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Little information has been published about the mortality of the Métis people of Canada. This study describes mortality patterns among Métis and Registered Indian adults, compared with the non-Aboriginal population. The 1991 to 2001 Canadian census mortality followup study tracked mortality among a 15% sample of respondents aged 25 or older, including 11,800 Métis, 56,700 Registered Indians and 2,624,300 non-Aboriginal adults, all of whom were enumerated by the 1991 census long-form questionnaire. Age-specific and age-standardized mortality rates and period life tables based on the number of person-years at risk were calculated across the various groups. Métis were defined by ethnic origin (ancestry). Compared with non-Aboriginal members of the cohort, life expectancy at age 25 was 3.3 and 5.5 years shorter for Métis men and women, respectively, and 4.4 and 6.3 years shorter for Registered Indians. For both Aboriginal groups, mortality rate ratios were highest at younger ages. Mortality rate differences among Métis men were particularly elevated for external causes and circulatory, respiratory and digestive system diseases; among Métis women, for circulatory system diseases, cancers, and digestive and respiratory system diseases. Generally, rate differences for Registered Indian men and women were further elevated. Métis adults had higher mortality rates compared with non-Aboriginal members of the cohort, but lower rates than did Registered Indians.

Because of a lack of Aboriginal identifiers on death registrations, standard data sources and methods cannot be used to estimate basic health indicators for Inuit in Canada. Instead, a geographic-based approach was used to estimate life expectancy for the entire population of Inuit-inhabited areas. The data are from the Canadian Mortality Database and the Census of Canada. Areas where at least 33% of residents were Inuit were identified, based on census results. Vital statistics death records for 1989 through 2003 and census population counts for 1991, 1996 and 2001 were used to compute abridged life tables for the Inuit-inhabited areas in each of the three 5-year periods centered around those census years. In 1991, life expectancy at birth in the Inuit-inhabited areas was about 68 years, which was 10 years lower than for Canada overall. From 1991 to 2001, life expectancy in the Inuit-inhabited areas did not increase, although it rose by about two years for Canada as a whole. As a result, the gap widened to more than 12 years. Life expectancy in the Inuit-inhabited areas was generally highest in the Inuvialuit region (Northwest Territories) and Nunavut (Territory), followed by Nunatsiavut (Labrador) and Nunavik (Quebec). While these results are not specific to the Inuit population, such geographic-based methods can be used with any administrative datasets that include postal codes or municipal-level locality codes.

Purpose Once difficult ventilation and intubation are declared, guidelines suggest the use of a supraglottic airway (SGA) as a rescue device to ventilate and, if oxygenation is restored, subsequently as an intubation conduit. Nevertheless, few trials have formally studied recent SGA devices in patients. Our objective was to compare the efficacy of three second-generation SGA devices as conduits for bronchoscopy-guided endotracheal intubation. Methods In this prospective, single-blinded three-arm randomized controlled trial, patients with an American Society of Anesthesiologists Physical Status of I–III undergoing general anesthesia were randomized to bronchoscopy-guided endotracheal intubation using AuraGain™, Air-Q® Blocker, or i-gel® devices. We excluded patients with contraindications to an SGA or drugs and who were pregnant or had a neck, spine, or respiratory anomaly. The primary outcome was intubation time, measured from SGA circuit disconnection to CO 2 measurement. Secondary outcomes included ease, time, and success of SGA insertion; success of intubation on first attempt; overall intubation success; number of attempts to intubate; ease of intubation; and ease of SGA removals. Results One hundred and fifty patients were enrolled from March 2017 to January 2018. Median intubation times were similar across the three groups (Air-Q Blocker, 44 sec; AuraGain, 45 sec; i-gel, 36 sec; P = 0.08). The i-gel was faster to insert (i-gel: 10 sec; Air-Q Blocker, 16 sec; AuraGain, 16 sec; P < 0.001) and easier to insert (Air-Q Blocker vs i-gel, P = 0.001; AuraGain vs i-gel, P = 0.002). Success of SGA insertion, success of intubation, and number of attempts were similar. The Air-Q Blocker was easier to remove than the i-gel ( P < 0.001). Conclusion All three second-generation SGA devices performed similarly regarding intubation. Despite minor benefits of the i-gel, clinicians should select their SGA based on clinical experience. Study registration ClinicalTrials.gov (NCT02975466); registered on 29 November 2016.

