Persons In Canada Research Articles

Concurrent Disorders and Health Care Utilization Among Homeless and Vulnerably Housed Persons in Canada

ABSTRACTObjective: Individuals who are homeless or vulnerably housed have a higher prevalence of concurrent disorders, defined as having a mental health diagnosis and problematic substance use, compared to the general housed population. The study objective was to investigate the effect of having concurrent disorders on health care utilization among homeless or vulnerably housed individuals, using longitudinal data from the Health and Housing in Transition Study. Methods: In 2009, 1190 homeless or vulnerably housed adults were recruited in Ottawa, Toronto, and Vancouver, Canada. Participants completed baseline interviews and four annual follow-up interviews, providing data on sociodemographics, housing history, mental health diagnoses, problematic drug use with the Drug Abuse Screening Test (DAST-10), problematic alcohol use with the Alcohol Use Disorders Identification Test (AUDIT), chronic health conditions, and utilization of the following health care services: emergency department (ED), hospitalization, and primary care. Concurrent disorders were defined as the participant having ever received a mental health diagnosis at baseline and having problematic substance use (i.e., DAST-10 ≥ 6 and/or AUDIT ≥ 20) at any time during the study period. Three generalized mixed effects logistic regression models were used to examine the independent association of having concurrent disorders and reporting ED use, hospitalization, or primary care visits in the past 12 months. Results: Among our sample of adults who were homeless or vulnerably housed, 22.6% (n = 261) reported having concurrent disorders at baseline. Individuals with concurrent disorders had significantly higher odds of ED use (adjusted odds ratio [AOR] = 1.71; 95% confidence interval [CI], 1.4–2.11), hospitalization (AOR = 1.45; 95% CI, 1.16–1.81), and primary care visits (AOR = 1.34; 95% CI, 1.05–1.71) in the past 12 months over the four-year follow-up period, after adjusting for potential confounders. Conclusions: Concurrent disorders were associated with higher rates of health care utilization when compared to those without concurrent disorders among homeless and vulnerably housed individuals. Comprehensive programs that integrate mental health and addiction services with primary care as well as community-based outreach may better address the unmet health care needs of individuals living with concurrent disorders who are vulnerable to poor health outcomes.

An Exception to the Rule or a Rule for the Exception? The Potential of Using HIV-Positive Donors in Canada.

Selected human immunodeficiency virus (HIV)-infected patients with end organ failure can safely receive an organ transplant from an HIV uninfected donor. Recent demonstration of the short term safety of organ transplantation between HIV-infected persons prompted a change in US American law to allow such transplantations. Prompted by the recent completion of the first organ transplantation between HIV-infected persons in Canada, we review Canadian law regarding the use of organs from HIV-infected donors, estimate the number of potential HIV-infected donors in Canada, and critically review considerations related to advancing organ transplantation from HIV-infected donors in Canada. Existing legislation allows organ transplantation from an HIV-infected donor under exceptional medical circumstances and therefore no change in legislation is required to increase utilization of organs from HIV-infected donors for transplantation in Canada. Among 335,793 hospital deaths between 2005 and 2009 in Canadian provinces excluding Quebec, 39 potential HIV-infected donors were identified. The actual number of HIV potential donors is estimated to be approximately 60% lower (3-5 potential donor per year), if the absence of viremia is required for transplantation. Although offering all Canadians the opportunity to donate organs is a laudable goal, further research to understand the need for HIV-positive donors and the willingness of HIV-positive recipients to accept organs from HIV-positive donors is needed to inform future policy regarding organ donation from HIV-infected persons in Canada.

Protection options for trafficked persons in Canada: The need for a more coordinated approach

Protection options for trafficked persons in Canada: The need for a more coordinated approach

Residential Stability Reduces Unmet Health Care Needs and Emergency Department Utilization among a Cohort of Homeless and Vulnerably Housed Persons in Canada.

