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Background: Active screening for tuberculosis (TB) involves systematic detection of previously undiagnosed TB disease or latent TB infection (LTBI). It may be an important step toward elimination of TB among Inuit in Canada. We aimed to evaluate the cost-effectiveness of community-wide active screening for TB infection and disease in 2 Inuit communities in Nunavik.Methods: We incorporated screening data from the 2 communities into a decision analysis model. We predicted TB-related health outcomes over a 20-year time frame, beginning in 2019. We assessed the cost-effectiveness of active screening in the presence of varying outbreak frequency and intensity. We also considered scenarios involving variation in timing, impact and uptake of screening programs.Results: Given a single large outbreak in 2019, we estimated that 1 round of active screening reduced TB disease by 13% (95% uncertainty range -3% to 27%) and was cost saving compared with no screening, over 20 years. In the presence of simulated large outbreaks every 3 years thereafter, a single round of active screening was cost saving, as was biennial active screening. Compared with a single round, we also determined that biennial active screening reduced TB disease by 59% (95% uncertainty range 52% to 63%) and was estimated to cost Can$6430 (95% uncertainty range -$29 131 to $13 658 in 2019 Can$) per additional active TB case prevented. With smaller outbreaks or improved rates of treatment initiation and completion for people with LTBI, we determined that biennial active screening remained reasonably cost-effective compared with no active screening.Interpretation: Active screening is a potentially cost-saving approach to reducing disease burden in Inuit communities that have frequent TB outbreaks. [ABSTRACT FROM AUTHOR]

Background: Indigenous people worldwide are disproportionately affected by diabetes and its complications. We aimed to assess the monitoring, treatment and control of blood glucose and lipids in First Nations people in Ontario.Methods: We conducted a longitudinal population-based study using administrative data for all people in Ontario with diabetes, stratified by First Nations status. We assessed age- and sex-specific rates of completion of recommended monitoring for low-density lipoprotein (LDL) and glycated hemoglobin (A1c) from 2001/02 to 2014/15. We used data from 2014/15 to conduct a cross-sectional analysis of rates of achievement of A1c and LDL targets and use of glucose-lowering medications.Results: The study included 22 240 First Nations people and 1 319 503 other people in Ontario with diabetes. Rates of monitoring according to guidelines were 20%-50% for A1c and 30%-70% for lipids and were lowest for younger First Nations men. The mean age- and sex-adjusted A1c level was higher among First Nations people than other people (7.59 [95% confidence interval (CI) 7.57 to 7.61] v. 7.03 [95% CI 7.02 to 7.03]). An A1c level of 8.5% or higher was observed in 24.7% (95% CI 23.6 to 25.0) of First Nations people, compared to 12.8% (95% CI 12.1 to 13.5) of other people in Ontario. An LDL level of 2.0 mmol/L or less was observed in 60.3% (95% CI 59.7 to 61.6) of First Nations people, compared to 52.0% (95% CI 51.1 to 52.9) of other people in Ontario. Among those aged 65 or older, a higher proportion of First Nations people than other Ontarians were using insulin (28.1% v. 15.1%), and fewer were taking no medications (28.3% v. 40.1%).Interpretation: As of 2014/15, monitoring and achievement of glycemic control in both First Nations people and other people in Ontario with diabetes remained suboptimal. Interventions to support First Nations patients to reach their treatment goals and reduce the risk of complications need further development and study. [ABSTRACT FROM AUTHOR]

Background: Infant mortality is higher in Indigenous than non-Indigenous populations, but comparable data on infant morbidity are lacking in Canada. We evaluated disparities in infant morbidities experienced by Indigenous populations in Canada.Methods: We used linked population-based birth and health administrative data from Quebec, Canada, to compare hospitalization rates, an indicator of severe morbidity, in First Nations, Inuit and non-Indigenous singleton infants (< 1 year) born between 1996 and 2010.Results: Our cohort included 19 770 First Nations, 3930 Inuit and 225 380 non-Indigenous infants. Compared with non-Indigenous infants, all-cause hospitalization rates were higher in First Nations infants (unadjusted risk ratio [RR] 2.05, 95% confidence interval [CI] 1.99-2.11; fully adjusted RR 1.43, 95% CI 1.37-1.50) and in Inuit infants (unadjusted RR 1.96, 95% CI 1.87-2.05; fully adjusted RR 1.37, 95% CI 1.24-1.52). Higher risks of hospitalization (accounting for multiple comparisons) were observed for First Nations infants in 12 of 16 disease categories and for Inuit infants in 7 of 16 disease categories. Maternal characteristics (age, education, marital status, parity, rural residence and Northern residence) partly explained the risk elevations, but maternal chronic illnesses and gestational complications had negligible influence overall. Acute bronchiolitis (risk difference v. non-Indigenous infants, First Nations 37.0 per 1000, Inuit 39.6 per 1000) and pneumonia (risk difference v. non-Indigenous infants, First Nations 41.2 per 1000, Inuit 61.3 per 1000) were the 2 leading causes of excess hospitalizations in Indigenous infants.Interpretation: First Nations and Inuit infants had substantially elevated burdens of hospitalizations as a result of diseases of multiple systems. The findings identify substantial unmet needs in disease prevention and medical care for Indigenous infants. [ABSTRACT FROM AUTHOR]

