze the answers, we used contingency tables and compared means using a Student's t test. Finally, we conducted six audio-recorded focus groups about how the participants experienced the usability of the app. The objective of this part of the study was to classify and quantify the contributions of individuals and the group according to three predefined categories: potential benefits and positive aspects, potential obstacles or difficulties in carrying out the project, and concrete suggestions for improving the interface. There were not significant differences between the sociodemographic variables and the variables related to use of the app between professionals and PWID. Both professionals and PWID rated the app as intuitive and useful, especially the geolocation function for NEPs. Both groups also thought that the interface contained too much information and that this excess could be confusing for users. Both groups also had similar opinions about the app and its uses. An important difference between the two groups is that PWID reported that they would use the app, while professionals reported that they didn't think PWID would use it. All participants proposed improvements on the prototype, suggestions that will be applied in the creation of the definitive interface. Including professionals and patients in this sort of usability test enables researchers and developers to detect the needs of potential app users.

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Spatio-Temporal Dynamics of Tick-Borne Diseases in North-Central Wisconsin from 2000–2016

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17145105 ◽

2020 ◽

Vol 17 (14) ◽

pp. 5105

Author(s):

Austin Rau ◽

Claudia Munoz-Zanzi ◽

Anna M. Schotthoefer ◽

Jonathan D. Oliver ◽

Jesse D. Berman

Keyword(s):

Public Health ◽

Temporal Dynamics ◽

Disease Risk ◽

Public Awareness ◽

Laboratory Data ◽

Healthcare Providers ◽

Public Health Problem ◽

Spatial And Temporal Patterns ◽

North Central ◽

Over Time

Lyme disease is a well-recognized public health problem in the USA, however, other tick-borne diseases also have major public health impacts. Yet, limited research has evaluated changes in the spatial and temporal patterns of non-Lyme tick-borne diseases within endemic regions. Using laboratory data from a large healthcare system in north-central Wisconsin from 2000–2016, we applied a Kulldorf’s scan statistic to analyze spatial, temporal and seasonal clusters of laboratory-positive cases of human granulocytic anaplasmosis (HGA), babesiosis, and ehrlichiosis at the county level. Older males were identified as the subpopulation at greatest risk for non-Lyme tick-borne diseases and we observed a statistically significant spatial and temporal clustering of cases (p < 0.05). HGA risk shifted from west to east over time (2000–2016) with a relative risk (RR) ranging from 3.30 to 11.85, whereas babesiosis risk shifted from south to north and west over time (2004–2016) with an RR ranging from 4.33 to 4.81. Our study highlights the occurrence of non-Lyme tick-borne diseases, and identifies at-risk subpopulations and shifting spatial and temporal heterogeneities in disease risk. Our findings can be used by healthcare providers and public health practitioners to increase public awareness and improve case detection.

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Suicide Mortality in the Americas. Regional Report 2010–2014

10.37774/9789275123300 ◽

2021 ◽

Keyword(s):

Public Health ◽

Risk Factor ◽

North America ◽

Suicidal Behavior ◽

Suicide Rate ◽

Health Problem ◽

Public Health Problem ◽

Suicide Mortality ◽

Suicide Rates ◽

Hispanic Caribbean

Suicide is a serious public health problem surrounded by stigma, myths, and taboos. With an annual average of 81,746 suicide deaths in the period 2010–2014 and an age-adjusted suicide rate of 9.3 per 100,000 population (age-unadjusted rate of 9.6), suicide continues to be a public health problem of great relevance in the Region of the Americas. Contrary to common belief, suicides are preventable with timely, evidence-based, and often low-cost interventions. It is estimated that for each suicide that occurs, there are more than 20 attempts. Suicide can occur at any age and it is the third highest cause of death among young people between the ages of 20 and 24 in the Region of the Americas. This report corresponds to the five-year period between 2010 and 2014. It provides a general description of suicide mortality in the Americas, by subregions and countries. It analyzes the distribution of suicide according to age, sex, and methods used, along with the changes in suicide from 2010 to 2014. This report is limited to the study of mortality as, in most countries, no record of self-harm exists, due to lack of appropriate surveillance systems. In the period 2010–2014, 55.8% of suicide deaths in the Region occurred in North America. The age-adjusted suicide rate was also highest in North America (12.8 per 100,000 population), which along with the non-Hispanic Caribbean (9.8) was higher than the regional rate, while the other two subregions had rates lower than the regional rate (6.7 in Central America, the Hispanic Caribbean, and Mexico; 6.9 in South America). In Latin America and the Caribbean, it is essential that national suicide prevention programs be developed, especially in those countries with higher suicide rates. This report identifies 12 countries in the Region of the Americas with high suicide rates compared with the regional average and where two-thirds of the suicide deaths are concentrated. Strengthening information systems and surveillance of suicidal behavior is required. Improving mortality registries alone is not enough. It is also necessary to develop registries of suicidal behavior and implement follow-up mechanisms in high-risk cases. This report identifies the most frequent suicide methods. The availability of firearms is an important risk factor, particularly in North America. Access to pesticides in rural areas is another risk factor, especially in the non-Hispanic

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Tobacco Associated Factors of Adolescents

Journal of Health Sciences ◽

10.17921/2447-8938.2020v22n2p196-202 ◽

2020 ◽

Vol 22 (2) ◽

pp. 196-202

Author(s):

Maristela Prado e Silva Nazario ◽

Mariana Marra Sepulveda ◽

Olga Dillenburg Rezer ◽

Juliana Santi Sagin Pinto Bergamim ◽

Marcly Schelles Lima ◽

...

