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Lunsky Y, Matheson FI, Kouyoumdjian F, Whittingham L, Lin E, Durbin A, Calzavara A, Moser A, Dastoori P, Sirotich F, Volpe T. Intellectual and developmental disabilities in Ontario's criminal justice and forensic mental health systems: Using data to tell the story. Crim Behav Ment Health 2024; 34:197-207. [PMID: 38264949 DOI: 10.1002/cbm.2331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 01/04/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND International studies show that adults with intellectual and developmental disabilities (IDD) are disproportionately represented in the criminal justice and forensic mental health systems; however, it is difficult to capture their involvement across systems in any one jurisdiction. AIMS The current study aimed to estimate the prevalence of IDD across different parts of the criminal justice and forensic mental health systems in Ontario and to describe the demographic and clinical profiles of these individuals relative to their counterparts without IDD. METHODS This project utilised administrative data to identify and describe the demographic and clinical characteristics of adults with IDD and criminal justice or forensic involvement across four sectors: federal correctional facilities, provincial correctional facilities, forensic inpatient mental health care and community mental health programmes. Questions were driven by and results were contextualised by a project advisory group and people with lived experience from the different sectors studied, resulting in a series of recommendations. RESULTS Adults with IDD were over-represented in each of the four settings, ranging from 2.1% in federal corrections to 16.7% in forensic inpatient care. Between 20% (forensic inpatient) and 38.4% (provincial corrections) were under the age of 25 and between 34.5% (forensic inpatient) and 41.8% (provincial corrections) resided in the lowest income neighbourhoods. Medical complexity and rates of co-occurring mental health conditions were higher for people with IDD than those without IDD in federal and provincial corrections. CONCLUSIONS Establishing a population-based understanding of people with IDD within these sectors is an essential first step towards understanding and addressing service and care needs. Building on the perspectives of people who work in and use these systems, this paper concludes with intervention recommendations before, during and after justice involvement.
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Affiliation(s)
- Yona Lunsky
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Flora I Matheson
- ICES, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Fiona Kouyoumdjian
- ICES, Toronto, Ontario, Canada
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Lisa Whittingham
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Child and Youth Studies, Brock University, St. Catharines, Ontario, Canada
| | - Elizabeth Lin
- ICES, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Office of Education, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Anna Durbin
- ICES, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health, Toronto, Ontario, Canada
| | | | - Andrea Moser
- Research Branch, Correctional Service Canada, Ottawa, Ontario, Canada
| | - Parisa Dastoori
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health, Toronto, Ontario, Canada
| | - Frank Sirotich
- Canadian Mental Health Association, Toronto Branch, Toronto, Ontario, Canada
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Tiziana Volpe
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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VanSteelandt A, Chang GYS, McKenzie K, Kouyoumdjian F. Accidental substance-related acute toxicity deaths among youth in Canada: a descriptive analysis of a national chart review study of coroner and medical examiner data. Health Promot Chronic Dis Prev Can 2024; 44:77-88. [PMID: 38501679 DOI: 10.24095/hpcdp.44.3.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
INTRODUCTION Substance-related acute toxicity deaths (ATDs) are a public health crisis in Canada. Youth are often at higher risk for substance use due to social, environmental and structural factors. The objectives of this study were to understand the characteristics of youth (aged 12-24 years) dying of accidental acute toxicity in Canada and examine the substances contributing to and circumstances surrounding youth ATDs. METHODS Data from a national chart review study of coroner and medical examiner data on ATDs that occurred in Canada between 2016 and 2017 were used to conduct descriptive analyses with proportions, mortality rates and proportionate mortality rates. Where possible, youth in the chart review study were compared with youth in the general population and youth who died of all causes, using census data. RESULTS Of the 732 youth who died of accidental acute toxicity in 2016-2017, most (94%) were aged 18 to 24 years. Youth aged 20 to 24 who were unemployed, unhoused or living in collective housing were overrepresented among accidental ATDs. Many of the youth aged 12 to 24 who died of accidental acute toxicity had a documented history of substance use. Fentanyl, cocaine and methamphetamine were the most common substances contributing to death, and 38% of the deaths were witnessed or potentially witnessed. CONCLUSION The findings of this study point to the need for early prevention and harm reduction strategies and programs that address mental health, exposure to trauma, unemployment and housing instability to reduce the harms of substance use on Canadian youth.
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Lebenbaum M, Kouyoumdjian F, Huang A, Kurdyak P. The Association Between Prior Mental Health Service Utilization and Risk of Recidivism among Incarcerated Ontario Residents. Can J Psychiatry 2024; 69:21-32. [PMID: 36518095 PMCID: PMC10867412 DOI: 10.1177/07067437221140385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND There is mixed evidence on the link between mental health and addiction (MHA) history and recidivism. Few studies have examined post-release MHA care. Our objective was to examine the association between prior (pre-incarceration) MHA service use and post-release recidivism and service use. METHODS We conducted a population-based cohort study linking individuals held in provincial correctional institutions in 2010 to health administrative databases. Prior MHA service use was assigned hierarchically in order of hospitalization, emergency department visit and outpatient visit. We followed up individuals post-release for up to 5 years for the first occurrence of recidivism and MHA hospitalization, emergency department visit and outpatient visit. We use Cox-proportional hazards models to examine the association between prior MHA service use and each outcome adjusting for prior correctional involvement and demographic characteristics. RESULTS Among a sample consisting of 45,890 individuals, we found that prior MHA service use was moderately associated with recidivism (hazard ratio (HR): 1.20-1.50, all P < 0.001), with secondary analyses finding larger associations for addiction service use (HR range: 1.34-1.54, all P < 0.001) than for mental health service use (HR range: 1.09-1.18, all P < 0.001). We found high levels of post-release MHA hospitalization and low levels of outpatient MHA care relative to need even among individuals with prior MHA hospitalization. DISCUSSION Despite a high risk of recidivism and acute MHA utilization post-release, we found low access to MHA outpatient care, highlighting the necessity for greater efforts to facilitate access to care and care integration for individuals with mental health needs in correctional facilities.
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Affiliation(s)
- Michael Lebenbaum
- ICES, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
| | - Fiona Kouyoumdjian
- ICES, Toronto, ON, Canada
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | | | - Paul Kurdyak
- ICES, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Ramaswamy M, Manz C, Kouyoumdjian F, Vest N, Puglisi L, Wang E, Salyer C, Osei B, Zaller N, Rebbeck TR. Cancer equity for those impacted by mass incarceration. J Natl Cancer Inst 2023; 115:1128-1131. [PMID: 37219371 PMCID: PMC10560595 DOI: 10.1093/jnci/djad087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/26/2023] [Accepted: 05/11/2023] [Indexed: 05/24/2023] Open
Abstract
The cancer disparities between people with incarceration histories compared with those who do not have those histories are vast. Opportunities for bolstering cancer equity among those impacted by mass incarceration exist in criminal legal system policy; carceral, community, and public health linkages; better cancer prevention, screening, and treatment services in carceral settings; expansion of health insurance; education of professionals; and use of carceral sites for health promotion and transition to community care. Clinicians, researchers, persons with a history of incarceration, carceral administrators, policy makers, and community advocates could play a cancer equity role in each of these areas. Raising awareness and setting a cancer equity plan of action are critical to reducing cancer disparities among those affected by mass incarceration.