Information on health disparities between Aboriginal and non-Aboriginal populations is essential for developing public health programs aimed at reducing such disparities. The lack of data on disparities in birth outcomes between Inuit and non-Inuit populations in Canada prompted us to compare birth outcomes in Inuit-inhabited areas with those in the rest of the country and in other rural and northern areas of Canada. We conducted a cohort study of all births in Canada during 1990–2000 using linked vital data. We identified 13 642 births to residents of Inuit-inhabited areas and 4 054 489 births to residents of all other areas. The primary outcome measures were preterm birth, stillbirth and infant death. Compared with the rest of Canada, Inuit-inhabited areas had substantially higher rates of preterm birth (risk ratio [RR] 1.45, 95% confidence interval [CI] 1.38–1.52), stillbirth (RR 1.68, 95% CI 1.38–2.04) and infant death (RR 3.61, 95% CI 3.17–4.12). The risk ratios and absolute differences in risk for these outcomes changed little over time. Excess mortality was observed for all major causes of infant death, including congenital anomalies (RR 1.64), immaturity-related conditions (RR 2.96), asphyxia (RR 2.43), sudden infant death syndrome (RR 7.15), infection (RR 8.32) and external causes (RR 7.30). Maternal characteristics accounted for only a small part of the risk disparities. Substantial risk ratios for preterm birth, stillbirth and infant death remained when the comparisons were restricted to other rural or northern areas of Canada. The Inuit-inhabited areas had much higher rates of preterm birth, stillbirth and infant death compared with the rest of Canada and with other rural and northern areas. There is an urgent need for more effective interventions to improve maternal and infant health in Inuit-inhabited areas.

Background Australia, Canada, and New Zealand are all developed nations that are home to Indigenous populations which have historically faced poorer outcomes than their non-Indigenous counterparts on a range of health, social, and economic measures. The past several decades have seen major efforts made to close gaps in health and social determinants of health for Indigenous persons. We ask whether relative progress toward these goals has been achieved. Methods We used census data for each country to compare outcomes for the cohort aged 25–29 years at each census year 1981–2006 in the domains of education, employment, and income. Results The percentage-point gaps between Indigenous and non-Indigenous persons holding a bachelor degree or higher qualification ranged from 6.6% (New Zealand) to 10.9% (Canada) in 1981, and grew wider over the period to range from 19.5% (New Zealand) to 25.2% (Australia) in 2006. The unemployment rate gap ranged from 5.4% (Canada) to 16.9% (Australia) in 1981, and fluctuated over the period to range from 6.6% (Canada) to 11.0% (Australia) in 2006. Median Indigenous income as a proportion of non-Indigenous median income (whereby parity = 100%) ranged from 77.2% (New Zealand) to 45.2% (Australia) in 1981, and improved slightly over the period to range from 80.9% (Canada) to 54.4% (Australia) in 2006. Conclusions Australia, Canada, and New Zealand represent nations with some of the highest levels of human development in the world. Relative to their non-Indigenous populations, their Indigenous populations were almost as disadvantaged in 2006 as they were in 1981 in the employment and income domains, and more disadvantaged in the education domain. New approaches for closing gaps in social determinants of health are required if progress on achieving equity is to improve.

In 2004, Registered Indian teenage girls aged 15 to 19 had a 94‰ fertility rate, 7 times the average Canadian rate for the same age group. Despite various general studies on the subject, there has been little interest in the past on the intergenerational character of teenage fertility. Analysis of data from the Indian Register of the Ministry of Aboriginal Affairs and Northern Development Canada (AANDC) reveals that, among Registered Indian teenage girls, the fertility of daughters of teenage mothers is systematically higher than for daughters of mothers aged 20 or older. While it is impossible to establish a direct link of causality, the results of this study demonstrate for the first time the intergenerational nature of teenage motherhood among Registered Indian girls.