This study examined the association of housing status over time with unmet physical health care needs and emergency department utilization among homeless and vulnerably housed persons in Canada. Homeless and vulnerably housed individuals completed interviewer-administered surveys on housing, unmet physical health care needs, health care utilization, sociodemographic characteristics, substance use, and health conditions at baseline and annually for 4years. Generalized logistic mixed effects regression models examined the association of residential stability with unmet physical health care needs and emergency department utilization, adjusting for potential confounders. Participants were from Vancouver (n = 387), Toronto (n = 390), and Ottawa (n = 396). Residential stability was associated with lower odds of having unmet physical health needs (adjusted odds ratio (AOR), 0.82; 95% confidence interval (CI), 0.67, 0.98) and emergency department utilization (AOR, 0.74; 95% CI, 0.62, 0.88) over the 4-year follow-up period, after adjusting for potential confounders. Residential stability is associated with fewer unmet physical health care needs and lower emergency department utilization among homeless and vulnerably housed individuals. These findings highlight the need to address access to stable housing as a significant determinant of health disparities.

Factors Impacting Transgender Patients' Discomfort with Their Family Physicians: A Respondent-Driven Sampling Survey.

BackgroundRepresenting approximately 0.5% of the population, transgender (trans) persons in Canada depend on family physicians for both general and transition-related care. However, physicians receive little to no training on this patient population, and trans patients are often profoundly uncomfortable and may avoid health care. This study examined factors associated with patient discomfort discussing trans health issues with a family physician in Ontario, Canada.Methods433 trans people age 16 and over were surveyed using respondent-driven sampling for the Trans PULSE Project; 356 had a family physician. Weighted logistic regression models were fit to produce prevalence risk ratios (PRRs) via average marginal predictions, for transmasculine (n = 184) and transfeminine (n = 172) trans persons.ResultsAmong the 83.1% (95% CI = 77.4, 88.9) of trans Ontarians who had a family physician, approximately half reported discomfort discussing trans health issues. 37.2% of transmasculine and 38.1% of transfeminine persons reported at least one trans-specific negative experience. In unadjusted analysis, sociodemographics did not predict discomfort, but those who planned to medically transition sex, but had not begun, were more likely to report discomfort (transmasculine: PRR = 2.62 (95% CI = 1.44, 4.77); transfeminine: PRR = 1.85 (95% CI = 1.08, 3.15)). Adjusted for other factors, greater perceived physician knowledge about trans issues was associated with reduced likelihood of discomfort, and previous trans-specific negative experiences with a family physician with increased discomfort. Transfeminine persons who reported three or more types of negative experiences were 2.26 times as likely, and transmasculine persons 1.61 times as likely, to report discomfort. In adjusted analyses, sociodemographic associations differed by gender, with being previously married or having higher education associated with increased risk of discomfort among transfeminine persons, but decreased risk among transmasculine persons.ConclusionsWithin this transgender population, discomfort in discussing trans health issues with a family physician was common, presenting a barrier to accessing primary care despite having a regular family physician and “universal” health insurance.

Disparities in Cancer Survival between Indigenous and Non-Indigenous Adults in Canada: Results from a Linkage of the Canadian Long Form Census to the Canadian Cancer Registry

Disparities in Cancer Survival between Indigenous and Non-Indigenous Adults in Canada: Results from a Linkage of the Canadian Long Form Census to the Canadian Cancer Registry

The Canadian Criminal Code Offence of Trafficking in Persons: Challenges from the Field and within the Law

Despite early ratification of the United Nations Trafficking in Persons Protocol, the <em>Criminal Code</em> offence of trafficking in persons in Canada has received little analytical or interpretive attention to date. Adopted in 2005, this offence has resulted in successful convictions in a limited number of cases and criminal justice authorities have continued to rely on alternate or complementary charges in cases of human trafficking. In particular, prosecutions for cases involving non-sexual labour trafficking remain extremely low. This article provides a socio-legal examination of why the offence of trafficking in persons in Canada is under-utilized in labour trafficking cases. Based on an analysis of data generated from 56 one-on-one interviews gathered from a variety of actors involved in counter trafficking response mechanisms and a legal examination of the key components of the offence, we argue that definitional challenges have resulted in narrow understandings and problematic interpretations of the Criminal Code offence. Such narrow interpretations have resulted in restricted applicability, particularly in cases of labour trafficking. More broadly, the article points to the need to address the limitations of the <em>Criminal Code</em> while formulating responses to trafficking that are not dependent on criminal law.