Five years after Canada's Truth and Reconciliation Commission issued calls to action, and 12 years after health care workers ignored Brian Sinclair as he died in a Winnipeg emergency department, the death of Joyce Echaquan last fall underscored how unsafe hospitals remain for many Indigenous people. Linklater is the senior director of Shkaabe Makwa, Canada's first hospital-based centre focused on Indigenous mental health. [Extracted from the article]

Background: Canada experienced two distinct waves of pandemic (H1N1) influenza during the 2009 pandemic, one in the spring and the second in early fall 2009. We compared the incidence of hospital admissions and severe outcomes (admission to intensive care unit [ICU] and death) during the two waves. Methods: We reviewed data on all laboratory-confirmed cases of pandemic (H1N1) influenza that resulted in hospital admission, ICU admission or death reported to the Public Health Agency of Canada by all provinces and territories from Apr. 18, 2009, to Apr. 3, 2010. Results: A total of 8678 hospital admissions (including 1473 ICU admissions) and 428 deaths related to pandemic (H1N1) influenza were reported during the pandemic and post-peak period. There were 4.8 times more hospital admissions, 4.0 times more ICU admissions and 4.6 times more deaths in the second pandemic wave than in the first wave. ICU admissions and deaths as a proportion of hospital admissions declined in the second wave; there was a 16% proportional decline in ICU admissions and a 6% proportional decline in deaths compared with the first wave. Compared with patients admitted to hospital in the first wave, those admitted in the second wave were older (median age 30 v. 23 years) and more had underlying conditions (59.7% v. 47.5%). Pregnant women and Aboriginal people accounted for proportionally fewer patients who were admitted to hospital or who died in the second wave than in the first. Interpretation: The epidemiologic features of the first and second waves of the 2009 pandemic differed. The second wave was substantially larger and, although the patients admitted to hospital were older and more of them had underlying conditions, a smaller proportion had a severe outcome. [ABSTRACT FROM AUTHOR]

Indigenous health research can support reconciliation if it responds to the Truth and Reconciliation Commission of Canada's calls to action and uses the United Nations Declaration on the Rights of Indigenous Peoples as its framework for relationships. As gaps in Indigenous health outcomes are rooted in racism and colonization, Indigenous health research must be explicitly antiracist and anticolonial in order to contribute to closing these gaps. 2 Honouring the truth, reconciling for the future: summary of the final report of the Truth and Reconciliation Commission of Canada.. Winnipeg: Truth and Reconciliation Commission of Canada; 2015. [Extracted from the article]

The article offer information on the cultural safety training in health care for working with Indigenous people. Topics discussed include requirement of cultural safety training in all medical residency programs; views of Dr. Lisa Richardson, cochair of the college's Indigenous Health Committee, on issue; and focusing on the treatment of type 2 diabetes which is specific to Inuit people and culture.

The article reports that patient-oriented research in the context of First Nations health research requires a collaborative co-leadership approach that integrates community-based participatory research approaches and First Nations principles of ownership, control, access and possession of data and information (OCAP). It mentions that First Nations–led research addressed important gaps where data are needed to improve decision making and advocacy.

The article reports on the impact of language barriers on the health care access for the indigenous people in Nunavut. Topics discussed include the restriction of health care access due to language barriers, the training of health care workers speaking local language, and the necessity of promoting indigenous languages in health care services.

The article reflects on the 2018 federal budget of Canada dedicated to science and health care research. Research investments in the budget include a national pharmacare plan, making progress on addressing health inequalities experienced by Indigenous communities, and the opioid crisis, as well as funding for Canada Foundation for Innovation. It also notes some doctors praising the health research budget, including Art McDonald, Anne Wilson, and Michael Schull.

The article focuses on the racism and discrimination faced by indigenous people in the health care system in Canada based on the report of the Saskatoon Health Region and on the death of Brian Sinclair at the emergency department of the Health Sciences Hospital in Winnipeg, Manitoba. Topics include how Aboriginal women were forced into tubal ligation after giving birth in hospital, the racist events in hospitals, and the role of effective interventions in addressing the issue.

The article reports on a suicide prevention strategy being drafted by Saskatchewan First Nations to counter the growing rate of death among their youth. University of Saskatchewan researcher Jack Hicks claims that First Nations' girls aged ten to 19 are committing suicide at a rate 26 times higher than non-indigenous girls. A graph is also presented that shows Saskatchewan suicide rate from 2005 to 2016 by ethnicity and sex.