Aboriginal peoples experience a disproportionate burden of disease, compared with other Canadians. However, relatively little information is available about mortality among Métis and non-Status Indians. This study calculates potential years of life lost before age 75 (PYLL) for people aged 25 to 74 by all-cause and cause-specific mortality, and examines the effect of socio-economic factors on premature mortality. Age-specific and age-standardized PYLL rates were calculated for 11,600 Métis, 5,400 non-Status Indians, and 2,475,700 non-Aboriginal adults based on the number of person-years at risk up to age 75. Métis and non-Status Indian adults had about twice the risk of dying before age 75, compared with non-Aboriginal adults. While the largest percentage of PYLL was due to non-communicable diseases such as cardiovascular disease and cancer, relative and absolute inequalities were greatest for injuries. Socioeconomic indicators such as income, education and employment explained a large share of the disparities in premature mortality. The results highlight the losses of potential years of life due to chronic diseases, as well as the possible importance of injury prevention programs for Métis and non-Status Indians.

Following the article by Hélène Vézina et al. on the relation between ancestral origins and reported ethnic origins in Canada published in this same issue, this second article shows how an individual's reported ethnic affiliation is liable to vary over time. Using record linkage between the 2001 and 2006 censuses, Éric CARON-MALENFANT, Simon COULOMBE, Eric GUIMOND, Chantal GRONDIN and André LEBEL reveal the extent to which individuals' self-reported identity changes within the space of five years. Between the two censuses, this ethnic mobility accounted for much of the increase in populations of North American Indians, and of Métis in particular, to the detriment of non- Aboriginal populations. This article shows how these ethnic categories are appropriated and used by different populations, and reveals the instability of reported ethnic affiliation over the life course.

This article reviews literature on the gradual construction of teenage pregnancy as a social issue in North America. It shows how teen motherhood emerged not as an issue unto itself, but as a microcosm of numerous, closely intertwined phenomena including: the evolution of Western views on human sexuality and gender roles; the place of religious values in society; and the emergence of various modern technologies, the social and medical sciences, and how such disciplines view childhood, motherhood, and women in society. In particular, it shows that even as teen pregnancy is today viewed primarily through public health and/or socioeconomic lenses, it has never been completely divorced from its original construction – as an indicator of failure to adhere to social, religious, and moral values. The article closes with an informal content analysis of several First Nations-related documents that highlight both similarities and differences to the non-Aboriginal perspective. Cet article examine la documentation sur la construction graduelle de la grossesse à l’adolescence en tant que « problème » social en Amérique du Nord. Il montre la façon dont la grossesse à l’adolescence est devenue non pas une question en soi, mais un microcosme de nombreux phénomènes étroitement liés, dont: l’évolution des points de vue occidentaux sur la sexualité humaine et les rôles des sexes; la place des valeurs religieuses dans la société; l’émergence de diverses technologies modernes ainsi que des sciences sociales et médicales, et le regard que ces disciplines portent sur l’enfance et la maternité. Plus particulièrement, nous constatons à quel point, même si la grossesse à l’adolescence est surtout abordée aujourd’hui d’un point de vue socioéconomique et de santé publique, elle n’a jamais complètement été séparée de sa construction initiale, c’est à dire comme indicateur de non respect des valeurs sociales, religieuses et morales. En este artículo se examina la documentación sobre la interpretación gradual de los embarazos de las adolescentes como un ‘problema’ social en América del Norte. En él se muestra cómo los embarazos de las adolescentes surgieron no como una cuestión en sí, sino como un microcosmos de numerosos fenómenos estrechamente ligados entre sí, como: la evolución en Occidente de los puntos de vista sobre la sexualidad humana y los roles establecidos en función del sexo; el lugar de los valores religiosos en la sociedad; y la aparición de diversas tecnologías y de las ciencias sociales y médicas modernas y la manera en la que estas disciplinas ven la infancia y la maternidad. De manera concreta, nos damos cuenta de que, aunque los embarazos de adolescentes se ven principalmente en la actualidad desde una perspectiva socioeconómica y de salud, nunca se han distanciado de su interpretación original, esto es, como un indicador de no conformidad con los valores sociales, religiosos o morales.