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Affiliation(s)
- Megha Ramaswamy
- Population Health, Obstetrics and Gynecology, University of Kansas Medical Center/University of Kansas Cancer Center, Kansas City, KS, USA
| | - Christopher Manz
- Medical Oncology, Population Sciences, Dana-Farber/Harvard Cancer Center, Boston, MA, USA
| | | | - Noel Vest
- Community Health Sciences, School of Public Health, Boston University, Boston, MA, USA
| | - Lisa Puglisi
- Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Emily Wang
- Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Chelsea Salyer
- Population Health, Obstetrics and Gynecology, University of Kansas Medical Center/University of Kansas Cancer Center, Kansas City, KS, USA
| | - Beverly Osei
- Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Nick Zaller
- Health Behavior and Health Education, College of Public Health, University of Arkansas Medical Sciences, Little Rock, AR, USA
| | - Timothy R Rebbeck
- Medical Oncology, Population Sciences, Dana-Farber/Harvard Cancer Center, Boston, MA, USA
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Butler A, Croxford R, Bodkin C, Akbari H, Bayoumi AM, Bondy SJ, Guenter D, McLeod KE, Gomes T, Kanagalingam T, Kiefer LA, Orkin AM, Owusu-Bempah A, Regenstreif L, Kouyoumdjian F. Burden of opioid toxicity death in the fentanyl-dominant era for people who experience incarceration in Ontario, Canada, 2015-2020: a whole population retrospective cohort study. BMJ Open 2023; 13:e071867. [PMID: 37164452 DOI: 10.1136/bmjopen-2023-071867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
OBJECTIVES To describe mortality due to opioid toxicity among people who experienced incarceration in Ontario between 2015 and 2020, during the fentanyl-dominant era. DESIGN In this retrospective cohort study, we linked Ontario coronial data on opioid toxicity deaths between 2015 and 2020 with correctional data for adults incarcerated in Ontario provincial correctional facilities. SETTING Ontario, Canada. PARTICIPANTS Whole population data. MAIN OUTCOMES AND MEASURES The primary outcome was opioid toxicity death and the exposure was any incarceration in a provincial correctional facility between 2015 and 2020. We calculated crude death rates and age-standardised mortality ratios (SMR). RESULTS Between 2015 and 2020, 8460 people died from opioid toxicity in Ontario. Of those, 2207 (26.1%) were exposed to incarceration during the study period. Among those exposed to incarceration during the study period (n=1 29 152), 1.7% died from opioid toxicity during this period. Crude opioid toxicity death rates per 10 000 persons years were 43.6 (95% CI=41.8 to 45.5) for those exposed to incarceration and 0.95 (95% CI=0.93 to 0.97) for those not exposed. Compared with those not exposed, the SMR for people exposed to incarceration was 31.2 (95% CI=29.8 to 32.6), and differed by sex, at 28.1 (95% CI=26.7 to 29.5) for males and 77.7 (95% CI=69.6 to 85.9) for females. For those exposed to incarceration who died from opioid toxicity, 10.6% died within 14 days of release and the risk was highest between days 4 and 7 postrelease, at 288.1 per 10 000 person years (95% CI=227.8 to 348.1). CONCLUSIONS The risk of opioid toxicity death is many times higher for people who experience incarceration compared with others in Ontario. Risk is markedly elevated in the week after release, and women who experience incarceration have a substantially higher SMR than men who experience incarceration. Initiatives to prevent deaths should consider programmes and policies in correctional facilities to address high risk on release.
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Affiliation(s)
- Amanda Butler
- Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Ruth Croxford
- Statistical Consultant, (freelance), Toronto, Ontario, Canada
| | - Claire Bodkin
- Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Hanaya Akbari
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Ahmed M Bayoumi
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Susan J Bondy
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Dale Guenter
- Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Tara Gomes
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Tharsan Kanagalingam
- Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - Lori A Kiefer
- Ontario Ministry of the Solicitor General, Toronto, Ontario, Canada
| | - Aaron Michael Orkin
- Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
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Kurdyak P, Friesen EL, Young JT, Borschmann R, Iqbal J, Huang A, Kouyoumdjian F. Prevalence of Mental Health and Addiction Service use Prior to and During Incarceration in Provincial Jails in Ontario, Canada: A Retrospective Cohort Study. Can J Psychiatry 2022; 67:690-700. [PMID: 34792415 PMCID: PMC9449135 DOI: 10.1177/07067437211055414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Individuals with mental illness and addiction are overrepresented in prisons. Few studies have assessed mental health and addiction (MHA)-related service use among individuals experiencing incarceration using health administrative data and most focus on service use after prison release. The objective of this study was to determine the prevalence of MHA-related service use in the 5 years prior to and during incarceration. METHODS We used linked correctional and administrative health data for people released from Ontario provincial jails in 2010. MHA-related service use in the 5 years prior to the index incarceration was categorized hierarchically into four mutually exclusive categories based on the type of service use: psychiatric hospitalization, MHA-related emergency department (ED) visit, MHA-related outpatient visit (from psychiatrist or primary care physician), and no MHA-related service use. Demographic, diagnostic, and incarceration characteristics were compared across the four service use categories. MHA-related service use during the index incarceration was assessed by category and length of incarceration. RESULTS A total of 48,917 individuals were included. Prior to incarceration, 6,116 (12.5%) had a psychiatric hospitalization, 8,837 (18.1%) had an MHA-related ED visit, and 15,866 (32.4%) had an MHA-related outpatient visit. Of the individuals with any MHA-related service prior to incarceration, 60.4% did not receive outpatient care from a psychiatrist prior to incarceration and 65.6% did not receive MHA-related care during incarceration. CONCLUSION Despite a high prevalence of mental illness and addiction among people experiencing incarceration, access to and use of MHA-related care prior to and during incarceration is poor. Increasing the accessibility and use of MHA-related services throughout the criminal justice pathway is warranted.
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Affiliation(s)
- Paul Kurdyak
- 7978Centre for Addiction and Mental Health, Toronto, ON, Canada.,ICES, Toronto, ON, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Erik L Friesen
- 7978Centre for Addiction and Mental Health, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Jesse T Young
- Justice Health Unit, Centre for Health Equity, 50066Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia.,Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia.,National Drug Research Institute, Curtin University, Perth, Western Australia, Australia
| | - Rohan Borschmann
- Justice Health Unit, Centre for Health Equity, 50066Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia.,Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Psychiatry; Warneford Hospital, University of Oxford, Oxford OX3 7JX, UK.,Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | | | | | - Fiona Kouyoumdjian
- ICES, Toronto, ON, Canada.,Department of Family Medicine, 3710McMaster University, Hamilton, ON, Canada
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Russell C, Lange S, Kouyoumdjian F, Butler A, Ali F. Opioid agonist treatment take-home doses ('carries'): Are current guidelines resulting in low treatment coverage among high-risk populations in Canada and the USA? Harm Reduct J 2022; 19:89. [PMID: 35948961 PMCID: PMC9363267 DOI: 10.1186/s12954-022-00671-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 08/02/2022] [Indexed: 11/12/2022] Open
Abstract
Opioid agonist treatment (OAT) is the primary intervention for opioid use disorder (OUD) in Canada and the USA. Yet, a number of barriers contribute to sub-optimal treatment uptake and retention, including daily-supervised medication administration. Thus, clients are eventually granted access to take-home OAT doses (i.e., ‘carries’) to reduce this burden. However, this decision is based on physician discretion and whether patients can demonstrate stability in various life domains, many of which are inextricably linked to the social determinants of health (SDOH). Current Canadian and USA OAT carry guidance documents are not standardized and do not take the SDOH into consideration, resulting in the potential for inequitable access to OAT carries, which may be the case particularly among marginalized populations such as individuals with OUD who have been released from custody. This perspective article posits that current OAT guidelines contribute to inequities in access to OAT carries, and that these inequities likely result in disproportionately low coverage for OUD treatment among some high-risk groups, including individuals on release from incarceration in particular. Relevant impacts of COVID-19 and related policy changes are considered, and suggestions and recommendations to amend current OAT guidance documents are provided.
