Background: Chronic kidney disease is more prevalent among First Nations people than in non-First Nations people. Emerging research suggests that First Nations people are subject to greater disease burden than non-First Nations people. Objective: We aimed to identify the severity of chronic kidney disease and quantify the geographical challenges of obtaining kidney care by Saskatchewan’s First Nations people. Design: This study is a retrospective analysis of the provincial electronic medical record clinical database from January 2012 to December 2013. Setting: The setting involved patients followed by the Saskatchewan provincial chronic kidney care program, run out of two clinics, one in Regina, SK, and one in Saskatoon, SK. Patients: The patients included 2478 individuals (379 First Nations and 2099 non-First Nations) who were older than 18 years old, resident in Saskatchewan, and followed by the provincial chronic kidney care program. First Nations individuals were identified by their Indigenous and Northern Affairs Canada (INAC) Number. Measurements: The demographics, prevalence, cause of end-stage renal disease, severity of chronic kidney disease, use of home-based therapies, and distance traveled for care among patients are reported. Methods: Data were extracted from the clinical database used for direct patient care (the provincial electronic medical record database for the chronic kidney care program), which is prospectively managed by the health care staff. Actual distance traveled by road for each patient was estimated by a Geographic Information System Analyst in the First Nations and Inuit Health Branch of Health Canada. Results: Compared with non-First Nations, First Nations demonstrate a higher proportion of end-stage renal disease (First Nations = 33.0% vs non-First Nations = 21.4%, P < .001), earlier onset of chronic kidney disease (M_FN = 56.4 years, SD = 15.1; M_NFN = 70.6 years, SD = 14.7, P < .001), and higher rates of end-stage renal disease secondary to type 2 diabetes (First Nations = 66.1% vs non-First Nations = 39.0%, P < .001). First Nations people are also more likely to be on dialysis (First Nations = 69.7% vs non-First Nations = 40.2%, P < .001), use home-based therapies less frequently (First Nations = 16.2% vs non-First Nations = 25.7%; P = 003), and must travel farther for treatment ( P < .001), with First Nations being more likely than non-First Nations to have to travel greater than 200 km. Limitations: Patients who are followed by their primary care provider or solely through their nephrologist’s office for their chronic kidney disease would not be included in this study. Patients who self-identify as Aboriginal or Indigenous without an INAC number would not be captured in the First Nations cohort. Conclusions: In Saskatchewan, First Nations’ burden of chronic kidney disease reveals higher severity, utilization of fewer home-based therapies, and longer travel distances than their non-First Nations counterparts. More research is required to identify innovative solutions within First Nations partnering communities.

Sixty-one percent of households in the Greater Accra Region of Ghana (GAR), with an average size of 3.8 persons, occupy single bedrooms. Addressing their housing needs would require strategies of unleashing room supply through new housing and from existing housing through housing transformations (HT). Extant literature on HT in Ghana has generally focused on immediate empirical questions such as who are the housing transformers and their socio-economic identities and characteristics, and how to predict the occurrence of HT. Consumer sovereignty and utility maximization – the autonomous preferences of transformers – within the market context, as the determinant of the production and consumption of rooms, are implicit in these discussions, which are reminiscent of the ‘self-help’ housing thesis. This study’s alternative model employs primary data to identify the transformers and non-transformers as social classes with specific housing market capacities, and HT as enmeshed in broader processes of production and consumption of housing within the developing capitalist mode of production and its petty commodity production sector in GAR. The findings leave little optimism about a potential role of HT in making a significant dent in the staggering housing deficit.

Public safety personnel (PSP) are frequently exposed to psychologically traumatic events. The exposures potentiate posttraumatic stress injuries (PTSIs), including posttraumatic stress disorder (PTSD). The Royal Canadian Mounted Police (RCMP) Protocol was designed to mitigate PTSIs using ongoing monitoring and PSP-delivered Emotional Resilience Skills Training (ERST) based on the Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders. The current study pilot-tested ERST effectiveness among diverse PSP. A 16-month longitudinal design engaged serving PSP (n = 119; 34 % female; firefighters, municipal police, paramedics, public safety communicators) who completed PSP-delivered ERST. Participants were assessed for symptoms of PTSIs, including but not limited to PTSD, at pre- and post-training, and 1-year follow-up using self-report measures and clinical interviews. There were reductions in self-report and clinical diagnostic interview positive screens for PTSD and other PTSI from pre- to post-training (ps < 0.05), with mental health sustained or improved at 1-year follow-up. Improvements were observed among firefighters (Cohen's d = 0.40 to 0.71), police (Cohen's d = 0.28 to 0.38), paramedics (Cohen's d = 0.20 to 0.56), and communicators (Cohen's d = 0.05 to 0.14). Ongoing monitoring and PSP-delivered ERST, can produce small to large mental health improvements among diverse PSP, or mitigate PSP mental health challenges, with variations influenced by pre-training factors and organizational supports. ERST replication and extension research appears warranted. Hypotheses Registration: aspredicted.org, #90136. Registered 7 March 2022 - Prospectively registered. ClinicalTrials.gov, NCT05530642.

