Developing an alcohol strategy for the Northwest Territories: Evaluating global research evidence against rural and remote realities.

OBJECTIVES: This paper outlines the engagement process that was used to develop the Northwest Territories Alcohol Strategy, based on a recommendation by the developers of the Canadian Alcohol Policy Evaluation report, and how this informed the final actions in the strategy. METHODS: A literature review, four targeted engagement activities, and iterative validation by advisory groups and community and Indigenous leadership were used to evaluate, modify, or reject the original recommendations and develop the final actions that were included in the NWT Alcohol Strategy. RESULTS: There are fourteen original CAPE recommendations, four of which had already been implemented in the Northwest Territories before the development of the strategy. On completion of the process, four recommendations had already been implemented in the NWT. Two recommendations were included in the strategy without changes, two were adapted for use in the strategy, and six were not included. One stand-alone alcohol policy measure was created and included. CONCLUSION: Alcohol strategies are dependent on a variety of contextual factors. Developers need to take into consideration the unique geography, political climate, and cultural context of the region for which they are being developed, in order to produce a strategy that is applicable, acceptable, and feasible at the community level.

RéSUMé: OBJECTIFS: Cet article présente la méthodologie de projet utilisée pour élaborer la Stratégie sur l'alcool des Territoires du Nord-Ouest (TNO), basée sur un ensemble de recommandations formulées par les auteurs du rapport d'évaluation des politiques canadiennes sur l'alcool (CAPE). Il présente également les orientations et actions finales de la stratégie. MéTHODES: Une analyse documentaire, un dispositif de concertation multi-canal, ainsi qu'une validation itérative par des groupes consultatifs, des représentants des populations locales et autochtones ont été utilisées pour évaluer, modifier ou rejeter les recommandations originales et élaborer les actions finales à inclure dans la Stratégie sur l'alcool des TNO. RéSULTATS: Le CAPE comprend quatorze recommandations d'origine, dont quatre étaient déjà en vigueur dans les TNO avant l'élaboration de la stratégie. À l'issue du processus, quatre recommandations avaient déjà été mises en œuvre dans les TNO. Deux recommandations ont été incluses dans la stratégie sans modifications, deux ont été adaptées pour être mises en œuvre dans la stratégie, et six n'ont pas été incluses. En outre, une politique indépendante de quantification a été créée et incluse. CONCLUSION: Les stratégies en matière d'alcool dépendent de divers facteurs contextuels. Les concepteurs doivent tenir compte de la singularité géographique, du climat politique et du contexte culturel de la région pour laquelle elles sont élaborées, afin de rendre la stratégie applicable, acceptable et réalisable pour la population.

Ligne directrice canadienne pour la prise en charge clinique de la consommation d'alcool à risque élevé et du trouble d'utilisation de l'alcool.

CONTEXTE: Au Canada, on note que les équipes soignantes et les personnes qui bénéficieraient de soins ciblés connaissent peu les interventions fondées sur des données probantes pour la prise en charge clinique du trouble d'utilisation de l'alcool. Pour combler cette lacune, l'Initiative canadienne de recherche sur l'abus de substances a créé un comité national dans le but d'élaborer une ligne directrice pour la prise en charge clinique de la consommation d'alcool à risque élevé et du trouble lié à la consommation d'alcool. MÉTHODES: L'élaboration de cette ligne directrice s'est faite selon le processus ADAPTE, et est inspirée par une ligne directrice britanno-colombienne de 2019 pour le trouble lié à la consommation d'alcool. Un comité national de rédaction de la ligne directrice (composé de 36 membres de divers horizons, notamment des universitaires, des médecins, des personnes ayant ou ayant eu des expériences de consommation d'alcool et des personnes s'identifiant comme Autochtones ou Métis) a choisi les thèmes prioritaires, a passé en revue les données probantes et atteint un consensus relatif aux recommandations. Nous avons utilisé l'outil AGREE II (Appraisal of Guidelines for Research and Evaluation Instrument II) et les principes de divulgation des intérêts et de gestion des conflits lors du processus de rédaction des lignes directrices (Principles for Disclosure of Interests and Management of Conflicts in Guidelines) publiés en anglais par le Réseau international des lignes directrices (Guidelines International Network) pour nous assurer que la ligne directrice répondait aux normes internationales de transparence, de qualité élevée et de rigueur méthodologique. Nous avons évalué les recommandations finales à l'aide de l'approche GRADE (Grading of Recommendations Assessment, Development, and Evaluation). Les recommandations ont fait l'objet d'une revue externe par 13 spécialistes et parties prenantes d'ici et de l'étranger. RECOMMANDATIONS: La ligne directrice comprend 15 recommandations qui concernent le dépistage, le diagnostic, la prise en charge du sevrage et le traitement continu, y compris les interventions psychosociales, les pharmacothérapies et les programmes communautaires. Le comité de rédaction de la ligne directrice a reconnu la nécessité d'insister sur la sous-utilisation des interventions qui pourraient être bénéfiques et sur les modes de prescription et autres pratiques d'usage courant qui ne reposent pas sur des données probantes et pourraient aggraver les effets de la consommation d'alcool. INTERPRÉTATION: La ligne directrice se veut une ressource à l'intention des médecins, des responsables des orientations politiques et des membres des équipes cliniques et autres, de même que des personnes, des familles et des communautés affectées par la consommation d'alcool. Ces recommandations proposent un cadre fondé sur des données probantes pour alléger le lourd fardeau du trouble d'utilisation de l'alcool au Canada et combler les besoins en matière de traitements et de soins.