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Affiliation(s)
- Cayley Russell
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin St, Toronto, ON, M5S 2S1, Canada. .,Ontario Node, Canadian Research Initiative in Substance Misuse (CRISM), 33 Ursula Franklin St, ON, M5S 2S1, Toronto, Canada.
| | - Shannon Lange
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin St, Toronto, ON, M5S 2S1, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), ON, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Fiona Kouyoumdjian
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada.,Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada
| | - Amanda Butler
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Farihah Ali
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin St, Toronto, ON, M5S 2S1, Canada.,Ontario Node, Canadian Research Initiative in Substance Misuse (CRISM), 33 Ursula Franklin St, ON, M5S 2S1, Toronto, Canada
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Aho J, Lybeck C, Tetteh A, Issa C, Kouyoumdjian F, Wong J, Anderson A, Popovic N. Rising syphilis rates in Canada, 2011-2020. Can Commun Dis Rep 2022; 48:52-60. [PMID: 35341093 PMCID: PMC8889924 DOI: 10.14745/ccdr.v48i23a01] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Syphilis rates are of public health concern in Canada, with multiple jurisdictions reporting outbreaks over the past five years. The objective of this article is to describe trends in infectious and congenital syphilis in Canada 2011-2020. METHODS Routine surveillance of syphilis is conducted through the Canadian Notifiable Disease Surveillance System (CNDSS). In response to rising rates of syphilis, all provinces and territories (P/Ts) have also submitted enhanced surveillance data on infectious syphilis to the Public Health Agency of Canada through the Syphilis Outbreak Investigation Coordinating Committee (SOICC) starting in 2018. Descriptive analyses of CNDSS and SOICC surveillance data 2011-2020 by age, sex, pregnancy status, male sexual orientation and P/Ts were performed. RESULTS The national rate of infectious syphilis increased from 5.1 per 100,000 population in 2011 to 24.7 per 100,000 population in 2020.The rates increased in almost all P/Ts, with the Prairie provinces reporting the greatest relative increases from 2016 to 2020 (more than 400%). Rates in males were consistently higher than rates in females over the past 10 years; however, from 2016 to 2020, rates among females increased by 773%, compared with 73% among males. Although the proportion of cases who self-identify as gay, bisexual and other men who have sex with men decreased from 54% to 38% between 2018 and 2020, they still represent a high proportion of cases (according to data from eight P/Ts). From 2016 to 2020, rates of infectious syphilis increased in every age group, especially in females aged 15-39 years. Confirmed early congenital syphilis cases for 2020 increased considerably from prior years, with 50 cases reported in 2020, compared with 4 cases in 2016. CONCLUSION Infectious and congenital syphilis rates are a growing concern in Canada and the nature of the syphilis epidemics across Canada appears to be evolving, as evidenced by recent trends. More data and research are needed to better understand the drivers associated with the recent changes in the epidemiology of syphilis in Canada.
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Affiliation(s)
- Josephine Aho
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON
| | - Cassandra Lybeck
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON
| | - Ashorkor Tetteh
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON
| | - Carmen Issa
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON
| | | | - Jason Wong
- BC Centre for Disease Control, Vancouver, BC
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC
| | - Alexandrea Anderson
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON
| | - Nashira Popovic
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON
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9
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Bodkin C, Bondy S, Regenstreif L, Kiefer L, Kouyoumdjian F. Rates of opioid agonist treatment prescribing in provincial prisons in Ontario, Canada, 2015-2018: a repeated cross-sectional analysis. BMJ Open 2021; 11:e048944. [PMID: 34794988 PMCID: PMC8603292 DOI: 10.1136/bmjopen-2021-048944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE To describe opioid agonist treatment prescribing rates in provincial prisons and compare with community prescribing rates. DESIGN We used quarterly, cross-sectional data on the number and proportion of people prescribed opioid agonist treatment in prison populations. Trends were compared with Ontario surveillance data from prescribers, reported on a monthly basis. SETTING Provincial prisons and general population in Ontario, Canada between 2015 and 2018. PARTICIPANTS Adults incarcerated in provincial prisons and people ages 15 years and older in Ontario. MAIN OUTCOMES AND MEASURES Opioid agonist treatment prescribing prevalence, defined as treatment with methadone or buprenorphine/naloxone. RESULTS In prison, 6.9%-8.4% of people were prescribed methadone; 0.8% to 4.8% buprenorphine/naloxone; and 8.2% to 13.2% either treatment over the study period. Between 2015 and 2018, methadone prescribing prevalence did not substantially change in prisons or in the general population. The prevalence rate of buprenorphine/naloxone prescribing increased in prisons by 1.70 times per year (95% CI 1.47 to 1.96), which was significantly higher than the increase in community prescribing: 1.20 (95% CI 1.19 to 1.21). Buprenorphine/naloxone prescribing prevalence was significantly different across prisons. CONCLUSIONS The increase in opioid agonist treatment prescribing between 2015 and 2018 in provincial prisons shows that efforts to scale up access to treatment in the context of the opioid overdose crisis have included people who experience incarceration in Ontario. Further work is needed to understand unmet need for treatment and treatment impacts.
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Affiliation(s)
- Claire Bodkin
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Susan Bondy
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Leonora Regenstreif
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Lori Kiefer
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Ontario Ministry of Community Safety and Correctional Services, Toronto, Ontario, Canada
| | - Fiona Kouyoumdjian
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
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10
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Liauw J, Jurgutis J, Nouvet E, Dineley B, Kearney H, Reaka N, Fitzpatrick-Lewis D, Peirson L, Kouyoumdjian F. Reproductive healthcare in prison: A qualitative study of women's experiences and perspectives in Ontario, Canada. PLoS One 2021; 16:e0251853. [PMID: 34003876 PMCID: PMC8130921 DOI: 10.1371/journal.pone.0251853] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 05/04/2021] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To explore women's experiences and perspectives of reproductive healthcare in prison. METHODS We conducted a qualitative study using semi-structured focus groups in 2018 with women in a provincial prison in Ontario, Canada. We asked participants about their experiences and perspectives of pregnancy and contraception related to healthcare in prison. We used a combination of deductive and inductive content analysis to categorize data. A concept map was generated using a reproductive justice framework. RESULTS The data reflected three components of a reproductive justice framework: 1) women have limited access to healthcare in prison, 2) reproductive safety and dignity influence attitudes toward pregnancy and contraception, and 3) women in prison want better reproductive healthcare. Discrimination and stigma were commonly invoked throughout women's experiences in seeking reproductive healthcare. CONCLUSIONS Improving reproductive healthcare for women in prison is crucial to promoting reproductive justice in this population. Efforts to increase access to comprehensive, responsive, and timely reproductive healthcare should be informed by the needs and desires of women in prison and should actively seek to reduce their experience of discrimination and stigma in this context.
