Andrew Jin

Evaluation of a mobile diabetes care telemedicine clinic serving Aboriginal communities in northern British Columbia, Canada

Introduction. In British Columbia, Aboriginal diabetes prevalence, hospitalization and mortality rates are all more than twice as high as in the rest of the population. We describe and evaluate a program to improve access to diabetes care for Aboriginal people in northern communities. Study design. Cost-effectiveness evaluation. Methods. A diabetes nurse educator and an ophthalmic technician travel to Aboriginal reserves, offering people with diabetes services recommended in current clinical practice guidelines: retinopathy screening by digital retinal fundus photography, glaucoma screening by tonometry, point-of-care urine and blood testing to detect microalbuminuria and dyslipidemia and to measure glycated hemoglobin, foot examinations and foot care advice, blood pressure and height and weight measurement and diabetes care advice. Via electronic communication, an ophthalmologist and an endocrinologist in Vancouver review the findings and supervise the mobile clinic staff. Results. During the first year, 25 clinics were held at 22 sites, examining 339 clients with diabetes. Exit surveys showed high levels of client satisfaction. Mean cost per client (Cdn

The relationship of lead in soil to lead in blood and implications for standard setting

1,231) was less than for the alternative, transporting clients to care in the nearest cities (Cdn

Injury hospitalizations due to unintentional falls among the Aboriginal population of British Columbia, Canada: incidence, changes over time, and ecological analysis of risk markers, 1991-2010

1,437). Conclusions. The mobile clinic is cost-ef-fective and improves access to the recommended standard of diabetes care.

The RISC research project: injury in First Nations communities in British Columbia, Canada

As part of a soil lead regulation process, this review was conducted to determine the association between lead in soil and established human health effects of lead or validated biomarkers of lead exposure. We reviewed only studies where soil exposure could be distinguished from other sources of lead and whose design could reasonably be used to infer a causal relationship between soil lead and either biomarkers or health effects. No such studies of health effects were found. Studies describing a quantitative relationship between soil lead and blood lead did meet our criteria: 22 cross-sectional studies in areas with polluted soil; and three prospective studies of soil lead pollution abatement trials. The cross-sectional studies indicated that, compared to children exposed to soil lead levels of 100 ppm, those exposed to levels of 1000 ppm had mean blood lead concentrations 1.10-1.86 times higher and those exposed to soil lead levels of 2000 ppm had blood lead concentrations 1.13-2.25 times higher. The prospective studies showed effects within the ranges predicted by the cross-sectional studies. Differences in results between studies were surprisingly modest and likely explainable by random sampling error, different explanatory variables included in data analyses and differences in methods of measuring lead in environmental specimens.

Diabetes mellitus in the First Nations population of British Columbia, Canada. Part 2. Hospital morbidity

Background Aboriginal people in British Columbia (BC) have higher injury incidence than the general population. Our project describes variability among injury categories, time periods, and geographic, demographic and socio-economic groups. This report focuses on unintentional falls. Methods We used BC’s universal health care insurance plan as a population registry, linked to hospital separation and vital statistics databases. We identified Aboriginal people by insurance premium group and birth and death record notations. We identified residents of specific Aboriginal communities by postal code. We calculated crude incidence and Standardized Relative Risk (SRR) of hospitalization for unintentional fall injury, standardized for age, gender and Health Service Delivery Area (HSDA), relative to the total population of BC. We tested hypothesized associations of geographic, socio-economic, and employment-related characteristics with community SRR of injury by linear regression. Results During 1991 through 2010, the crude rate of hospitalization for unintentional fall injury in BC was 33.6 per 10,000 person-years. The Aboriginal rate was 49.9 per 10,000 and SRR was 1.89 (95% confidence interval 1.85-1.94). Among those living on reserves SRR was 2.00 (95% CI 1.93-2.07). Northern and non-urban HSDAs had higher SRRs, within both total and Aboriginal populations. In every age and gender category, the HSDA-standardized SRR was higher among the Aboriginal than among the total population. Between 1991 and 2010, crude rates and SRRs declined substantially, but proportionally more among the Aboriginal population, so the gap between the Aboriginal and total population is narrowing, particularly among females and older adults. These community characteristics were associated with higher risk: lower income, lower educational level, worse housing conditions, and more hazardous types of employment. Conclusions Over the years, as socio-economic conditions improve, risk of hospitalization due to unintentional fall injury has declined among the Aboriginal population. Women and older adults have benefited more.