Keyword(s):

Public Health ◽

Smoking Cessation ◽

Associated Factors ◽

Public Health Problem ◽

Government Policies ◽

Tobacco Prevention ◽

Tobacco Use Disorder ◽

Relationship Of ◽

The Relationship ◽

Over Time

Currently, smoking is considered a serious public health problem and is considered the greatest avoidable cause of illness, disability and death. Several studies, over time, have concluded the relationship of smoking to serious diseases that are responsible for anti-smoking government policies worldwide. There are many advances in tobacco prevention and smoking cessation, but data on smoking deaths are still alarming. Brazil is considered a great inspiration for other countries when it comes to these policies, just as other countries served as inspiration for Brazil, such as Canada. Children and adolescents are a group that is very vulnerable to smoking and therefore are considered a priority when it comes to prevention. In light of the above, a bibliographical review was carried out with the objectives of contextualizing the problem of smoking and of identifying the factors that lead adolescents to use tobacco. The study shows that smoking is considered one of several risk situations that the adolescent is exposed in this phase of so many transformations. Most authors point to curiosity as the major factor that leads the adolescent to smoking and the parents and friends smokers as main influences for the initiation of this habit. Keywords: Tobacco. Tobacco Use Disorder. Young. Resumo Atualmente o tabagismo é considerado um sério problema de saúde pública, sendo considerada a maior causa evitável de doenças, invalidez e morte. Diversos estudos, ao longo do tempo, foram concluindo a relação do hábito tabágico às doenças graves que são responsáveis por políticas governamentais antitabagismo em todo mundo. Muitos são os avanços para a prevenção do tabagismo, bem como para o auxílio na cessação deste hábito, porém ainda são alarmantes os dados relacionados ao óbito de fumantes. O Brasil é considerado uma grande inspiração para outros países quando se trata dessas políticas, assim como outros países serviram de inspiração para o Brasil, como o Canadá. As crianças e os adolescentes formam um grupo muito vulnerável ao tabagismo e por este motivo são considerados prioridade quando se trata de prevenção. Frente ao exposto, realizou-se uma revisão bibliográfica com os objetivos de contextualizar a problemática do tabagismo e de identificar os fatores que levam os adolescentes a fazerem uso do tabaco. O estudo mostra que o tabagismo é considerado uma das várias situações de risco que o adolescente é exposto nessa fase de tantas transformações. A maioria dos autores apontam a curiosidade como o maior fator que leva o adolescente ao tabagismo e os pais e amigos fumantes como principais influências para a iniciação deste hábito. Palavras-chave: Tabaco. Tabagimo. Saúde do Adolescente.

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The Economic, Institutional, and Political Determinants of Public Health Delivery System Structures

Public Health Reports ◽

10.1177/003335491212700210 ◽

2012 ◽

Vol 127 (2) ◽

pp. 208-215 ◽

Cited By ~ 10

Author(s):

Richard C. Ingram ◽

F. Douglas Scutchfield ◽

Glen P. Mays ◽

Michelyn W. Bhandari

Keyword(s):

Public Health ◽

Delivery System ◽

Health Agency ◽

Policy Makers ◽

Local Public Health ◽

Public Health Agencies ◽

Health Delivery ◽

Health Agencies ◽

Health Delivery System ◽

Over Time

Objectives. A typology of local public health systems was recently introduced, and a large degree of structural transformation over time was discovered in the systems analyzed. We present a qualitative exploration of the factors that determine variation and change in the seven structural configurations that comprise the local public health delivery system typology. Methods. We applied a 10-item semistructured telephone interview protocol to representatives from the local health agency in two randomly selected systems from each configuration—one that had maintained configuration over time and one that had changed configuration over time. We assessed the interviews for patterns of variation between the configurations. Results. Four key determinants of structural change emerged: availability of financial resources, interorganizational relationships, public health agency organization, and political relationships. Systems that had changed were more likely to experience strengthened partnerships between public health agencies and other community organizations and enjoy support from policy makers, while stable systems were more likely to be characterized by strong partnerships between public health agencies and other governmental bodies and less supportive relationships with policy makers. Conclusions. This research provides information regarding the determinants of system change, and may help public health leaders to better prepare for the impacts of change in the areas discussed. It may also help those who are seeking to implement change to determine the contextual factors that need to be in place before change can happen, or how best to implement change in the face of contextual factors that are beyond their control.