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Affiliation(s)
- Jessica Liauw
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada
| | - Jessica Jurgutis
- Department of Indigenous Learning, Lakehead University, Ontario, Canada
- Department of Women’s Studies, Lakehead University, Ontario, Canada
| | - Elysée Nouvet
- School of Health Studies, University of Western Ontario, Ontario, Canada
| | - Brigid Dineley
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada
| | - Hannah Kearney
- Faculty of Health Sciences, School of Medicine, McMaster University, Ontario, Canada
| | - Naomi Reaka
- Faculty of Health Sciences, School of Medicine, McMaster University, Ontario, Canada
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Whittingham L, Durbin A, Lin E, Matheson FI, Volpe T, Dastoori P, Calzavara A, Lunsky Y, Kouyoumdjian F. The prevalence and health status of people with developmental disabilities in provincial prisons in Ontario, Canada: A retrospective cohort study. J Appl Res Intellect Disabil 2020; 33:1368-1379. [PMID: 32529696 DOI: 10.1111/jar.12757] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 04/15/2020] [Accepted: 05/06/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Data on the prevalence of developmental disabilities in people who experience imprisonment and on their characteristics are lacking. METHODS The present authors identified adults with developmental disabilities who were released from Ontario provincial prisons in 2010 and a general population comparator group using administrative data. The present authors examined demographic characteristics, morbidity and healthcare use. RESULTS The prevalence of developmental disabilities was 2.2% in the prison group (N = 52,302) and 0.7% in the general population (N = 10,466,847). The prevalence of psychotic illness, substance-related disorder and self-harm was higher among people in the prison group with developmental disabilities. People with developmental disabilities were more likely to have emergency department visits and hospitalizations in prison and in the year after release. CONCLUSIONS People with developmental disabilities are overrepresented in provincial prisons and have a high burden of disease. Strategies are indicated to prevent incarceration and to improve health.
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Affiliation(s)
- Lisa Whittingham
- Department of Child and Youth Studies, Brock University, Saint Catharines, ON, Canada
| | - Anna Durbin
- ICES, Toronto, ON, Canada.,MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Elizabeth Lin
- ICES, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Flora I Matheson
- ICES, Toronto, ON, Canada.,MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada
| | - Tiziana Volpe
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Parisa Dastoori
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada
| | | | - Yona Lunsky
- ICES, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Fiona Kouyoumdjian
- ICES, Toronto, ON, Canada.,Department of Family Medicine, McMaster University, Hamilton, ON, Canada
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Kronfli N, Buxton JA, Jennings L, Kouyoumdjian F, Wong A. Hepatitis C virus (HCV) care in Canadian correctional facilities: Where are we and where do we need to be? Can Liver J 2019; 2:171-183. [PMID: 35992759 PMCID: PMC9202815 DOI: 10.3138/canlivj.2019-0007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 03/26/2019] [Indexed: 07/29/2023]
Abstract
Approximately 25% of people in Canadian correctional facilities have been previously exposed to hepatitis C virus (HCV). Despite being a high-prevalence setting, most Canadian prisons have thus far failed to engage the majority of those with chronic HCV infection in care. Several factors, including the lack of systematic screening programs, lack of on-site and trained health care personnel to improve access to care and treatment during incarceration, and the absence of standardized procedures needed to facilitate linkage to care following release likely contribute to poor engagement along the HCV care cascade for people in prison. HCV screening and engagement in care for people in prison can be improved through the implementation of universal opt-out screening upon admission and consideration of multidisciplinary care models for the provision of care. As well, the dissemination of prison-based needle and syringe programs to avert new HCV infections and re-infections should be considered. To meet the World Health Organization (WHO) 2030 HCV elimination goals, engaging researchers, clinicians and other health care providers, policy makers, correctional officials, and members of community in dialogue will be an essential first step going forward.
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Affiliation(s)
- Nadine Kronfli
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University, Montreal, Quebec, Canada
| | - Jane A Buxton
- BC Centre of Disease Control and School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lindsay Jennings
- Prisoners with HIV/AIDS Support Action Network, Toronto, Ontario, Canada
| | - Fiona Kouyoumdjian
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
- Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Alexander Wong
- Department of Medicine, University of Saskatchewan, Regina, Saskatchewan, Canada
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Kouyoumdjian F. Attachment to primary care and team-based primary care: Retrospective cohort study of people who experienced imprisonment in Ontario. Can Fam Physician 2019; 65:e433-e442. [PMID: 31604754 PMCID: PMC6788664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To examine attachment to primary care and team-based primary care in the community for people who experienced imprisonment in Ontario, and to compare these attachment data with data for the general population. DESIGN Population-based retrospective cohort study. SETTING Ontario. PARTICIPANTS All persons released from provincial prison in Ontario to the community in 2010 who were linked with provincial health administrative data, and an age- and sex-matched general population group. MAIN OUTCOME MEASURES Primary care attachment and team-based primary care attachment in the 2 years before admission to provincial prison (baseline) and in the 2 years after release in 2010 (follow-up) for the prison release group, and for the corresponding periods for the general population group. RESULTS People in the prison release group (n = 48 861) were less likely to be attached to primary care compared with the age- and sex-matched general population group (n = 195 444), at 58.9% versus 84.1% at baseline (P < .001) and 63.0% versus 84.4% during follow-up (P < .001), respectively. The difference in attachment to team-based primary care was small in magnitude but statistically significant, at 14.4% versus 16.1% at baseline (P < .001) and 19.9% versus 21.6% during follow-up (P < .001), respectively. CONCLUSION People who experience imprisonment have lower primary care attachment compared with the general population. Efforts should be made to understand barriers and to facilitate access to high-quality primary care for this population, including through initiatives to link people while in prison with primary care in the community.
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Affiliation(s)
- Fiona Kouyoumdjian
- Assistant Professor in the Department of Family Medicine at McMaster University in Hamilton, Ont, Affiliate Scientist at the Centre for Urban Health Solutions at St Michael’s Hospital in Toronto, Ont, and Adjunct Scientist at ICES
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Abstract
The United Nations states that prisoners should enjoy the same standards of health care that are available in the community. Despite this, persons in prison experience barriers to care and face unique health challenges. Given the ways in which prisons shape health outcomes for incarcerated persons, it is important to interrogate how the provision of health care is governed in custodial settings. In this article, we examine one important aspect of governance: legislation governing the provision of health care in prisons. We view this issue through a critical lens, building on a body of poststructural scholarship which has illuminated how laws and policies are not merely tools of governance but also key sites for the production of meanings around social "problems," including the "problem of health." Taking Canada's Corrections and Conditional Release Act as a case example and applying Carol Bacchi's "What's the Problem Represented to Be" analytical framework, we examine how the specific representation of "health" in this legislation works to produce effects for persons in federal prison. Three key themes are formed through this analysis. First, what constitutes "essential services" in the context of federal prisons is more limited compared with the broader community. Second, the dichotomy between the rights of persons in prison versus the protection of society that is produced in development of these laws has significant bearing on the treatment of those in prison. Third, this representation has negative effects on the health of persons in prison. In order to meet United Nations standards, greater attention must be paid to the ways in which laws and other governing practices reproduce inequities in health care provision in prisons.
