Tag Archives: Health Services

Reducing interprofessional conflicts in order to facilitate better rural care: A report from a 2016 Rural Surgical Network Invitational Meeting

Author: Hayley Pelletier

Abstract

An invitational meeting organized by the Centre for Rural Health Research convened to facilitate respectful dialogue with general surgeons in British Columbia to clearly understand concerns and address questions around rural family physicians with enhanced surgical skills (FPESS). In particular, the meeting focused on interprofessional challenges that hinder the adoption of a network model between general surgeons and FPESS. This report summarizes the findings (n=5) and recommendations (n=8) from the meeting. The meeting underscored the need for more thoughtful discussions to develop interprofessional trust and support between general surgeons and FPESS through an integrated health care system and proper networks.

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Healthcare in Cuba: Defining Features and Future Trends

In 2016, Cuba made headlines for the status of its economic embargo with the US, its increasing foreign investments through tourism, and the death of Fidel Castro. Besides these recent events, in a sense foreshadowing Cuba’s future political and economic paths, throughout the 20th century, Cuba’s healthcare system has been acclaimed as one of the best healthcare systems in the world with very good health outcomes for the Cuban people. For example, infant mortality is lower than in the US and the life expectancy is 77.5 years of age (WHO, 2016). What are the Cuban healthcare system’s defining features? Will recent events alter some of its key aspects?

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Finding Potential in Another Mother’s Breastmilk

In Canada, the primary cause of mortality in infancy and long-term disability in children is being born at very low birth weight (<1500g or <3.3lbs; Saigal & Doyle, 2008). If these infants are fed their mother’s milk in the neonatal intensive care unit (NICU) they experience fewer severe infections (Hylander, Strobino, & Dhanireddy, 1998; Patel et al., 2013), improved feeding tolerance (Schanler, Shulman, & Lau, 1999; Sisk, Lovelady, Gruber, Dillard, & O’Shea, 2008), lower colonization of pathogenic bacteria (Yoshioka, Iseki, & Fujita, 1983), and increased neurocognitive development (Anderson, Johnstone, & Remley, 1999). However, due to many reasons related to preterm birth, as many as 70% of mothers cannot provide a sufficient amount of breastmilk to meet the demands of these infants, therefore, a supplement is necessary (Callen & Pinelli, 2005). Currently in Canada, either pasteurized donor breastmilk (donor milk) or preterm formula is used as a supplement to mother’s milk.

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Planning and delivery of health services – an article review on urban aboriginal mobility in Canada: examining the association with healthcare utilization

Author: Ankit Dhawan

Abstract

An article from Social Science and Medicine, written by Snyder and Wilson (2012), examined the use of healthcare services by urban Aboriginal populations in Canada. Using the Behavioural Model of Health Services Use (BMHSU), predisposing, enabling, and need factors were organized and used for data analysis. Specifically, a comparison was made between conventional (physicians and nurses) and traditional (traditional healers) health service utilization in Toronto and Winnipeg. In addition to the geographical and educational factors, the results of the research recognized mobility as a significant predisposing complement to healthcare utilization.

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The Development of Scoring Criteria for a New Picture Naming Task

Authors: Ferzin MahavaChristine SheppardLaura MonettaVanessa Taler

Abstract

Objective: The purpose of the study was to develop a scoring system for a novel naming task suitable for assessing naming performance in younger (18-30 years) and older (65+ years) adults in monolingual English, monolingual French, and English-French bilingual groups. This novel naming task will serve as an important health service to help diagnose and assess cognitively impaired older individuals, while also serving as an educational tool for healthcare providers.

Materials and Methods: The Naming Task consists of 120 images organized in the same randomized order, and are shown on a white background displayed on a computer screen using PowerPoint. Participants are instructed to name the image displayed. Monolinguals completed the test in their native language and bilinguals completed the test in English only, French only, and a bilingual administration. Scoring criteria was established based on the responses from testing.

Results: Strict and lenient scoring criteria developed for the Naming Task are presented. Eight items were removed from the original Naming Task due to quality and/or clarity, inability to name the image, or too many alternate responses. Performance in mono-lingual English and French was similar in younger and older adults for strict and lenient scoring. Bilinguals performed better with bilingual administration and worse with French administration, where scores were the lowest of all age and language groups.