Background: Public safety personnel (PSP; e.g., border services personnel, correctional workers, firefighters, paramedics, police, public safety communicators) are frequently exposed to potentially psychologically traumatic events. Such events contribute to substantial and growing challenges from posttraumatic stress injuries (PTSIs), including but not limited to posttraumatic stress disorder. Methods: The current protocol paper describes the PSP PTSI Study (i.e., design, measures, materials, hypotheses, planned analyses, expected implications, and limitations), which was originally designed to evaluate an evidence-informed, proactive system of mental health assessment and training among Royal Canadian Mounted Police for delivery among diverse PSP (i.e., firefighters, municipal police, paramedics, public safety communicators). Specifically, the PSP PTSI Study will: (1) adapt, implement, and assess the impact of a system for ongoing (i.e., annual, monthly, daily) evidence-based assessments; (2) evaluate associations between demographic variables and PTSI; (3) longitudinally assess individual differences associated with PTSI; and, (4) assess the impact of providing diverse PSP with a tailored version of the Emotional Resilience Skills Training originally developed for the Royal Canadian Mounted Police in mitigating PTSIs based on the Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders. Participants are assessed pre- and post-training, and then at a follow-up 1-year after training. The assessments include clinical interviews, self-report surveys including brief daily and monthly assessments, and daily biometric data. The current protocol paper also describes participant recruitment and developments to date. Discussion: The PSP PTSI Study is an opportunity to implement, test, and improve a set of evidence-based tools and training as part of an evidence-informed solution to protect PSP mental health. The current protocol paper provides details to inform and support translation of the PSP PTSI Study results as well as informing and supporting replication efforts by other researchers. Trial registration: Hypotheses Registration: aspredicted.org, #90136. Registered 7 March 2022—Prospectively registered. Trial registration: ClinicalTrials.gov, NCT05530642. Registered 1 September 2022—Retrospectively registered. The subsequent PSP PTSI Study results are expected to benefit the mental health of all participants and, ultimately, all PSP.

Background: Public safety personnel (PSP) experience occupational stressors and potentially psychologically traumatic events, which increase the odds of screening positive for mental health disorders, and the risk of suicide. This study estimates suicidal ideation, planning, and attempts among Canadian PSP, and assesses associations with Emotional Resilience Skills Training (ERST).Method: The current study uses a longitudinal prospective sequential experimental cohort design that engages participants for approximately 16 months. Participants (n = 186, 60.5% men) were administered the structured Mini‐International Neuropsychiatric Interview at three time points relative to the ERST: pre‐training, post‐training, and 1‐year follow‐up.Results: At pre‐training, PSP reported past‐month suicidal ideation (n = 24; 12.9%), planning (n = 7; 3.8%), and no attempts. At post‐training, PSP reported past‐month suicidal ideation (n = 12; 10.1%), suicidal planning (n < 5), and no attempts (n = 0). At the 1‐year follow‐up, PSP reported past‐month suicidal ideation (n = 7; 12.5%), and no planning (n = 0) or attempts (n = 0).Conclusions: The results indicate suicide‐related challenges for PSP, particularly PSP who self‐identify as women and females. The results suggest sector‐specific differences in suicide attempts, indicating unique sector‐specific challenges among PSP. The results evidenced reductions in suicidal ideation and planning directly after ERST; however, attrition impacted analyses at 1‐year follow‐up. Additional sector‐specific mixed‐methods research would help inform suicide mitigation strategies.Trial Registration: ClinicalTrials.gov, NCT05530642. Hypotheses Registration: aspredicted.org, #90136. Registered 7 March 2022—Prospectively registered