Canadian guideline for the clinical management of high-risk drinking and alcohol use disorder.

BACKGROUND: In Canada, low awareness of evidence-based interventions for the clinical management of alcohol use disorder exists among health care providers and people who could benefit from care. To address this gap, the Canadian Research Initiative in Substance Misuse convened a national committee to develop a guideline for the clinical management of high-risk drinking and alcohol use disorder. METHODS: Development of this guideline followed the ADAPTE process, building upon the 2019 British Columbia provincial guideline for alcohol use disorder. A national guideline committee (consisting of 36 members with diverse expertise, including academics, clinicians, people with lived and living experiences of alcohol use, and people who self-identified as Indigenous or Métis) selected priority topics, reviewed evidence and reached consensus on the recommendations. We used the Appraisal of Guidelines for Research and Evaluation Instrument (AGREE II) and the Guidelines International Network's Principles for Disclosure of Interests and Management of Conflicts to ensure the guideline met international standards for transparency, high quality and methodological rigour. We rated the final recommendations using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) tool; the recommendations underwent external review by 13 national and international experts and stakeholders. RECOMMENDATIONS: The guideline includes 15 recommendations that cover screening, diagnosis, withdrawal management and ongoing treatment, including psychosocial treatment interventions, pharmacotherapies and community-based programs. The guideline committee identified a need to emphasize both underused interventions that may be beneficial and common prescribing and other practice patterns that are not evidence based and that may potentially worsen alcohol use outcomes. INTERPRETATION: The guideline is intended to be a resource for physicians, policymakers and other clinical and nonclinical personnel, as well as individuals, families and communities affected by alcohol use. The recommendations seek to provide a framework for addressing a large burden of unmet treatment and care needs for alcohol use disorder within Canada in an evidence-based manner.

Injuries in the North--analysis of 20 years of surveillance data collected by the Canadian Hospitals Injury Reporting and Prevention Program.

BACKGROUND: Injury is a major public health concern, particularly for Canadians living in Arctic regions where the harsh physical and social conditions pose additional challenges. Surveillance data collected over the past 2 decades through the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) provide insights into the burden of injuries in certain parts of Canada. OBJECTIVES: This study aims to summarize and compare patterns of injuries in the Northwest Territories (NWT) and Nunavut to other southern communities across Canada. METHODS: Analysis was based on CHIRPP data covering the period 1991-2010. Proportionate injury ratio (PIR) and its 95% confidence interval were used to summarize and compare the injury experience of Canadians living in the Arctic regions to other CHIRPP sites across Canada. RESULTS: Between 1991 and 2010, there were 65,116 reported injuries. Approximately 83% of the cases were unintentional in nature; however, significantly higher proportions were observed for assaults and maltreatment (PIR = 2.80, 95% CI: 2.72-2.88) among Canadians living in northern communities. Significantly higher proportions were also observed for crushing/amputations (PIR = 2.28, 95% CI: 2.14-2.44), poison/toxic effects (PIR = 1.21, 95% CI: 1.15-1.28), drowning/asphyxiations (PIR = 1.52, 95% CI: 1.33-1.74) and frostbites (PIR = 7.39, 95% CI: 6.60-8.28). The use of all-terrain vehicles or snowmobiles also resulted in significantly higher proportions of injuries (PIR = 1.93, 95% CI: 1.79-2.09). CONCLUSIONS: This study contributes to the limited literature describing injuries in northern communities where the harsh physical and social climates pose additional challenges. Excesses in the proportions identified in this study could be useful in identifying strategies needed to minimize injury risks in northern communities within Canada.

Sex ratios in the Arctic--do man-made chemicals matter?

OBJECTIVES: The objective was to analyze the variation of secondary sex ratios across the Arctic and to estimate the time trend. The rationale for this was claims in news media that, in the Arctic, sex ratios have become reduced due to exposure to anthropogenic contaminants in the environment. METHODS: Data was collected from 27 circumpolar jurisdictions from public websites of the eight Arctic countries. Sex ratios at birth were calculated for each jurisdiction and each available year. Linear regression models of the sex ratios across time were fit within each jurisdiction to estimate the change in sex ratio over time. RESULTS: All male:female sex ratios were close to 1.05 with time trends close to 0. In a Bayesian hierarchical model overall sex ratio was estimated at 1.054 (95% confidence interval 1.048, 1.058). The estimate for the 10-year slope across all jurisdictions was 0.0010 (95% confidence interval -0.0021, 0.0046). Separate analyses of indigenous populations in Alaska and Greenland gave similar results and similar sex ratios were found among Greenland Inuit in 1900 and today. CONCLUSIONS: The absence of deviation of the secondary sex ratio in any of the Arctic jurisdictions indicates that the contaminants that are present are not disrupting endocrine systems to the extent that sex ratios are being affected.