Conclusion: The Naming Task appears to be suitable for monolingual French and English individuals. Results suggest that a bilingual administration should be used when testing English-French bilinguals.

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Transmission of Human Papillomavirus Without Sexual Contact

Authors: Naweed Ahmed, Wakqas Kayani, Sahab Jamshidi, Suneil Bapat, Ahmed ImamovicPanteha Tavassol

Abstract

Human papillomavirus (HPV) is one of the most common sexually transmitted infections. There are four common HPV strains: 6, 11, 16, and 18. Strains 6 and 11 cause genital warts, while strains 16 and 18 are asymptomatic in males and may progress to cervical cancer in females. Although uncommon, a small percentage of males and females have been diagnosed with HPV without previous sexual contact. In this case report, we discuss a case conducted on a 15-year-old South Asian male who contracted an unknown low-risk strain of HPV with no history of sexual contact. HPV is highly infectious, however in the majority of cases the immune system is able to clear the infection, preventing the appearance of genital warts. In cases such as these, it is important to help control the spread of viral infections. Several determinants of health are involved in and affect the trans-mission of HPV, including income and social status, social support networks, education and literacy, culture, social and physical environments, and health services. To aid in the prevention of HPV, sexual education should be taught at early ages within schools and the Gardasil® vaccine should be administered to both females and males at an early age to reduce the burden of disease and the incidence of HPV.

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A Healthcare Lesson: Comparing Chaoulli v. Quebec (2005) and Cambie Surgery Centre v. British Columbia (2016)

Publicly insured healthcare in Canada, also known as Medicare, is currently being reviewed in a judicial case in the Supreme Court of British Columbia. The lawsuit filed by Cambie Surgery Centre is calling for allowing “medically necessary services” – those covered by public insurance – to be privately insured in order to improve access to care. Health services researchers, policy makers and citizens alike, are worried of the outcome of this 8-month provincial trial, as it is suggested that an outcome in favour of Cambie’s position would lead to a complete overhaul of Canada’s public healthcare system. In the midst of heated debates, we tend to forget that just over a decade ago, a similar legal battle challenging the extent of public insurance in Canada occurred in the province of Quebec. How are these two cases similar or different? What are the implications of each? What are lessons that can be learnt?

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Choice in childbirth: VBAC

Childbirth is a ubiquitous experience among mothers. Birth can occur in many ways, from medication-free natural labour, to cesarean section. Mothers in Canada can, for the most part, choose how they want to deliver. However, women with a prior cesarean section have a more difficult choice to make. They can choose to have a repeat cesarean section, or to attempt a vaginal birth after cesarean – a VBAC. How do women make this decision, and how can healthcare providers support them?

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Ins and outs of cancer screening

 

It’s estimated that approximately 2 in 5 Canadians will develop cancer during their lifetime, and that 1 in 4 will die from the disease1. Cancer affects or touches almost everyone in this country in some way, and a lot of research has gone into preventing and treating the disease. The overall 5-year survival rate for all cancers in Canada was 63% for 2006-20081. It’s well known that cancers that are caught early have a higher chance of successful treatment and survival. One of the ways that we can diagnose these early-stage cancers is through screening.

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Let’s talk about sex: navigating the social, political, and medical perspectives of sexual and reproductive health research

As health scientists and researchers, one of the questions we get asked the most often about our work is, “Okay, but why should I care about that?” As someone who specializes in sexual and reproductive health, I’ll admit that this is a pretty easy question to answer. Sex and reproduction are not only essential to our survival as a human race, but they are also important parts of our day-to-day lives.

Every year, there are more than 208 million pregnancies that occur worldwide; more than 40% of these pregnancies are unplanned (Singh, Sedgh, & Hussain, 2010). The World Health Organization reports that every day in 2013, 800 women around the world died due to complications with pregnancy and childbirth, even though the majority of these deaths could have been prevented (World Health Organization, 2015). Further, over 10% of women worldwide do not have access to or are not using an effective method of contraception.

On a more individual level, while making decisions about sexual activity and family planning may not be all that we do, it certainly influences every aspect of our lives. Our occupational, educational, financial, and social outcomes are all directly affected by if, when, and how we have children. Further, our parents’ choices about birth spacing and family size undoubtedly impacted our childhoods and influenced how we envision and interact with our (current or future) families.