Aboriginal People and Confidence in the Police

No nationally representative study has been conducted about differential confidence in the police between Aboriginal people and non-Aboriginal persons in Canada. Based on the 2009 General Social Survey of Canada, this article examines the influence of Aboriginal status on confidence in the police. Consistent with the theoretical prediction, results of multiple regression analyses show that Aboriginal people and visible minorities have a significantly lower level of confidence than other Canadians do, after the effects of both expressive and instrumental concerns are controlled for. The persistent effects of Aboriginal or visible minorities status raise questions about racial relationships in Canada. Other significant predictors of confidence in the police are expressive concerns, such as trust, and instrumental concerns, such as community context, crime experiences, perceptions of crime in one’s own neighbourhood, and police contact. Findings indicate that continued reform measures are needed for the police force to gain the confidence of Aboriginal people and visible minorities in Canada.

Preventing tuberculosis in the foreign-born population of Canada: a mathematical modelling study

Foreign-born persons in Canada contribute 67% of all tuberculosis (TB) cases annually, but represent only 21% of the total population. Molecular epidemiological studies suggest that most foreign-born TB cases result from the reactivation of latent tuberculous infection (LTBI) acquired before immigration. To estimate the effect on incidence of a prevention strategy that would screen selected immigrants at arrival for LTBI and offer preventive treatment to those who test positive. A deterministic model was developed to quantify the incidence of active TB in immigrants to Canada and validated with national immigration and TB case data. Model simulations suggested that it would be optimal to screen and treat LTBI in new immigrants from countries of birth with an estimated TB incidence rate in excess of 50 per 100 000 person-years. If this strategy had been implemented in 1986, the national TB incidence rate would have fallen by 18.5%, from 5.4 to 4.4 cases per 100 000 population by 2002. This study suggests that screening and treating LTBI in foreign-born persons from high TB incidence countries is the most effective strategy in terms of total persons screened and treated and percentage reduction in national incidence.

It is a scandal!

Purpose – This study aims to explore the causes and consequences of media scandals involving nursing homes for older persons in Canada, Norway, Sweden, the UK and the USA. Design/methodology/approach – This study uses a descriptive case-study methodology which provides an in-depth, focused, qualitative analysis of one selected nursing home scandal in each jurisdiction. Scandals were selected on the basis of being substantive enough to potentially affect policy. An international comparative perspective was adopted to consider whether and how different social, political and economic contexts might shape scandals and their consequences. Findings – This study found that for-profit residential care provision as well as international trends in the ownership and financing of nursing homes were factors in the emergence of all media scandals, as was investigative reporting and a lack of consensus around the role of the state in the delivery of residential care. All scandals resulted in government action but such action generally avoided addressing underlying structural conditions. Research limitations/implications – This study examines only the short-term effects of five media scandals. Originality/value – While there has been longstanding recognition of the importance of scandals to the development of residential care policy, there have been few studies that have systematically examined the causes and consequences of such scandals. This paper contributes to a research agenda that more fully considers the media's role in the development of residential care policy, attending to both its promises and shortcomings.

