Harvey V. Thommasen

Health And Quality Of Life Of Aboriginal Residential School Survivors, Bella Coola Valley, 2001

The purpose of this study was to make comparisons between Aboriginal residential school survivors’ perceptions of health status and overall quality of life, and Aboriginal non-residential school attendees, as well as between non-Aboriginals. Data were obtained from thirty-three questions derived from the 2001 Determinants of Health and Quality of Life Survey, based on a sample of 687 residents from the Bella Coola Valley area of British Columbia, Canada. A retrospective review of local Medical Clinic charts enabled 47 Aboriginal residential school survivors to be identified from the survey and matched, based on age and gender, with Aboriginal non-residential school attendees to form a cohort (n = 60), as well as with non-Aboriginals (n = 94). A series of descriptive, univariate, and Pearson Chi-square analyses were used to compare data of health status and quality of life outcome measures, physician visits, and disease prevalence rates between groups. The findings suggest that Aboriginal residential school survivors and Aboriginal non-residential school attendees both experience poorer health and quality of life compared to non-Aboriginals, as well as higher rates of diabetes. Surprisingly, also found was evidence contrary to the received view of the devastation of the residential school experience. The effects of residential school continuing to influence second, third, and fourth generations in relation to Aboriginal health and quality of life is complex, necessitating further inquiry.

Prevalence of Depression and Prescriptions for Antidepressants, Bella Coola Valley, 2001

Objective: To determine the prevalence of depression–anxiety disorders and the degree to which physicians prescribed antidepressants for Aboriginal and non-Aboriginal populations living in a remote rural community in British Columbia in 2001. Methods: To obtain data for our main outcome measures, we retrospectively reviewed the charts of 2375 patients living in the Bella Coola Valley as of September 2001 and attending the Bella Coola Medical Clinic. Results: The 2001 prevalence rate of depression–anxiety disorders in the Bella Coola Valley was 7.5% (177/2375). Depression was the most common problem (86%) in these patients. Women had a higher rate of depression–anxiety disorders (10.3%) than did men (4.7%) (P < 0.001). Non-Aboriginal people had a slightly higher rate (8.5%) than did Aboriginal people (6.3%); however, the difference was not statistically significant. Antidepressant medications were commonly prescribed for chronic pain and insomnia. The general pattern of antidepressant medication use in 2001 among both Aboriginal and non-Aboriginal people living in the Bella Coola Valley was as follows: peak use of antidepressants was in the middle to late years; the rate for women was roughly double the rate for men; and proportionately more Aboriginal people, especially the women, were taking antidepressants. Conclusions: Depression–anxiety disorder prevalence rates for Aboriginal and non-Aboriginal populations are similar. When using antidepressant medication prescriptions as a community health indicator, health care administrators should be aware that antidepressant medications are commonly prescribed for conditions other than depression–anxiety disorder.

Neutrophil margination in the lung in adult respiratory distress syndrome

Abstract In patients who develop adult respiratory distress syndrome (ARDS), leukopenia may precede the clinical expression of lung injury. In order to determine if this finding is associated with neutrophil margination in the lung, we calculated neutrophil flux across the lung in eight patients who developed ARDS, 18 patients who were at risk but did not develop ARDS, and in eight control patients who had respiratory failure due to congestive heart failure or atelectasis. Neutrophil flux was calculated by multiplying cardiac output by the difference in neutrophil concentration between mixed venous and arterial blood. A positive value indicated margination and a negative value indicated demargination of neutrophils in the lung. Measurements were averaged during the 24-hour period of lowest PaO 2 /FiO 2 in each patient. Margination of neutrophils was more frequent in patients who developed ARDS, whereas demargination of neutrophils was more frequent in patients who did not develop ARDS. In the patients who developed ARDS and who had margination of neutrophils, this phenomenon occurred 14.4 ± 9.1 (x ± SD) hours before the diagnosis of ARDS. The sensitivity and specificity of margination of neutrophils in the lung as a test for ARDS were 87% and 78%, respectively. Margination of neutrophils in the lung is one cause of leukopenia in ARDS and may be a useful discriminator of ARDS in patients at risk.