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Affiliation(s)
| | - Kari Lancaster
- Centre for Social Research in Health, UNSW Sydney, Australia
| | - Fiona Kouyoumdjian
- McMaster University, Canada; Centre for Urban Health Solutions, St. Michael's Hospital, Canada
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15
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Ramirez AC, Kouyoumdjian F, Liauw J, Costescu D, Lu H, Holder L. INFANT AND MATERNAL OUTCOMES IN WOMEN WHO EXPERIENCE IMPRISONMENT IN ONTARIO, CANADA: A RETROSPECTIVE COHORT STUDY. Journal of Obstetrics and Gynaecology Canada 2019. [DOI: 10.1016/j.jogc.2019.02.172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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16
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Orkin AM, McArthur A, Venugopal J, Kithulegoda N, Martiniuk A, Buchman DZ, Kouyoumdjian F, Rachlis B, Strike C, Upshur R. Defining and measuring health equity in research on task shifting in high-income countries: A systematic review. SSM Popul Health 2019; 7:100366. [PMID: 30886887 PMCID: PMC6402379 DOI: 10.1016/j.ssmph.2019.100366] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 01/16/2019] [Accepted: 01/23/2019] [Indexed: 12/25/2022] Open
Abstract
Introduction Task shifting interventions have been implemented to improve health and address health inequities. Little is known about how inequity and vulnerability are defined and measured in research on task shifting. We conducted a systematic review to identify how inequity and vulnerability are identified, defined and measured in task shifting research from high-income countries. Methods and analysis We implemented a novel search process to identify programs of research concerning task shifting interventions in high-income countries. We searched MEDLINE, Embase, CINAHL, PsycINFO, Web of Science, and CENTRAL to identify articles published from 2004 to 2016. Each program of research incorporated a "parent" randomized trial and "child" publications or sub-studies arising from the same research group. Two investigators extracted (1) study details, (2) definitions and measures of health equity or population vulnerability, and (3) assessed the quality of the reporting and measurement of health equity and vulnerability using a five-point scale developed for this study. We summarized the findings using a narrative approach. Results Fifteen programs of research met inclusion criteria, involving 15 parent randomized trials and 62 child publications. Included programs of research were all undertaken in the United States, among Hispanic- (5/15), African- (2/15), and Korean-Americans (1/15), and low socioeconomic status (2/15), rural (2/15) and older adult populations (2/15). Task shifting interventions included community health workers, peers, and a variety of other non-professional and lay workers to address a range of non-communicable diseases. Some research provided robust analyses of the affected populations' health inequities and demonstrated how a task shifting intervention redressed those concerns. Other studies provided no such definitions and measured only biomedical endpoints. Conclusion Included studies vary substantially in the definition and measurement of health inequity and vulnerability. A more precise theoretical and evaluative framework for task shifting is recommended to effectively achieve the goal of equitable health.
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Affiliation(s)
- Aaron M Orkin
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Schwartz/Reisman Emergency Medicine Institute, Sinai Health System, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Allison McArthur
- Ontario Public Health Libraries Association, Toronto, ON, Canada
| | - Jeyasakthi Venugopal
- Schwartz/Reisman Emergency Medicine Institute, Sinai Health System, Toronto, ON, Canada
| | - Natasha Kithulegoda
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Women's College Research Institute, Toronto, ON, Canada
| | - Alexandra Martiniuk
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,University of Sydney, Sydney, NSW, Australia.,George Institute for Global Health Australia, Sydney, NSW, Australia
| | - Daniel Z Buchman
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,University Health Network, Toronto, ON, Canada.,Joint Centre for Bioethics, University of Toronto, Toronto, ON, Canada
| | - Fiona Kouyoumdjian
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada.,Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Beth Rachlis
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Ontario HIV Treatment Network, Toronto, ON, Canada.,Dignitas International, Toronto, ON, Canada
| | - Carol Strike
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Ross Upshur
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Bodkin C, Pivnick L, Bondy SJ, Ziegler C, Martin RE, Jernigan C, Kouyoumdjian F. History of Childhood Abuse in Populations Incarcerated in Canada: A Systematic Review and Meta-Analysis. Am J Public Health 2019; 109:e1-e11. [PMID: 30676787 DOI: 10.2105/ajph.2018.304855] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND A history of childhood abuse may affect people's health and criminal justice system involvement. Understanding the prevalence of childhood abuse among individuals in prison is important to inform effective and appropriate correctional services. OBJECTIVES To review and summarize data on the prevalence of childhood abuse among people experiencing imprisonment in Canada. SEARCH METHODS We searched for studies in bibliographic indexes, reference lists, and gray literature, and we consulted experts. SELECTION CRITERIA We included studies published since 1987 that reported data on prevalence of a history of abuse before the age of 18 years among people in Canadian prisons, including any abuse, physical abuse, sexual abuse, emotional abuse, and neglect. DATA COLLECTION AND ANALYSIS Two authors independently reviewed titles and abstracts for eligibility and reviewed full texts for eligibility. Analyses included summary estimates and meta-regression with random effects. MAIN RESULTS The search identified 1429 records. We included 34 unique studies in our review and 29 nonoverlapping studies in our meta-analysis. The summary prevalence for any type of childhood abuse was 65.7% (95% confidence interval [CI] = 52.6, 77.7; range = 56.2% to 75.0%) among women; only one study reported the prevalence among men (35.5%). The summary prevalence of sexual abuse was 50.4% (95% CI = 33.5, 67.2; range = 9.9% to 77.3%) among women and 21.9% (95% CI = 15.7, 28.8; range = 8.3% to 55.6%) among men. The prevalence of neglect was 51.5% (95% CI = 43.1, 59.7; range = 45.5% to 65.1%) among women and 42.0% (95% CI = 12.7, 74.6; range = 6.8% to 99.0%) among men. The prevalence of physical abuse was 47.7% (95% CI = 41.3, 54.0; range = 16.3% to 83.0%), and the prevalence of emotional abuse was 51.5% (95% CI = 34.8, 67.9; range = 8.7% to 96.0%); we did not find differences according to gender. Prevalence estimates for all types of abuse showed high and unexplained variability across studies. CONCLUSIONS Half of people in prisons in Canada experienced abuse in childhood. Public Health Implications. Prisons should incorporate trauma-informed approaches. Research is required to understand the association between a history of childhood abuse and criminal justice system involvement and to prevent childhood abuse and mitigate its adverse effects. Systematic Review Registration. PROSPERO CRD42017056192.