Strategies for Determining Occupational Exposures in Risk Assessments: A Review and a Proposal for Assessing Fungicide Exposures in the Lumber Industry

Background The project, Injury in British Columbias Aboriginal Communities: Building Capacity while Developing Knowledge, funded by the Canadian Institutes of Health Research (CIHR), aims to expand knowledge on injury rates among First Nations communities in British Columbia (BC), Canada. Objective The purpose is to improve understanding of community differences and to identify community-level risk and protective factors. Generally, injury incidence rates in the Aboriginal population in Canada greatly exceed those found in the non-Aboriginal population; however, variability exists between Aboriginal communities, which have important implications for prevention. Design This study uses administrative records of deaths, hospitalizations, ambulatory care episodes, and workers’ compensation claims due to injuries to identify communities that have been especially successful in maintaining low rates of injury. Results The analysis of risk and protective factors extends the work of Chandler and Lalonde who observed that community efforts to preserve and promote Aboriginal culture and to maintain local control over community life are strongly associated with lower suicide rates. Conclusion The discussion on psychological and cultural considerations on healing and reducing the rates of injury expands the work of McCormick on substance use in Aboriginal communities.

A History of Process and Chemical Changes for Fungicide Application in the Western Canadian Lumber Industry: What Can We Learn?

Objectives: To describe hospitalization rates from diabetes mellitus or its complications among residents of the province of British Columbia, Canada during the 5-year period 1993 to 1997, comparing people with Indian Status to rest of the population. Study design: A data base of all acute-care hospital discharges with diabetes mellitus anywhere among the discharge diagnoses was created. Case definitions of diabetes-related hospitalization were based on logical combinations of ICD-9 coded discharge diagnoses. Indirect standardization was used to adjust for age differences between the two populations. Results: Among persons aged 35 years or older, Status Indian males and pregnant females were twice as likely to be hospitalized for diabetes-related illness than other males or pregnant females. Status Indian non-pregnant females were three times as likely to be hospitalized as their non-Status Indian counterparts. Under age 35 years there was no difference in risk. Older First Nations women have a higher risk of diabetes during pregnancy but this analysis cannot distinguish gestational diabetes from pre-existing Type 2 diabetes.

A diabetes mellitus in the First Nations population of British Columbia, Canada. Part 1. Mortality

To select an exposure monitoring protocol for assessing the occupational risk of fungicides in the lumber industry, the main strategies for determining exposures for risk assessment were reviewed. A survey of lumber industry work sites using fungicides observed the methods of application and opportunities for exposure. In addition, a review of existing measurement data was done. These investigations indicated that fungicide application techniques and process locations were varied from site to site, such that it would be extremely difficult to select a few representative locations for quasi-experimental studies, as is usually done in agricultural pesticide exposure assessment. Existing measurement data mainly describe exposures to fungicides no longer in use, and do not cover the range of application techniques or process technology observed in the survey. A probability sample of the exposed population was therefore proposed.

Consumption guideline concerning cadmium in moose meat in northern British Columbia, Canada

Abstract In this article we examine historical changes in anti-sapstain fungicide application in the western Canadian lumber industry. Modifications have included (1) changes in fungicide formulations, (2) substitution with new fungicides, and (3) changes in application technology. The data were collected during three related studies: a retrospective cohort study of chlorophenate-exposed sawmill workers; a study of the acute effects of substitute fungicides; and a cross-sectional survey of fungicide application techniques in sawmills and shipping terminals. We discovered that chlorophenate formulations and application technology were changed without systematic collection of data to evaluate their impact on worker exposure. Cross-sectional surveys examining a wide range of technologies, or studies of exposure before and after changes are made, would allow more methodical evaluation of engineering changes in the future. We also found that substitution of new fungicide active ingredients occurred before a fu...

Risk of Hospitalization Due to Unintentional Fall Injury in British Columbia, Canada, 1999–2008: Ecological Associations with Socioeconomic Status, Geographic Place, and Aboriginal Ethnicity

Objectives: To describe mortality from diabetes mellitus or related diseases among residents of the province of British Columbia, Canada during the 6-year period 1991–1996, comparing the First Nations population (people with Indian Status) to the population of BC who are not Status Indian. Study Design: A data base of all deaths during the 6-year period was created for this purpose. The number of deaths were tabulated using the 3-digit ICD-9 code for diabetes mellitus or a related disease, when they were recorded as the Underlying Cause of Death. Indirect standardization was used to adjust for age and gender differences between the two populations. Results: For diabetes, Status Indian males had a Standardized Mortality Ratio (SMR) of 1.5 compared to other BC males (95% confidence interval 1.0 to 2.6). Status Indian females had an SMR of 2.2 (95% CI 1.5 to 4.5). Age-specific rates of death from diabetes were higher among Status Indian persons, for males aged 50 to 84 and females aged 45 to 84 years. Status Indian persons also Experienced higher mortality from cardiovascular and renal disease. Conclusions: In British Columbia, death from diabetes mellitus or a related disease was more common among First Nations people than in the rest of the population.