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IntroductionMechanical ventilation (MV) is an important intervention used in critically ill patients. Accurately identifying MV use in Hospital Discharge Abstracts will be extremely useful in population-based research. Although Canadian Institute for Health Information collects information on MV for all hospitalization, its validity in intensive care unit (ICU) patients is unknown.
Objectives and ApproachWe validated MV use within ICU patients in Hospital Discharge Abstracts. Winnipeg Regional Health Authority (WRHA) ICU database prospectively collects use of MV by trained nurses. All patients admitted to a WRHA ICU (82 beds) between April 1, 2000 and March 31, 2012 were identified in Hospital Discharge Abstracts. MV was identified in Hospital Discharge Abstracts through International Classification of Diseases (ICD-9-CM), prior to 2004, while Canadian Classification of Health Interventions (CCI) were used 2004 onwards. Agreement between the WRHA database (gold standard) and Hospital Discharge Abstracts for invasive ventilation, non-invasive ventilation or neither was calculated at ICU encounter level.
ResultsThere were 54,680 WRHA ICU admission during the study period. The linking of these two sources was highly successful with accurate identification exceeding 99%. There were 26,083 mechanical ventilations (25,387 invasive; 696 non-invasive) from the Hospital Discharge Abstracts and 30,455 (28,315 invasive; 4,554 non-invasive) from the CIC data. Hospital Discharge Abstracts had a sensitivity of 82.8%, specificity of 96.4%, Positive Predictive Value (PPV) of 96.7%, and Negative Predictive Value (NPV) of 81.7% for identifying mechanical ventilation. For invasive ventilation, Sensitivity was 85.5%, Specificity was 95.6%, PPV was 95.4% and NPV was 86.0%. Validation of non-invasive ventilation was poor in sensitivity (9.38%) and PPV (61.35%): with specificity 99.5% and NPV 92.36%.
Conclusion/ImplicationsHospital Abstracts data are a good source to identity mechanically ventilated patients for ICU containing hospital stays especially invasive mechanical ventilations. Future research needs to explore the poor agreement with non-invasive mechanical ventilation.

Introduction: Child abuse exposure is highly prevalent among military personnel compared with the general population. However, little is known regarding its relationship to compromised positive mental health outcomes, particularly in the Canadian Armed Forces (CAF). The objectives of this study were (1) to describe the prevalence of overall positive functioning and emotional well-being among CAF personnel with and without a child abuse history compared with the Canadian general population (CGP) and (2) to examine the relationships between child abuse and positive functioning and emotional well-being among the CAF compared with the CGP. Methods: Data were drawn from two nationally representative datasets: the 2013 Canadian Forces Mental Health Survey (Regular Forces, n = 6,692, response rate = 79.8%; Reserve Forces, n = 1,469, response rate = 78.7%) and the 2012 Canadian Community Health Survey–Mental Health ( n = 23,395; response rate = 68.9%). Keyes' Mental Health Continuum–Short Form was used to measure positive functioning and emotional well-being. Results: Compared with the CGP, CAF personnel had reduced functioning and emotional well-being. All child abuse types were associated with increased odds of experiencing moderate and languishing mental health and decreased odds of reporting individual indicators of positive functioning and emotional well-being among the CGP and CAF personnel. One significant population interaction effect was found, indicating that among the CAF, exposure to intimate partner violence had a stronger relationship with moderate mental health than among the CGP. Discussion: Child abuse history may be an important factor to consider when trying to improve positive functioning and emotional well-being among CAF personnel.

In Canada, suicide has transitioned from being a criminal activity with much associated stigma, to being a public health concern that needs to be managed by governments and clinicians in a culturally sensitive manner. In Canada and worldwide, the social attitudes toward and legal interpretation of suicide have been dynamic. Much has been proposed in the development of suicide policy in Canada, however Canada is unique in that it remains one of the only industrialized countries without a national suicide prevention strategy. The current article provides a critical review of the history of suicide in Canada, as well as an appraisal of Canadian suicide prevention policies and key government and political milestones that have impacted suicide policy. Current activity regarding a national suicide prevention strategy in Canada is discussed, as well as potential options for clinician involvement.