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Affiliation(s)
- Claire Bodkin
- Claire Bodkin is with the Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada. At the time of the study, Lucie Pivnick was with the Michael G. DeGroote School of Medicine, McMaster University. Susan J. Bondy is with the Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Carolyn Ziegler is with St. Michael's Hospital, Toronto. Ruth Elwood Martin is with the School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada. Fiona Kouyoumdjian is with the Department of Family Medicine, McMaster University, and the Centre for Urban Health Solutions, St. Michael's Hospital, Toronto
| | - Lucie Pivnick
- Claire Bodkin is with the Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada. At the time of the study, Lucie Pivnick was with the Michael G. DeGroote School of Medicine, McMaster University. Susan J. Bondy is with the Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Carolyn Ziegler is with St. Michael's Hospital, Toronto. Ruth Elwood Martin is with the School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada. Fiona Kouyoumdjian is with the Department of Family Medicine, McMaster University, and the Centre for Urban Health Solutions, St. Michael's Hospital, Toronto
| | - Susan J Bondy
- Claire Bodkin is with the Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada. At the time of the study, Lucie Pivnick was with the Michael G. DeGroote School of Medicine, McMaster University. Susan J. Bondy is with the Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Carolyn Ziegler is with St. Michael's Hospital, Toronto. Ruth Elwood Martin is with the School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada. Fiona Kouyoumdjian is with the Department of Family Medicine, McMaster University, and the Centre for Urban Health Solutions, St. Michael's Hospital, Toronto
| | - Carolyn Ziegler
- Claire Bodkin is with the Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada. At the time of the study, Lucie Pivnick was with the Michael G. DeGroote School of Medicine, McMaster University. Susan J. Bondy is with the Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Carolyn Ziegler is with St. Michael's Hospital, Toronto. Ruth Elwood Martin is with the School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada. Fiona Kouyoumdjian is with the Department of Family Medicine, McMaster University, and the Centre for Urban Health Solutions, St. Michael's Hospital, Toronto
| | - Ruth Elwood Martin
- Claire Bodkin is with the Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada. At the time of the study, Lucie Pivnick was with the Michael G. DeGroote School of Medicine, McMaster University. Susan J. Bondy is with the Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Carolyn Ziegler is with St. Michael's Hospital, Toronto. Ruth Elwood Martin is with the School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada. Fiona Kouyoumdjian is with the Department of Family Medicine, McMaster University, and the Centre for Urban Health Solutions, St. Michael's Hospital, Toronto
| | - Carey Jernigan
- Claire Bodkin is with the Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada. At the time of the study, Lucie Pivnick was with the Michael G. DeGroote School of Medicine, McMaster University. Susan J. Bondy is with the Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Carolyn Ziegler is with St. Michael's Hospital, Toronto. Ruth Elwood Martin is with the School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada. Fiona Kouyoumdjian is with the Department of Family Medicine, McMaster University, and the Centre for Urban Health Solutions, St. Michael's Hospital, Toronto
| | - Fiona Kouyoumdjian
- Claire Bodkin is with the Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada. At the time of the study, Lucie Pivnick was with the Michael G. DeGroote School of Medicine, McMaster University. Susan J. Bondy is with the Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Carolyn Ziegler is with St. Michael's Hospital, Toronto. Ruth Elwood Martin is with the School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada. Fiona Kouyoumdjian is with the Department of Family Medicine, McMaster University, and the Centre for Urban Health Solutions, St. Michael's Hospital, Toronto
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Khanna S, Leah J, Fung K, Antoniou T, Kouyoumdjian F. Health care utilization by people with HIV on release from provincial prison in Ontario, Canada in 2010: a retrospective cohort study. AIDS Care 2018; 31:785-792. [PMID: 30541330 DOI: 10.1080/09540121.2018.1556383] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Limited evidence suggests that at the time of release from prison, people with HIV face barriers to health care, which may contribute to worsening HIV clinical outcomes. We aimed to describe health care utilization for people with HIV released from provincial prison in Ontario in 2010, and to compare rates of use with prisoner and general population controls. We used Ontario's administrative health records and data from the Ontario Ministry of Community Safety and Correctional Services on all persons released from provincial prison in 2010. We matched each person with HIV released from provincial prison by age and sex with three controls in each of three groups: people with no HIV released from provincial prison, people with HIV in the general population, and people with no HIV in the general population. We compared rates of use of primary care, non-primary ambulatory care, emergency departments, and hospitalization in the year after the first release from provincial prison in 2010 and in the corresponding period for matched controls. We identified 330 persons with HIV released from provincial prison in 2010. Their median time to first HIV-ambulatory care visit after prison release was 177 days (SD 136-239). Compared to all control groups, people with HIV released from provincial prison had higher rates of primary care use, unscheduled emergency department visits and hospital admissions at 30, 90 and 365 days after release. People with HIV released from provincial prison have a long time to first contact with HIV ambulatory care, and higher rates of health care utilization across health care settings. Interventions are required to facilitate post-release linkage to care for this population.
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Affiliation(s)
- Sumeet Khanna
- a Department of Family and Community Medicine , St. Michael's Hospital, University of Toronto , Toronto , Canada
| | - Jessica Leah
- a Department of Family and Community Medicine , St. Michael's Hospital, University of Toronto , Toronto , Canada
| | - Kinwah Fung
- b Institute for Clinical Evaluative Sciences , Toronto , Canada
| | - Tony Antoniou
- c Department of Family and Community Medicine , St. Michael's Hospital, University of Toronto, Institute for Clinical Evaluative Sciences , Toronto , Canada
| | - Fiona Kouyoumdjian
- d Department of Family Medicine , McMaster University, Centre for Urban Health Solutions, St. Michael's Hospital, Institute for Clinical Evaluative Sciences , Hamilton, Ontario , Canada
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Young J, Borschmann R, Camacho X, Knight J, Kouyoumdjian F, Janjua N, Atkinson J, Kinner S. Linked data and inclusion health: Harmonised international data linkage to identify determinants of health inequalities. Int J Popul Data Sci 2018. [DOI: 10.23889/ijpds.v3i4.597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
A recent article in The Lancet establishing the principles of inclusion health, highlighted substantial gaps in our understanding of the drivers of health inequalities in socially excluded groups such as people with a history of incarceration, people who experience homelessness, sex workers, people with mental illness, and people who inject drugs1. Cross-sectoral data linkage of electronic health records with services working with socially excluded groups was one of the key recommendations of this article. The magnitude of health disparities observed in people that experience social exclusion necessitates an international public health response and addressing the determinants of social exclusion has been identified as a key component of closing the gap of Indigenous disadvantage2. This symposium will establish data linkage as a key component of the inclusion health and will complement the efforts of the Pan American Health Oranization's (PAHO) Commission on Equity and Health Inequalities in the Americas.
Traditional survey methodology is costly and often results in studies that are highly parochial in nature. Due to difficulties recruiting and retaining marginalized groups, these studies are commonly forced to adopt methodological concessions, often selecting the most convenient participants (i.e., selection bias) or incurring increased rates of loss-to-follow-up (i.e., attrition bias). Conversely, global studies aimed at modelling the burden of disease are often not sufficiently nuanced to answer specific inferential research questions. Data-linkage has the potential to overcome these common biases and limitations. Thus, harmonised international data-linkage studies are an important component of the inclusion health response to identify the determinants of health inequalities in socially excluded groups and inform the global inclusion health agenda.
This symposium will bring together facilitators from three countries with extensive experience conducting data linkage studies that generate evidence on health and social inequality in socially excluded groups. Using a current multinational study as an example, barriers to international data-linkage studies, methodological solutions, and distributed approaches to generating international comparative evidence will be presented. Innovative examples of cross-sectoral approaches to linkage with social service, correctional and national survey data will be discussed. The development of a novel framework for identifying social exclusion exposures and determinants of health inequalities typically not captured in administrative health data will also be discussed. The session will conclude with a discussion aimed at forming the foundation of an international data linkage project to address these current gaps identified in the inclusion health series and best practice for translation to policy and practice to address health disparities in socially excluded groups.