A Legacy of Derogation: Prejudice toward Aboriginal Persons in Canada

Interpersonal prejudice toward Aboriginal men and women has, to date, received little attention from Canadian social psychologists. The present study sought to address this omission by examining the correlates of Old-Fashioned Prejudice (O-PATAS) and Modern Prejudice (M-PATAS) toward Aboriginal persons. Data from two samples (Sample 1: n = 280, 71.6% females; Sample 2: n = 163, 70.9% females) were used. As predicted, in Sample 1, respondents evidenced greater levels of modern prejudice than old-fashioned prejudice, and both forms correlated positively with social dominance orientation, right-wing authoritarianism and negativity toward other stigmatized groups (specifically, gay men and overweight persons). For Sample 2, modern prejudice toward Aboriginal people correlated negatively with empathy as well as self-reported contact with Aboriginal people. However, no association was observed between scores on the M-PATAS and a multifaceted measure of religiosity.

Hope in Newly Diagnosed Cancer Patients

ContextHope is important to cancer patients as it helps them deal with their diagnosis. Little is known about hope in newly diagnosed cancer patients. ObjectivesBased on the Transcending Possibilities conceptual model of hope, the purpose of this study was to examine the relationship of hope with pain, energy, and psychological and demographic characteristics in newly diagnosed adult oncology outpatients. MethodsData from 310 New Patient Assessment Forms from cancer outpatients' health records were collected. Health records from the first six months of 2009 were reviewed and data were collected on hope, energy, pain, depression, anxiety, feeling overwhelmed, and demographic variables. A generalized linear modeling approach was used to study the relationship of hope scores with these variables. Hypothesized variables and variables that were significant at the P = 0.01 level from the univariate analysis were entered into the multivariate model, with hope scores as the dependent variable. ResultsHope scores were significantly negatively related to age (P = 0.02). More specifically, oncology patients who were 65 years of age or older had significantly less hope than those under the age of 65 years (P = 0.01). Gender (P = 0.009) also was a significant factor, with men having higher hope scores than women. No other variables were significant. ConclusionOlder adults comprise the majority of persons in Canada with cancer. The lower hope scores found in this age group compared with their younger counterparts underscore the importance of further research. This study provides a foundation for future research in this important area for oncology patients.

Lifetime Risk of ESRD

Lifetime Risk of ESRD

The Geographic Mobility of Elderly Canadians

The monograph Changing Residence: The Geographic Mobility of Elderly Canadians (Northcott, 1988) reviewed the research that had been done up to the mid-1980s on the geographic mobility of older persons in Canada and elsewhere. The purpose of this article is to provide an update and overview of developments in the study of the geographic mobility of seniors since the mid-1980s with a particular emphasis on Canada. In this review, we first examine progress over the past 25 years in research about seniors' geographic mobility and focus on three topics: the relocation and geographic concentration of seniors, seasonal migration ("snowbirds"), and international migration. Second, we assess the current status of research on elder migration in Canada. Finally, we identify future challenges and unanswered questions, and make suggestions for future research.

Illicit drug use as a challenge to the delivery of end-of-life care services to homeless persons: Perceptions of health and social services professionals

Homeless persons tend to die younger than the housed population and have complex, often unmet, end-of-life care needs. High levels of illicit drug use among this population are a particular challenge for health and social services professionals involved in end-of-life care services delivery. This article explores the challenges of end-of-life care services to homeless illicit drug users based on data collected during a national study on end-of-life care services delivery to homeless persons in Canada. The authors conducted qualitative interviews with 50 health and social services professionals involved in health services delivery to homeless persons in five cities. Interviews were transcribed verbatim and analysed thematically. Themes were organised into two domains. First, barriers preventing homeless illicit drug users from accessing end-of-life care services, such as competing priorities (e.g. withdrawal management), lack of trust in healthcare providers and discrimination. Second, challenges to end-of-life care services delivery to this population in health and social care settings, including non-disclosure of illicit drug use, pain and symptom management, interruptions in care, and lack of experience with addictions. The authors identify a need for increased research on the role of harm reduction in end-of-life care settings to address these challenges.

