Determinants of iron deficiency and anemia among Nunavimmiut: results from the Qanuilirpitaa? 2017 Nunavik Health Survey.

OBJECTIVE: To estimate the prevalence of iron deficiency (ID) and anemia and study their main distal and proximal protective and risk factors among Nunavimmiut 16 years and older in 2017. METHODS: In a cross-sectional participatory survey of 831 women and 436 men from the Qanuilirpitaa? 2017 Nunavik Inuit Health Survey, venous blood samples were collected to measure various indicators of iron status and anemia as well as biomarkers of nutritional and inflammatory status and contaminant exposures. Sociodemographic, food security status, anthropometric, lifestyle, dietary, and health data were collected using questionnaires, clinical sessions, and a medical chart review. ID and anemia diagnoses were based on serum ferritin (SF) and hemoglobin (Hb), respectively. Multiple regressions were used to assess correlates of anemia and iron status. RESULTS: Prevalence of ID was highest among women of childbearing age (16-49 years old, 33%) and anemia among adults aged 50 years and older (31%). These estimates are prone to biases due to the relatively low participation rate (37%). Serum vitamin D, omega-3 polyunsaturated fatty acid content of erythrocyte membranes, blood selenium, inflammation, higher socioeconomic status (SES), obesity, and alcohol consumption were all positively associated with SF, while Helicobacter pylori infection and a recent pregnancy were negatively associated with Hb among women of childbearing age. Among older adults, food insecurity was associated with lower SF. CONCLUSION: While data reported here provide some indication of an improvement since the previous survey conducted in 2004, additional efforts should be devoted to further increasing the SES and access to country foods and nutritious market foods in this population, the two main protective factors against ID and anemia identified in the present study.

RéSUMé: OBJECTIF: Estimer la prévalence de la carence en fer (CF) et de l'anémie et étudier leurs principaux facteurs de protection et de risque distaux et proximaux chez les Nunavimmiut de 16 ans et plus en 2017. MéTHODOLOGIE: Dans le cadre de l'enquête transversale participative Qanuilirpitaa? menée en 2017 auprès de 831 femmes et 436 hommes, des échantillons de sang furent prélevés pour mesurer divers indicateurs de la CF et de l'anémie ainsi que des biomarqueurs de l'état nutritionnel et inflammatoire et de l'exposition aux contaminants environnementaux. Des données sociodémographiques, anthropométriques, sur la sécurité alimentaire, sur le mode de vie, l'alimentation et la santé ont été recueillies à l'aide de questionnaires, de séances cliniques et d'un examen des dossiers médicaux. Les diagnostics de CF et d'anémie furent basés sur la ferritine sérique (SF) et l'hémoglobine (Hb), respectivement. Des régressions multiples ont été utilisées pour évaluer les déterminants de l'anémie et du statut en fer. RéSULTATS: La prévalence de la CF était la plus élevée chez les femmes en âge de procréer (16 à 49 ans, 33 %) et l'anémie chez les adultes âgés de 50 ans et plus (31 %). Ces estimés pourraient être biaisés puisque le taux de participation à l'enquête était relativement faible (37 %). Chez les femmes en âge de procréer, la vitamine D sérique, la teneur en acides gras polyinsaturés oméga-3 des membranes érythrocytaires, le sélénium sanguin, l'inflammation, un statut socio-économique plus élevé, l'obésité et la consommation d'alcool étaient tous associés positivement à la SF, tandis que l'infection à Helicobacter pylori et une grossesse récente étaient associées négativement à l'Hb. Chez les adultes plus âgés, l'insécurité alimentaire était associée à une diminution de la SF. CONCLUSION: Bien que les données de cette enquête suggèrent une amélioration depuis l'enquête précédente réalisée en 2004, des efforts additionnels sont requis pour améliorer le statut socioéconomique et l'accès aux aliments traditionnels et aux aliments de marché de qualité au Nunavik, les deux principaux facteurs protecteurs de la CF et de l'anémie identifiés dans la présente étude.

Inclusion of informal caregivers in the palliative and end-of-life care of older adults: a scoping review protocol.

INTRODUCTION: Palliative and end-of-life (EOL) care will increasingly be required in years to come as a result of an ageing population. An important component of this type of care is the inclusion of informal caregivers, who are family members or friends offering unpaid assistance to older adults with a terminal illness. Although systematic reviews were conducted on topics related to the inclusion of informal caregivers in the palliative and EOL care of older adults, several gaps remain as they were specific to a health condition and/or setting. The purpose of our scoping review is to map the extent of knowledge on this subject. METHODS AND ANALYSIS: We will conduct our scoping review following Levac's methodology. We will gather publications of various types through nine databases, manual searches in journals and search engines and reference lists. The selection process will be conducted by two independent reviewers and consist of screening by title and abstract, followed by reading the full text to confirm eligibility. An independent reviewer will then extract data and assess quality from included publications. Data extracted from different publication types will be synthesised together in the Excel software using a content analysis method, with quantitative data transformed into a qualitative description. Results will be presented through descriptive statistics and themes. During different steps of the review, we will also consult informal caregivers and health professionals for feedback as stakeholders. ETHICS AND DISSEMINATION: The conduction of this scoping review requires no ethical approval. Results will provide an overview of the state of knowledge on the inclusion of informal caregivers in palliative and EOL of older adults, which could help guide clinical practice, the development of interventions and policy and further research. We will disseminate these results by publishing an article, presenting in conferences, and discussing findings with stakeholders.