Outcome progress letter types: parent and physician preferences for letters from pediatric mental health services.

OBJECTIVE: To determine health care professional and parental preferences for receiving progress letters from a pediatric mental health program between a traditional text-only format and a version in which information was presented using graphs and tables with limited text. DESIGN: Mailed survey. SETTING: Nova Scotia. PARTICIPANTS: Parents (n = 98) of children who received treatment from and health care professionals (n = 74) who referred patients to the Strongest Families Program (formerly the Family Help Program) were eligible. Most of the health care professionals were family practitioners (83.8%). MAIN OUTCOME MEASURES: Preference between 2 letters that contained the same content (including progress in the program, results from a questionnaire, and resolved and ongoing problems) in different formats--one using text only, the other using graphs as well as text. RESULTS: In total, 83.8% of health professionals and 76.5% of parents indicated that they preferred to receive feedback in letters containing information in graphical format. Background and demographic information did not predict preferences. Parents preferred to receive progress letters at the beginning, midway through, and at the end of treatment, and health professionals preferred to receive progress letters at the beginning and end of treatment. CONCLUSION: When receiving progress letters from a pediatric mental health program, health care professionals and parents preferred to receive letters that used graphs to help convey information.

Health of First Nations children living off reserve and Métis children younger than age 6.

BACKGROUND: Aboriginal children have been shown to experience poorer health, compared with their non-Aboriginal counterparts. Differences in health status may be associated with family and social conditions, lifestyle or behaviour, and cultural factors. DATA AND METHODS: The current study examined the parent-/guardian-reported health of First Nations children living off reserve and Métis children younger than 6. This does not include the 43% of First Nations children who were living on reserves in 2006. Data from the 2006 Aboriginal Children's Survey were used to investigate measures of child health and assess possible associations with social determinants of health. RESULTS: Most First Nations children living off reserve and Métis children were reported to be in excellent or very good health. The most common chronic conditions reported by parents/guardians were asthma, speech and language difficulties, allergies, and lactose intolerance. Several social determinants were associated with child health, including parental education, household income, breastfeeding, and perceptions of housing conditions and health facilities in the community. INTERPRETATION: The findings suggest that social factors can be associated with parent-/guardian-rated health of First Nations children living off reserve and Métis children under age 6.

The health of Inuit children under age 6 in Canada.

OBJECTIVES: Previous research has suggested that Inuit children experience poor health as compared to their non-Aboriginal counterparts, although social determinants such as family and social conditions, lifestyle or behaviour, and cultural factors may be at play. The purpose of the current study was to examine the parent-reported health of Inuit children under 6 years of age living in Canada. STUDY DESIGN AND METHODS: Data from the 2006 Aboriginal Children's Survey were used to examine measures of Inuit child health as rated by parents including child health, limitations to physical activity, chronic conditions, ear infections, and dental problems. Associations between social determinants of health and parent-rated Inuit child health were also explored. RESULTS: Most Inuit children under age 6 were reported by their parents or guardians to be in excellent or very good health. The most common chronic conditions identified were asthma, speech and language difficulties, allergies, lactose intolerance, and hearing impairment. Several social determinants of health were associated with child health, including parental education, household income, breastfeeding, and perceived housing conditions. CONCLUSIONS: The findings show that social determinants of health, including both socio-economic and household characteristics, are associated with Inuit child health.

Suicidal ideation among Métis adult men and women--associated risk and protective factors: findings from a nationally representative survey.

OBJECTIVE: To determine the prevalence of suicidal ideation among Métis men and women (20-59 years) and identify its associated risk and protective factors using data from the nationally representative Aboriginal Peoples Survey (2006). STUDY DESIGN: Secondary analysis of previously collected data from a nationally representative cross-sectional survey. RESULTS: Across Canada, lifetime suicidal ideation was reported by an estimated 13.3% (or an estimated 34,517 individuals) of the total population of 20-to-59-year-old Métis. Of those who ideated, 46.2% reported a lifetime suicide attempt and 6.0% indicated that they had attempted suicide in the previous 12 months. Prevalence of suicidal ideation was higher among Métis men than in men who did not report Aboriginal identity in examined jurisdictions. Métis women were more likely to report suicidal ideation compared with Métis men (14.9% vs. 11.5%, respectively). Métis women and men had some common associated risk and protective factors such as major depressive episode, history of self-injury, perceived Aboriginal-specific community issues, divorced status, high mobility, self-rated thriving health, high self-esteem and positive coping ability. However, in Métis women alone, heavy frequent drinking, history of foster care experience and lower levels of social support were significant associated risk factors of suicidal ideation. Furthermore, a significant interaction was observed between social support and major depressive episode. Among Métis men, history of ever smoking was the sole unique associated risk factor. CONCLUSION: The higher prevalence of suicidal ideation among Métis women compared with Métis men and the observed gender differences in associations with some associated risk and protective factors suggest the need for gender-responsive programming to address suicidal ideation.

Family caregiver burden: results of a longitudinal study of breast cancer patients and their principal caregivers.

BACKGROUND: The vital role played by family caregivers in supporting dying cancer patients is well recognized, but the burden and economic impact on caregivers is poorly understood. We prospectively examined the psychosocial, occupational and economic impact of caring for a person with a terminal illness. METHODS: We studied 89 caregivers of women with advanced breast cancer receiving care at either the Ottawa or Hamilton regional cancer centres in Ontario. Patients were followed until their death or study completion at 3 years. Patients identified a principal caregiver to participate in the study. The Karnofsky Performance Status (KPS) index, the Medical Outcomes Study 36-item Short Form (SF-36), the Hospital Anxiety and Depression Scale, the Zarit Burden Inventory, FAMCARE and the Medical Outcomes Study Social Support Survey were administered during follow-up. Economic data were collected by means of a questionnaire administered by an interviewer. Assessments were conducted every 3 months during the palliative period (KPS score > 50) and every 2 weeks during the terminal period (KPS score < or = 50). RESULTS: Over half of the caregivers were male (55%) and the patient's spouse or partner (52%), with a mean age of 53 years. At the start of the palliative period, the caregivers' mean physical functioning score was better than the patients' (51.3 v. 35.1, 95% confidence interval [CI] 13.3-20.0); there were similar mean mental functioning scores (46.6 and 47.1 respectively); similar proportions were depressed (11% and 12%); and significantly more caregivers than patients were anxious (35% v. 19%, p = 0.009). More caregivers were depressed (30% v. 9%, p = 0.02) and had a higher level of perceived burden (26.2 v. 19.4, p = 0.02) at the start of the terminal period than at the start of the palliative period. Burden was the most important predictor of both anxiety and depression. Of employed caregivers, 69% reported some form of adverse impact on work. In the terminal period 77% reported missing work because of caregiving responsibilities. Prescription drugs were the most important component of financial burden. INTERPRETATION: Caregivers' depression and perceived burden increase as patients' functional status declines. Strategies are needed to help reduce the psychosocial, occupational and economic burden associated with caregiving.