Purpose– The purpose of this paper is to investigate how service professionals involved in the provision of services to clientele who use solvents and are often without stable housing understand the process of healing and recovery in their work.Design/methodology/approach– Using a narrative methodology, semi-structured interviews were conducted with 12 human service professionals (i.e. social workers, case managers, etc.) employed in providing recovery-based services to individuals who use volatile solvents.Findings– Despite the dominant cultural story about "street addicts" and solvent users' limited possibilities for recovery, professionals indicate that they view their clients as "just like everyone else." The dominant storyline was that of advocating for the capability of the client group. These stories are discussed in relation to hope for professionals who provide health and housing services to clientele with complex and multi-systemic needs.Originality/value– The findings have implications for how human service providers maintain hope and purpose in their work with stigmatized populations (e.g. homeless individuals, those with alcohol or other drug-related problems). This study highlights how human service professionals make sense of their role in their work and how they maintain hope for themselves and for the recovery of the clientele they work alongside.

Introduction: The risks of suicidality (suicidal ideation or behaviour) are higher in Canadian Armed Forces (CAF) Veterans (former members) than in the Canadian general population (CGP). Suicide prevention is everyone's responsibility, but it can be difficult for many to see how they can help. This article proposes an evidence-based theoretical framework for discussing suicide prevention. The framework informed the 2017 joint CAF – Veterans Affairs Canada (VAC) suicide prevention strategy. Methods: Evidence for the framework was derived from participation in expert panels conducted by the CAF in 2009 and 2016, a review of findings from epidemiological studies of suicidality in CAF Veterans released since 1976, suicide prevention literature reviews conducted at VAC since 2009, and published theories of suicide. Results: Common to all suicide theories is the understanding that suicide causation is multifactorial, complex, and varies individually such that factors interact rather than lie along linear causal chains. Discussion: The proposed framework has three core concepts: a composite well-being framework, the life course view, and opportunities for prevention along the suicide pathway from ideation to behaviour. Evidence indicates that Veterans are influenced onto, along, and off the pathway by variable combinations of mental illness, stressful well-being problems and life events, individual factors including suicidal diathesis vulnerability, barriers to well-being supports, acquired lethal capability, imitation, impulsivity, and access to lethal means. The proposed framework can inform discussions about both whole-community participation in prevention, intervention and postvention activities at the individual and population levels, and the development of hypotheses for the increased risk of suicidality in CAF Veterans.

Background: Canadian First Nations (FN) people have experienced and continue to experience significant adversities, yet many demonstrate aspects of resilience. Aim: The aim of this qualitative study was to specifically understand Cree adults' meanings and mechanisms of resilience following maltreatment. Methods: Ten Cree adults were interviewed individually. Modified grounded theory was used to interpret the transcribed interviews. Results: Participants discussed resilience as a journey of 'survival' and 'overcoming' and pathways to healing that were multifactorial and included traditional teachings. Conclusion: Mental health providers should consider and incorporate these mechanisms into treatment for Cree people, when appropriate, to aid recovery.

OBJECTIVE: This study sought to examine differences in sociodemographic risk factors, comorbid mental conditions, clinical presentations, and functional impairments associated with past-year generalized anxiety disorder (GAD) between Canadian Armed Forces (CAF) Regular Force personnel and the Canadian general population (CGP). METHOD: Data were from 2 nationally representative surveys collected by Statistics Canada: 1) the Canadian Community Health Survey on Mental Health, collected in 2012 (N = 25,113; response rate = 68.9%); and 2) the Canadian Forces Mental Health Survey, collected in 2013 (N = 8,161; response rate = 79.8%). RESULTS: The prevalence of lifetime and past-year GAD was significantly higher in the CAF (12.1% and 4.7%) than in the CGP (9.5% and 3.0%). Comorbid mental disorders were strongly associated with GAD in both populations. Although the content area of worry and the GAD symptoms endorsed were similar, CAF personnel were significantly more likely to endorse specific types of worries (i.e., success at school/work, social life, mental health, being away from home or loved ones, and war or revolution) and specific symptoms of GAD (i.e., restless, keyed up, or on edge and more irritable than usual) than civilians, after adjusting for sociodemographic covariates and comorbid mental disorders. CAF personnel with past-year GAD reported significantly higher functional impairment at home than civilians with past-year GAD. CONCLUSION: GAD is a substantial public health concern associated with significant impairment and disability in both military and civilian populations. GAD in military and civilian populations shows similarities and differences: Key similarities include its extensive comorbidity and significant functional impairment, whereas key differences include the focus of worries and symptom profile.