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Prevention of mental ill-health and suicide: Public health perspectives

European Psychiatry ◽

10.1016/j.eurpsy.2010.01.011 ◽

2010 ◽

Vol 25 (5) ◽

pp. 252-256 ◽

Cited By ~ 19

Author(s):

C.W. Hoven ◽

D.J. Mandell ◽

J.M. Bertolote

Keyword(s):

Public Health ◽

Public Health Problem ◽

World Health ◽

Suicide Mortality ◽

Sociocultural Factors ◽

Large Measure ◽

Current State ◽

National Organizations ◽

History Of ◽

Health Organization

AbstractAccording to the World Health Organization (WHO) estimates for the year 2020, approximately 1.5 million people will commit suicide, and at least 10 times that many will make an attempt. This paper offers a brief overview of the current state of the epidemiology of suicide, a burgeoning public health problem. The information provided is based in large measure on reports of suicide mortality from 130/193 countries. In order to contextualize these data, this paper explores the contribution of both individual and sociocultural factors that influence suicidal behavior, from which much has been learned. Outlining the history of attempts by international and national organizations like WHO, United Nations, member states in the European community and other countries to regularize identification and suicide reporting procedures, this paper also demonstrates that serious knowledge gaps remain. Minimal requirements for successful evidence-based interventions are presented.

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Central-line–Associated Bloodstream Infections Among Adult Intensive Care Unit Patients in Canadian Hospitals, 2011–2018

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.1138 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s464-s465

Author(s):

Wallis Rudnick ◽

Lynn Johnston ◽

Jocelyn A. Srigley ◽

Jun Chen Collet ◽

Jeannette Comeau ◽

...

Keyword(s):

Public Health ◽

Intensive Care ◽

Health Agency ◽

Bloodstream Infections ◽

Central Line ◽

Public Health Agency ◽

Fisher Exact Test ◽

The Public ◽

Annual Range ◽

Over Time

Background: Nosocomial central-line–associated bloodstream infections (CLABSIs) are an important cause of morbidity and mortality in hospitalized patients. CLABSI surveillance establishes rates for internal and external comparison, identifies risk factors, and allows assessment of interventions. Objectives: To determine the frequency of CLABSIs among adult patients admitted to intensive care units (ICUs) in CNISP hospitals and evaluate trends over time. Methods: CNISP is a collaborative effort of the Canadian Hospital Epidemiology Committee, the Association of Medical Microbiologists and Infectious Disease Canada and the Public Health Agency of Canada. Since 1995, CNISP has conducted hospital-based sentinel surveillance of healthcare-associated infections. Overall, 55 CNISP hospitals participated in ≥1 year of CLABSI surveillance. Adult ICUs are categorized as mixed ICUs or cardiovascular (CV) surgery ICUs. Data were collected using standardized definitions and collection forms. Line-day denominators for each participating ICU were collected. Negative-binomial regression was used to test for linear trends, with robust standard errors to account for clustering by hospital. We used the Fisher exact test to compare binary variables. Results: Each year, 28–42 adult ICUs participated in surveillance (27–37 mixed, 6–8 CV surgery). In both mixed ICUs and CV-ICUs, rates remained relatively stable between 2011 and 2018 (Fig. 1). In mixed ICUs, CLABSI rates were 1.0 per 1,000 line days in 2011, and 1.0 per 1,000 line days in 2018 (test for linear trend, P = .66). In CV-ICUs, CLABSI rates were 1.1 per 1,000 line days in 2011 and 0.8 per 1,000 line days in 2018 (P = .19). Case age and gender distributions were consistent across the surveillance period. The 30-day all-cause mortality rate was 29% in 2011 and in 2018 (annual range, 29%–35%). Between 2011 and 2018, the percentage of isolated microorganisms that were coagulase-negative staphylococci (CONS) decreased from 31% to 18% (P = .004). The percentage of other gram-positive organisms increased from 32% to 37% (P = .34); Bacillus increased from 0% to 4% of isolates and methicillin-susceptible Staphylococcus aureus from 2% to 6%). The gram-negative organisms increased from 21% to 27% (P = .19). Yeast represented 16% in 2011 and 18% in 2018; however, the percentage of yeast that were Candida albicans decreased over time (58% of yeast in 2011 and 30% in 2018; P = .04). Between 2011 and 2018, the most commonly identified species of microorganism in each year were CONS (18% in 2018) and Enterococcus spp (18% in 2018). Conclusions: Ongoing CLABSI surveillance has shown stable rates of CLABSI in adult ICUs from 2011 to 2018. The causative microorganisms have changed, with CONS decreasing from 31% to 18%.Funding: CNISP is funded by the Public Health Agency of Canada.Disclosures: Allison McGeer reports funds to her for studies, for which she is the principal investigator, from Pfizer and Merck, as well as consulting fees from Sanofi-Pasteur, Sunovion, GSK, Pfizer, and Cidara.

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