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

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

Lack of Mutual Respect in Relationship The Endangered Partner

Violence in a relationship and in a family setting has been an issue of concern to various interest groups and professional organizations. Of particular interest in this article is violence against women in a relationship. While there is an abundance of knowledge on violence against women in general, intimate or partner femicide seems to have received less attention. Unfortunately, the incidence of violence against women, and intimate femicide in particular, has been an issue of concern in the African setting. This article examines the trends of intimate femicide in an African setting in general, and in Botswana in particular. The increase in intimate femicide is an issue of concern, which calls for collective effort to address. This article also examines trends offemicide in Botswana, and the antecedents and the precipitating factors. Some studies have implicated societal and cultural dynamics as playing significant roles in intimate femicide in the African setting. It is believed that the patriarchal nature of most African settings and the ideology of male supremacy have relegated women to a subordinate role. Consequently, respect for women in any relationship with men is lopsided in favor of men and has led to abuse of women, including intimate femicide. Other militating factors in intimate femicide ,are examined and the implications for counseling to assist the endangered female partner are discussed

Quality of life, firm productivity, and the value of amenities across Canadian cities

We estimate quality‐of‐life and productivity differences across Canada's metropolitan areas in a hedonic general‐equilibrium framework. These are based on the estimated willingness‐to‐pay of heterogeneous households and firms to locate in various cities, which differ in their wage levels, housing costs, and land values. Using 2006 Canadian Census data, our metropolitan quality‐of‐life estimates are somewhat consistent with popular rankings, yet find Canadians care more about climate and culture. Quality of life is highest in Victoria for anglophones, Montreal for francophones, and Vancouver for allophones, and lowest in more remote cities. Toronto is Canada's most productive city; Vancouver is the overall most valuable city. Qualité de vie, productivité des entreprises, et la valeur des avantages dans les diverses villes canadiennes . On évalue les différences entre la qualité de vie et la productivité des entreprises entre les zones métropolitaines au Canada à l'aide d'un cadre d'analyse d'équilibre général hédonique. Ces métriques sont basées sur l'estimation de la volonté de payer de ménages et d'entreprises hétérogènes pour se localiser dans diverses villes, qui diffèrent tant pour ce qui est des niveaux de salaires, des coûts de l'habitation, et des prix des terrains. A l'aide des données du recensement canadien de 2006, on construit des évaluations de la qualité de vie des diverses zones métropolitaines qui s'arriment convenablement aux ordonnancements en vogue, mais on découvre que les Canadiens portent une attention particulière au climat et à la culture. La qualité de vie est la plus élevée à Victoria pour les anglophones, à Montreal pour les francophones, et à Vancouver pour les allophones, et la plus faible pour les villes éloignées des grands centres. Toronto est la ville la plus productive; Vancouver est généralement la plus appréciée.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/98300/1/caje12017.pd

Youth workers as literacy mediators:supporting young people's learning about institutional literacy practices

This article examines the role of youth workers as literacy mediators: people who help others with written texts. Drawing on a secondary analysis of data from a qualitative study conducted in Quebec (Canada), it discusses situations in which staff from a community-based organization helped young people with written texts such as bureaucratic letters or forms. Such institutional literacy practices were found to be stressful and difficult, but were crucial for the young people’s ability to access resources and opportunities. Literacy mediation, contrary to what other studies have shown, offers important opportunities for literacy learning. The youth workers were able to counter the negative emotions dominant literacy practices often provoked and in so doing helped young people develop greater confidence and ability to deal with such literacy practices in a more informed and empowered way

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

A comparison of benzodiazepine and related drug use in Nova Scotia and Australia

Objective: Benzodiazepines can be a problem if used for long periods, or in at-risk populations, such as the elderly. We compared the use of benzodiazepine and related prescription medicines in Nova Scotia and Australia

The utilization of antidepressants and benzodiazepines among people with major depression in Canada

Objective: Although clinical guidelines recommend monotherapy with antidepressants (ADs) for major depression, polypharmacy with benzodiazepines (BDZs) remains an issue. Risks associated with such treatments include tolerance and dependence, among others. We assessed the prevalence and determinants of AD and BDZ utilization among Canadians who experienced a major depressive episode (MDE) in the previous 12 months, and determined the association of seeing a psychiatrist on the utilization of ADs and BDZs. Method: Data were drawn from the 2002 Canadian Community Health Survey: Health and Well-Being, a nationally representative sample of Canadians aged 15 years and older. Descriptive statistics quantified utilization, while logistic regression identified factors associated with utilization, such as sociodemographic characteristics or type of physician seen. Sampling weights and bootstrap variance estimations were used for all analysis. Results: The overall prevalence of AD and BDZ utilization was 49.3% of respondents who experienced an MDE in the past 12 months and reported AD use. Key determinants of utilization were younger age and unemployment in the past week (OR 2.6; P < 0.001). Being seen by a psychiatrist increased utilization (OR 2.5; P < 0.001), possibly because psychiatrists were seeing patients with severe depression. Conclusion: A large proportion of people with past-year MDEs utilized ADs and BDZs. It is unclear how much of this is appropriate given that evidence-based clinical guidelines recommend monotherapy with ADs in the treatment of major depression