The article focuses on the Canadian Medical Association's (CMA) 150th annual general council meeting held in Quebec City, Quebec, wherein Health Minister Jane Philpott discussed a pan-Canadian health funding accord. Topics discussed include funding to be provided by the federal government to improve care in Manitoba, the aim to improve the country's primary care, and the role of the medical profession in providing care to indigenous people.

The authors convey their views on a holistic First Nations health strategy needed in Canada to emphasize cultural respect and safety to remove barriers for First Nations people. Topics mentioned include suicide and self-inflicted injuries as among the leading causes of death among Indigenous peoples, inequalities in every measure of health and wellness between First Nations and their non-Indigenous counterparts, and a shift in the way health care is given to First Nations people.

The article offers information on the access to health care among Indigenous people in Canada. It states that the country's health care for indigenous people is not culturally safe owing to the ways that health law, health policy and health practice continue to erode Indigenous cultural identities. It mentions that racism is one factor that affects every aspect of health care delivery for Indigenous peoples in the country.

The article reports on the issuance of a comprehensive treatment plan for healing the trauma on indigenous communities by the Truth and Reconciliation Commission in Canada. It highlights the inequity and inaction of the health system from research, medical training to hospital care. It also cites the efforts of the commission to improve the healthcare system in the country.

The article reports on the views of Canadian family physician Michael Kirlew on the quality of health care received by First Nations as of June 2016. Kirlew reportedly told Parliament's Standing Committee on Aboriginal Affairs and Northern Development in April 2016 that First Nations receive inferior quality of care with nursing stations running out of basic supplies. It notes that Kirlew appeared with several Nishnawbe Aski Nations chiefs before the committee.

The article reports that Dr. Ryan Meili, the executive director of Saskatoon, Canada-based nonprofit organization Upstream, has called for the federal government to analyze its polices and legislation through a health equity lens. He has urged the government to adopt a cross-departmental approach in analyzing policy interventions stressing the health inequity and the health outcomes between the indigenous and nonindigenous populations in Canada.

The article discusses closing the gap in Aboriginal health care as an issue for politicians campaigning for the 2015 Canadian elections. The Canadian health care system is said to have failed many Aboriginal children and adults. A benchmark Statistics Canada study shows that First Nations, Inuit and Métis people have higher rates of infant mortality and chronic diseases such as diabetes, tuberculosis and rickets as well as higher rates of domestic violence and sexual assault. [ABSTRACT FROM AUTHOR]

The article discusses how it is the responsibility of public health to reduce health inequalities present in the health care system of Canada. According to the author, poverty related inequalities and health inequalities experienced by Canada's Indigenous people are the two most important issues affecting Canadian health care and can be controlled by more investments in public health.

The article discuses the challenges faced by physicians while providing health care to indigenous peoples in remote areas in Philippines. Remoteness of location, cultural beliefs, shortage of financial resources and health care professionals are few challenges faced while providing health care. Malnutrition, sanitation and hygiene are few areas of concern for indigenous population residing in the country.

The article focuses on the claims of Canadian Medical Association (CMA) president doctor Jeffrey Turnbull regarding the low quality of health care in Canada. Turnbull says that mediocrity has been the accepted norm in the country's health care system. Turnbull mentions that basic levels of prescription drug coverage must be given to citizens particularly the often neglected groups including the poor, the elderly, and Aboriginal populations.

The article reports that indigenous leaders in Canada have urged the federal government to overhaul its approach to managing their health care and expediting indigenous control over health policy and delivery. It relates the statements of Natan Obed, president of the Inuit Tapiriit Kanatami, Ontario Regional Chief Isadore Day of the Assembly of First Nations, and Margaret Froh, president of the Métis Nation of Ontario, calling the Canadian government for the control of health care.

The article highlights the "Health and Health Care Implication of Systemic Racism on Indigenous Peoples in Canada", a guide on caring for indigenous patients, which was unveiled by the Indigenous Physicians Association of Canada in 2016. The guide is noted to be a response to the call of action from the Truth and Reconciliation Commission of Canada which aims to help doctors overcome the systemic racism. It tackles the death of Brian Sinclair, an indigenous man, in 2008.

The article reports on a new curriculum framework for aboriginal people in Canada, developed by the Association of Faculties of Medicine of Canada in collaboration with the Indigenous Physicians Association of Canada, as of June 2008. The framework is designed to educate students about the continuing impact of colonization on the health of indigenous peoples. It also intends to help create a more culturally safe environment at the country's 17 medical schools. According to the report, the curriculum framework comes three years after the deans of Canada's medical schools agreed that the initiative was needed to help educate students and medical faculty.

Announces that the University of British Columbia will launch Canada's first Aboriginal family practice residency program in July 2002. How Drs. Evan Adams and Shannon Waters will begin two years of training that will take them to rural Aboriginal communities; Details of the program.