References
Aldridge et al. Morbidity and mortality in homeless individuals, prisoners, sex workers, and individuals with substance use disorders in high-income countries: a systematic review and meta-analysis. The Lancet. 2017;391(10117):241-250. https://doi.org/10.1016/S0140-6736(17)31869-X
Greenwood M et al. Challenges in health equity for Indigenous peoples in Canada. The Lancet. 2018;Epub ahead of print. https://doi.org/10.1016/S0140-6736(18)30177-6
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Orkin AM, McArthur A, McDonald A, Mew EJ, Martiniuk A, Buchman DZ, Kouyoumdjian F, Rachlis B, Strike C, Upshur R. Defining and measuring health equity effects in research on task shifting interventions in high-income countries: a systematic review protocol. BMJ Open 2018; 8:e021172. [PMID: 30068611 PMCID: PMC6074666 DOI: 10.1136/bmjopen-2017-021172] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Task shifting interventions are intended to both deliver clinically effective treatments to reduce disease burden and address health inequities or population vulnerability. Little is known about how health equity and population vulnerability are defined and measured in research focused on task shifting. This systematic review will address the following questions: Among task shifting interventions in high-income settings that have been studied using randomised controlled trials or variants, how are health inequity or population vulnerability identified and defined? What methods and indicators are used to describe, characterise and measure the population's baseline status and the intervention's impacts on inequity and vulnerability? METHODS AND ANALYSIS Studies were identified through database searches (MEDLINE, Embase, CINAHL, PsycINFO and Web of Science). Eligible studies will be randomised controlled trials published since 2004, conducted in high-income countries, concerning task shifting interventions to treat any disease, in any population that may face health disadvantage as defined by the PROGRESS-Plus framework (place of residence, race/ethnicity/culture/language, occupation, gender/sex, religion, social capital, socioeconomic position, age, disability, sexual orientation, other vulnerable groups). We will conduct independent and duplicate title and abstract screening, then identify related papers from the same programme of research through further database and manual searching. From each programme of research, we will extract study details, and definitions and measures of health equity or population vulnerability based on the PROGRESS-Plus framework. Two investigators will assess the quality of reporting and measurement related to health equity and vulnerability using a scale developed for this study. A narrative synthesis will highlight similarities and differences between the gathered studies and offer critical analyses and implications. ETHICS AND DISSEMINATION This review does not involve primary data collection, does not constitute research on human subjects and is not subject to additional institutional ethics review or informed consent procedures. Dissemination will include open-access peer-reviewed publication and academic conference presentations.PROSPERO Registration Number CRD42017049959.
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Affiliation(s)
- Aaron M Orkin
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Schwartz/Reisman Emergency Medicine Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Allison McArthur
- Ontario Public Health Libraries Association, Toronto, Ontario, Canada
| | - André McDonald
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Emma J Mew
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Alexandra Martiniuk
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- George Institute for Global Health Australia, University of Sydney, Sydney, Australia
| | - Daniel Z Buchman
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
| | - Fiona Kouyoumdjian
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Beth Rachlis
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Ontario HIV Treatment Network, Toronto, Ontario, Canada
| | - Carol Strike
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Ross Upshur
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Kronfli N, Linthwaite B, Kouyoumdjian F, Klein MB, Lebouché B, Sebastiani G, Cox J. Interventions to increase testing, linkage to care and treatment of hepatitis C virus (HCV) infection among people in prisons: A systematic review. Int J Drug Policy 2018; 57:95-103. [PMID: 29715590 DOI: 10.1016/j.drugpo.2018.04.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 04/06/2018] [Accepted: 04/06/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND While the burden of chronic hepatitis C virus (HCV) infection is significantly higher among people in prisons compared to the general population, testing and treatment uptake remain suboptimal. The aim of this systematic review was to synthesize evidence on the effectiveness of interventions to increase HCV testing, linkage to care and treatment uptake among people in prisons. METHODS We searched Medline (Ovid 1996-present), Embase (Ovid 1996-present), and the Cochrane Central Register of Controlled Trials for English language articles published between January 2007 and November 2017. Studies evaluating interventions to enhance HCV testing, linkage to care and treatment uptake for people in prison were included. Two independent reviewers evaluated articles selected for full-text review. Disagreements were resolved by consensus. RESULTS A total of 475 unique articles were identified, 29 were eligible for full text review, and six studies were included. All but one study was conducted in the pre-direct-acting antiviral (DAA) era; no studies were conducted in low- or middle-income countries. Of the six studies, all but one focused on testing. Only two were randomised controlled trials; the remaining were single arm studies. Interventions to enhance HCV testing in prison settings included combination risk-based and birth-cohort screening strategies, on-site nurse-led opt-in screening clinics with pre-test counselling and education, and systematic dried blood spot testing. All interventions increased HCV testing, but risk of study bias was high in all studies. Interventions to enhance linkage to care included facilitated referral for HCV assessment and scheduling of specialist appointments; however, risk of study bias was critical. CONCLUSIONS There is a lack of recent data on interventions to improve the HCV care cascade in people in prisons. With the introduction of short-course, well-tolerated DAAs, rigorous controlled studies evaluating interventions to improve testing, linkage and treatment uptake for people in prison are necessary.
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Affiliation(s)
- Nadine Kronfli
- Chronic Viral Illness Services, McGill University Health Centre, Montreal, Quebec, Canada.
| | - Blake Linthwaite
- Chronic Viral Illness Services, McGill University Health Centre, Montreal, Quebec, Canada
| | - Fiona Kouyoumdjian
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada; Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Marina B Klein
- Chronic Viral Illness Services, McGill University Health Centre, Montreal, Quebec, Canada; CIHR Canadian HIV Trials Network, Vancouver, British Columbia, Canada
| | - Bertrand Lebouché
- Chronic Viral Illness Services, McGill University Health Centre, Montreal, Quebec, Canada; Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Giada Sebastiani
- Chronic Viral Illness Services, McGill University Health Centre, Montreal, Quebec, Canada
| | - Joseph Cox
- Chronic Viral Illness Services, McGill University Health Centre, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
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Kouyoumdjian F. Health status of prisoners in Canada: Narrative review. Can Fam Physician 2016; 62:215-222. [PMID: 27427562 PMCID: PMC4984599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To review the literature for quantitative research on the health status of persons in custody in provincial, territorial, and federal correctional facilities in Canada, and summarize recent evidence. QUALITY OF EVIDENCE A search was performed in research databases and the websites of relevant Canadian governmental and non-governmental organizations for quantitative studies of health conducted between 1993 and 2014. Studies were included that provided quantitative data on health status for youth or adults who had been detained or incarcerated in a jail or prison in Canada. MAIN MESSAGE The health status of this population is poor compared with the general Canadian population, as indicated by data on social determinants of health, mortality in custody, mental health, substance use, communicable diseases, and sexual and reproductive health. Little is known about mortality after release, chronic diseases, injury, reproductive health, and health care access and quality. CONCLUSION Health status data should be used to improve health care and to intervene to improve health for persons while in custody and after release, with potential benefits for all Canadians.
