Morbidity and mortality rates in a NOVA SCOTIA First Nations Community, 1996-1999

The impact of influenza on the Canadian First Nations

In March and April 2009, pandemic H1N1 2009 influenza A virus (pH1N1 2009) emerged among residents of and travelers to Mexico, the United States and Canada. During the 2009 pandemic, cases of pH1N1 2009 infection were reported from over 214 countries, with at least 18,449 recorded deaths. In Canada, over 8,500 cases were hospitalized, 16.8% of which required intensive care. A particularly concerning occurrence was the spread of pH1N1 2009 into First Nations communities in Canada. Although Aboriginal peoples constitute only 3.8% of Canada's population, members of the First Nations were 6.5 times more likely to be admitted to an ICU with pH1N1 2009 influenza than non-First Nations, and had rates of hospitalization nearly triple that of the national cumulative crude rate for all Canadians. We herein provide a succinct review of our current understanding of the risk of influenza among First Nations populations in Canada.

The relationship between socio-economic and geographic factors and asthma among Canada's Aboriginal populations

OBJECTIVES

To examine the prevalence, exacerbations and management of asthma among Canada's Aboriginal populations, and its relationship to socio-economic and geographic factors.

STUDY DESIGN

Secondary analysis of a national cross-sectional questionnaire survey.

METHODS

Data were collected in 2000 and 2001 through a survey of Aboriginal children and adults residing on- and off-reserve as part of the 2001 Aboriginal People's Survey (APS). The asthma related outcome variables - physician-diagnosed asthma, attack in past year and regular use of inhalants - were examined in relation to socio-economic and geographic factors such as income, education, housing and location of residence. Statistical analyses were based on weighted univariate and multivariate logistic regressions.

RESULTS

The results show variations in asthma diagnosis, attacks and inhalant use across geographic location, socio-economic and demographic characteristics. Geographic location was found to be significantly associated with asthma for both adults and children, with those living in the northern territories, on-reserve or rural locations being the least likely to be diagnosed. Geographic location and Aboriginal identity were also found to be significantly associated with asthma medication use.

CONCLUSIONS

While these findings may suggest a "healthier" population in more remote locations, they alternatively point to a general pattern of under-diagnosis, potentially due to poor health care access, as is typical in more remote locations.

Health care utilization and costs in Saskatchewan's registered Indian population with diabetes

BACKGROUND

The prevalence of diabetes in North American is recognized to be higher in Aboriginal populations. The relative magnitude of health care utilization and expenditures between Aboriginal and non-Aboriginal populations is uncertain, however. Our objective was to compare health care utilization and per capita expenditures according to Registered Indian and diabetes status in the province of Saskatchewan.

METHODS

Administrative databases from Saskatchewan Health were used to identify registered Indians and the general population diabetes cases and two controls for each diabetes case. Health care resource utilization (physician visits, hospitalizations, day surgeries and dialysis) and costs for these individuals in the 2001 calendar year were determined. The odds of having used each resource category, adjusted for age and location of residence, was assessed according to Registered Indian and diabetes status. The average number of encounters for each resource category and per capita healthcare expenditures were also determined.

RESULTS

Registered Indian diabetes cases were younger than general population cases (45.7 +/- 14.5 versus 58.4 +/- 16.4 years, p < 0.001) and fewer were male (42.3% versus 53.2%, p < 0.001). Registered Indians were more likely to visit a physician, be hospitalized or receive dialysis than the general population, regardless of diabetes status. Diabetes increased the probability of having used all resource categories for both Registered Indians and the general population. Per capita health care expenditures for the diabetes subgroups were more than twice that of their respective controls and were 40% to 60% higher for registered Indians than the general population, regardless of diabetes status.

CONCLUSION

Relative to individuals without the disease, both registered Indians and the general population with diabetes had substantially higher health care utilization and costs. Excess hospitalization and dialysis suggested that registered Indians with and without diabetes experienced greater morbidity than the general population.

Immunostimulant properties of Heracleum maximum Bartr

The root of Heracleum maximum Bartr. (Umbelliferae), known to possess direct antifungal and anti-mycobacterial properties, has been reported anecdotally to possess antiviral properties. It was therefore hypothesized that the plant may have immunostimulant properties. This hypothesis was tested using a macrophage activation assay to evaluate the ability of aqueous extracts of the root of Heracleum maximum to stimulate IL-6 production. All Heracleum maximum extracts were found to stimulate IL-6 and produced a steep dose-response curve. With the assay performed twice in the absence of the macrophage primer, IFN-gamma, the mean IL-6 production in the setting of the strongest extract was 3648pg/ml (95% CI 3361-3935) and 5430pg/ml (95% CI 4976-5885) as compared to 2722pg/ml (95% CI 2620-2824) and 6772pg/ml (95% CI 6282-7262) produced by the LPS positive control, respectively. In the presence of IFN-gamma, the strongest extract produced a mean concentration of IL-6 of 21804pg/ml (95% CI 19755-23854) surpassing the 14893pg/ml (13159-16628) produced by the LPS+IFN-gamma positive control. These positive results confirm the hypothesis of immunostimulation and thus support the anecdotal reports of antiviral activity.