Yet despite the fact that sexual and reproductive health issues affect us all, talking about these topics continues to be a challenge. There is an ongoing debate between the social, political, and medical perspectives with regards to issues such as contraception, abortion, HIV/AIDS, and more. For example, changes made in 2015 to Ontario’s sexual health curriculum for public school students resulted in province-wide protests and some parents choosing to remove their children from school.

From a medical perspective, there is a substantial body of evidence that shows that access to high-quality, safe family planning services and sexual health education is beneficial not just for individuals, but for societies as a whole. Indeed, when abortion is legalized, we see significant drops in the rate of maternal mortality (Cates, Grimes, & Schulz, 2003; Khan, Wojdyla, Say, Gülmezoglu, & Van Look, 2006). With access to contraception, rates of unplanned pregnancy and teenage births are reduced (Peipart, Madden, Allsworth, & Secura, 2012; Singh et al., 2010). And when sexual education is comprehensive, we see increased condom use, lower pregnancy rates, and a decrease in sexual risk taking among youth (Kirby, Laris, & Rolleri, 2007; Starkman & Rajani, 2002).

But as researchers, it is no easy feat to navigate the complex relationships between evidence-based medicine, stigma, and social attitudes and acceptability. Even if the evidence base is available, how do we convince policy makers to incorporate these facts?

In the summer of 2015, Health Canada finally approved mifepristone, the gold-standard of medication abortion that has been widely used around the world for almost two decades (Foster et al., 2009). Yet, after an unprecedentedly long decision making process, the approved regimen for the medication was not consistent with the most up-to date medical evidence (World Health Organization Task Force on Post-ovlulatory Methods of Fertility Regulation, 2003). Health Canada also stipulated that mifepristone could only be prescribed by physicians, despite a large body of evidence that demonstrates it can be safely provided by a variety of advanced practice clinicians (Berer, 2009; Foster et al., 2015).

The mifepristone ruling is but one example of the competing perspectives in sexual and reproductive health research and policymaking. It reminds us that even in Canada – a developed country where abortion has been decriminalized for more than 25 years – the social context matters. This is not intended to be discouraging. As health scientists, it is these complexities that must drive us to continue asking, investigating, and pushing for evidence-based health care. These are the challenges that mean we should all “care about that”.

 

References

Berer, B. (2009). Provision of abortion by mid-level providers: international policy, practice and perspectives. Bulletin of the World Health Organization, 87, 58–63.

Cates, W., Grimes, D. A., & Schulz, K. F. (2003). The public health impact of legal abortion: 30 years later. Perspectives on Sexual and Reproductive Health, 35(1), 25-28.

Foster, A. M., Jackson, C. B., LaRoche, K. J., Simmonds, K., & Taylor, D. (2015). From qualified physician to licensed health care professional: the time has come to change mifepristone’s label. Contraception, 92(2), 200-202.

Khan, K. S., Wojdyla, D., Say, L., Gülmezoglu, A.M., & Van Look, P. F. A. (2006). WHO analysis of causes of maternal death: a systematic review. Lancet, 367, 1066-1074.

Kirby, D. B., Laris, B. A., & Rolleri, L. A. (2007). Sex and HIV education programs: Their impact on sexual behaviors of young people throughout the world. Journal of Adolescent Health, 40, 206-217.

Peipart, J. F., Madden, T., Allsworth, J. E., & Secura, G. M. (2012). Preventing unintended pregnancies by providing no-cost contraception. Obstetrics & Gynecology, 120(6), 1291-1297.

Singh, S., Sedgh, G., & Hussain, R. (2010). Unintended pregnancy: worldwide levels, trends, and outcomes. Studies in Family Planning, 41(4), 241–250.

Starkman, N., & Rajani, N. (2002). The case for comprehensive sex education. Aids Patient Care & STDs, 16(7), 313-318.

World Health Organization Task-force on Post-ovulatory Methods of Fertility Regulation. (2003). Medical abortion at 57 to 63 days’ gestation with a lower dose of mifepristone and gemeprost. Acta Obstetricia et Gynecologica Scandinavica, 80(5), 447-451.gestation with a lower dose of mifepristone and gemeprost. Acta Obstetricia et Gynecologica Scandinavica, 80(5), 447-451.