Evidence-Based Approaches to Remedy and Also to Prevent Abuse of Community-Dwelling Older Persons

Elder abuse is a global issue, with an estimated 4–10% of older persons in Canada abused each year. Although Canadian legislation has been created to prevent and punish the abuse of older persons living in nursing homes and other care facilities, community-dwelling older persons are at greater risk of abuse. This paper highlights the importance of evidence-based actions targeted at three determinants of health: (a) personal health practices and coping skills, (b) social support networks, and (c) social environments. Two research studies are profiled as case studies that illustrate the ready possibility and value of two specific types of actions on community-based older-person abuse. This paper argues for the immediate and widespread adoption of these evidence-based measures and for additional empirical evidence to guide the correction of underreporting of abuse, raise awareness of its serious nature, and increase options to not only stop it but ultimately prevent it.

International Albumin Use: 1995 to 2006

Over the last ten years more reliable information regarding the risks and benefits of the use of albumin for fluid resuscitation has emerged. To determine what influence this has had on clinical practice, we sought to document albumin use (from mass of albumin supplied to hospitals) in 16 industrialised countries between 1995 and 2006. Data on national albumin and synthetic colloid use was sought from independent intensive care researchers and albumin issuers. The mass of albumin supplied per 10,000 persons on an annual basis by country and aggregated across the study countries was calculated. Volumes of synthetic colloid supplied per 10,000 persons were calculated. Data were obtained for 15 countries. Albumin use varied significantly between countries and throughout the observation period. Overall, aggregate albumin use decreased from a peak of 2.54 kg per 10,000 persons in 1995 to 1.40 kg per 10,000 persons in 1999; use has remained relatively constant since. Data on supply of synthetic colloids was available in only three countries and varied from 11.7 litres per 10,000 persons in Canada in 1995, to 231.8 litres per 10,000 persons in Denmark in 2004. Between 1995 and 1999 albumin use decreased and has been materially constant since; where data were available, use of synthetic colloids increased. Whether these practice changes have resulted in a net health gain or in harm requires further research.

Visits to Family Physicians or Specialists by Elderly Persons in Canada and the United States: An Exploratory Comparative Study

The objective of this exploratory study was to compare elderly persons likelihood of visiting a family doctor/general practitioner or a medical specialist and the association of that likelihood with socioeconomic factors and health-related quality of life (a measure of perceived need) in Canada and the United States. The data were obtained from the 2002-2003 Joint Canada/United States Survey of Health. The main dependent measure was whether respondents saw a medical specialist or a general practitioner during their last health care visit. U.S. patients in the highest household income group were more likely to have seen a specialist during their last health care visit, after adjusting for potential confounding factors. Further, visits to a specialist in Canada were determined by need rather than by household income. In Canada, likelihood of specialist visits by elderly persons is systematically related to the burden of illness (need) and not systematically related to income. In the United States, the opposite is the case. These results suggest that there may be important lessons from Canada on the organization of health care services.

Methicillin-ResistantStaphylococcus aureusin Marine Mammals

Methicillin-Resistant<i>Staphylococcus aureus</i>in Marine Mammals

Misrepresentations of Indigenous History and Science: Public broadcasting, the Internet, and education

This paper examines the role of history in power relations which suppress Indigenous knowledges. History is located as being about power and about how the powerful maintain their power. The paper further examines the Bering Strait theory/myth and ways that discourses in history combine with discourses in science to devalue Indigenous knowledges. The “truth” of science is challenged and examples of manipulation of scientific knowledge are provided, including discussions of a Canadian Broadcasting Corporation made for television production A people's history and an Internet website provided by the American government. These production activities supported by the Canadian and American governments are considered educational activities engaged in the practice of cultural representation in which dominant discourses about Indigenous peoples are presented. The paper challenges dominant misrepresentations of discourses about Indigenous peoples in a discussion of educational practices emphasizing the need of Indigenous peoples to control education and cultural representations. The paper concludes that it is a responsibility of society to educate all students to understand that any portrayal of history comes from a particular vantage point and to understand that dominant society privileges some representations and disadvantages others. If we teach in a critical way and challenge dominant discourses we can begin to create a society in which all persons in Canada and the USA, including Indigenous peoples, have a role to play.