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Kouyoumdjian F, Wiwcharuk J, Green S. Optimizing continuity of care throughout incarceration: case and opportunities. Can Fam Physician 2015; 61:107-e72. [PMID: 25676638 PMCID: PMC4325853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Fiona Kouyoumdjian
- Postdoctoral fellow at the Centre for Research on Inner City Health at St Michael's Hospital in Toronto, Ont, and a family physician at the Hamilton-Wentworth Detention Centre.
| | - Jill Wiwcharuk
- Family physician with the Shelter Health Network in Hamilton, the Maternity Centre of Hamilton, and the Brantford General Emergency Department in Ontario
| | - Samantha Green
- Family physician at St Michael's Hospital and Primary Care Lead at Inner City Health Associates in Toronto
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Lee CQT, Kouyoumdjian F, Christian J. Defining research priorities for bacterial sexually transmitted infections in Canada. Can J Public Health 2014; 105:e86-90. [PMID: 24735702 DOI: 10.17269/cjph.105.4210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 02/07/2014] [Accepted: 01/26/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVES We aimed to define priority areas for research on chlamydia, gonorrhea, and syphilis in Canada through the use of a consensus method. METHODS A modified Delphi method was conducted, consisting of two online surveys and an in-person meeting. Participants included people working in bacterial sexually transmitted infections (STIs) across Canada, including clinicians, policy-makers, public health practitioners, and researchers. RESULTS Consensus was achieved regarding the most important priority topics in bacterial STI research in Canada, within five general priority areas: the epidemiology of bacterial STIs, screening, partner notification and contact tracing, antimicrobial resistance, and identification of best practices for the prevention and control of bacterial STIs. CONCLUSIONS The findings of this consensus process can be used to inform research efforts, which could contribute to more effective control of bacterial STIs in Canada.
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Affiliation(s)
- Colin Q-T Lee
- 1) Public Health Ontario, Toronto, Ontario (at the time of study; currently at Simcoe Muskoka District Health Unit, Barrie, Ontario) 2) Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario.
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Fitzpatrick-Lewis D, Ganann R, Krishnaratne S, Ciliska D, Kouyoumdjian F, Hwang SW. Effectiveness of interventions to improve the health and housing status of homeless people: a rapid systematic review. BMC Public Health 2011; 11:638. [PMID: 21831318 PMCID: PMC3171371 DOI: 10.1186/1471-2458-11-638] [Citation(s) in RCA: 133] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Accepted: 08/10/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research on interventions to positively impact health and housing status of people who are homeless has received substantially increased attention over the past 5 years. This rapid review examines recent evidence regarding interventions that have been shown to improve the health of homeless people, with particular focus on the effect of these interventions on housing status. METHODS A total of 1,546 articles were identified by a structured search of five electronic databases, a hand search of grey literature and relevant journals, and contact with experts. Two reviewers independently screened the first 10% of titles and abstracts for relevance. Inter-rater reliability was high and as a result only one reviewer screened the remaining titles and abstracts. Articles were included if they were published between January 2004 and December 2009 and examined the effectiveness of an intervention to improve the health or healthcare utilization of people who were homeless, marginally housed, or at risk of homelessness. Two reviewers independently scored all relevant articles for quality. RESULTS Eighty-four relevant studies were identified; none were of strong quality while ten were rated of moderate quality. For homeless people with mental illness, provision of housing upon hospital discharge was effective in improving sustained housing. For homeless people with substance abuse issues or concurrent disorders, provision of housing was associated with decreased substance use, relapses from periods of substance abstinence, and health services utilization, and increased housing tenure. Abstinent dependent housing was more effective in supporting housing status, substance abstinence, and improved psychiatric outcomes than non-abstinence dependent housing or no housing. Provision of housing also improved health outcomes among homeless populations with HIV. Health promotion programs can decrease risk behaviours among homeless populations. CONCLUSIONS These studies provide important new evidence regarding interventions to improve health, housing status, and access to healthcare for homeless populations. The additional studies included in this current review provide further support for earlier evidence which found that coordinated treatment programs for homeless persons with concurrent mental illness and substance misuse issues usually result in better health and access to healthcare than usual care. This review also provides a synthesis of existing evidence regarding interventions that specifically support homeless populations with HIV.
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Affiliation(s)
- Donna Fitzpatrick-Lewis
- The Effective Public Health Practice Project, School of Nursing, McMaster University, Hamilton, Canada
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Maman S, Yamanis T, Kouyoumdjian F, Watt M, Mbwambo J. Intimate partner violence and the association with HIV risk behaviors among young men in Dar es Salaam, Tanzania. J Interpers Violence 2010; 25:1855-1872. [PMID: 19966247 DOI: 10.1177/0886260509354498] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
There is growing evidence of the association between gender-based violence and HIV from the perspective and experiences of women. The purpose of this study is to examine these associations from the perspective of young men living in Dar es Salaam, Tanzania. A community-based sample of 951 men were interviewed, of whom 360 had sex in the past 6 months and were included in these analyses. Almost a third of the men (29.2%) reported that they had been physically violent at least once with an intimate partner. Men who reported more lifetime sexual partners (OR = 8.75; 95% CI = 2.65, 28.92), experienced physical violence as a child at home (OR = 1.73; 95% CI = 1.09, 2.76), and were more educated (OR = 1.91; 95% CI = 1.18, 3.11) were significantly more likely to report perpetrating violence. These associations persisted after adjusting for other variables. These data from the perspective of young men reinforce earlier findings from women that HIV risk and violence are occurring together in relationships of young adults. Interventions are needed to identify men at high risk for HIV and engage them in interventions that are designed to change norms and behaviors related to power and control with their sexual partners.
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Affiliation(s)
- Suzanne Maman
- University of North Carolina, Chapel Hill, 27599, USA.
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Kouyoumdjian F. In pursuit of equity. CMAJ 2009. [DOI: 10.1503/cmaj.090012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Kouyoumdjian F, Cardy VL. Practising sound medicine in the absence of evidence. CMAJ 2004; 170:767; author reply 767-8. [PMID: 14993154 PMCID: PMC343830 DOI: 10.1503/cmaj.1031733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Kobor MS, Archambault J, Jansma D, Lester W, Simon L, Kouyoumdjian F, Greenblatt J. Regulation of transcription by an RNA polymerase II CTD phosphatase. Biochem Cell Biol 1999. [DOI: 10.1139/o99-903q] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Kobor MS, Archambault J, Lester W, Holstege FC, Gileadi O, Jansma DB, Jennings EG, Kouyoumdjian F, Davidson AR, Young RA, Greenblatt J. An unusual eukaryotic protein phosphatase required for transcription by RNA polymerase II and CTD dephosphorylation in S. cerevisiae. Mol Cell 1999; 4:55-62. [PMID: 10445027 DOI: 10.1016/s1097-2765(00)80187-2] [Citation(s) in RCA: 170] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The carboxy-terminal domain (CTD) of the largest subunit of RNA polymerase II is phosphorylated soon after transcriptional initiation. We show here that the essential FCP1 gene of S. cerevisiae is linked genetically to RNA polymerase II and encodes a CTD phosphatase essential for dephosphorylation of RNA polymerase II in vivo. Fcp1p contains a phosphatase motif, psi psi psi DXDX(T/V)psi psi, which is novel for eukaryotic protein phosphatases and essential for Fcp1p to function in vivo. This motif is also required for recombinant Fcp1p to dephosphorylate the RNA polymerase II CTD or the artificial substrate p-nitrophenylphosphate in vitro. The effects of fcp1 mutations in global run-on and genome-wide expression studies show that transcription by RNA polymerase II in S. cerevisiae generally requires CTD phosphatase.
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Affiliation(s)
- M S Kobor
- Banting and Best Department of Medical Research, University of Toronto, Ontario, Canada
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