Tag Archives: Health Services

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.

Client (non-) adherence to treatment: A challenge in Peru and Canada

In July and August 2015, I completed a medical volunteer trip in Lima with the organization International Volunteer HQ. I wanted to experience a different health care system and practice my skills as a nursing student. In Peru, poverty creates a large barrier from accessing healthcare for a significant portion of the population. To increase access to care, the government of the Callao region has installed a “clinibus” program which I was involved in. It consists of a bus that travels to different areas providing specialist care. The government covers the cost of visits and most medications; however many clients do not follow the prescribed treatment. During my time in Peru, I observed a lack of information on how to administer treatments, limited understanding of the importance of routine treatment, and distrust of health care professionals.

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The Promise of a Qualitative Case Study Approach for Research on Caregiver Involvement in Inpatient Traumatic Brain Injury Rehabilitation

Authors: Kaylee Eady and Katherine Moreau

Abstract

Purpose: To demonstrate that, theoretically, a qualitative case study approach holds substantial promise for conducting research on caregiver involvement in inpatient traumatic brain injury (TBI) rehabilitation.

Methods: Narrative reviews of the TBI rehabilitation and case study literature are presented to explain our rationale for advocating the use of a qualitative case study approach for research in this area.

Results: We found that there are four interconnected reasons why this research approach is well suited for investigating caregiver involvement in inpatient TBI rehabilitation. More specifically, a qualitative case study approach allows us to: (a) address the context of inpatient TBI rehabilitation; (b) account for the complexity of caregiver involvement; (c) adapt research to the practical and ethical needs of TBI inpatients and their caregivers; and (d) create research that is congruent with family-centered theory.

Conclusion: A qualitative case study approach has the ability to address the complexity and context that surrounds caregiver involvement in inpatient TBI rehabilitation. A case study approach is also congruent with the characteristics of inpatient rehabilitation settings and can take into consideration family-centered theory, which is instrumental to understanding caregiver involvement.

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The unpredictable prognosis of Medicare – A book review on Chronic condition: Why Canada’s health-care system needs to be dragged into the 21st century by Jeffrey Simpson

Author: Kelly Brennan

Canadians cherish their health-care system. In fact, polls reveal Medicare is among the top most important national symbols and takes part in defining what it means to be Canadian (Mendelsohn, 2002). Why is it then, that Canada has one of the most expensive health-care systems, but some of the worst health outcomes when looking at comparable country’s health systems? (Skinner & Rovere, 2012). A politicians’ worst financial nightmare is formed when health-care budgets exponentially outgrow government revenues and calls for more efficient services compete with an intolerance for higher taxes. Incorporating the demographics of an aging population and the restrictions on privately funded health-care services supports why the subject is not a very popular one (Simpson, 2012).

Continue reading The unpredictable prognosis of Medicare – A book review on Chronic condition: Why Canada’s health-care system needs to be dragged into the 21st century by Jeffrey Simpson

Access to abortion in Canada: will RU-486 make a difference?

On Wednesday, July 29, 2015, Health Canada officially approved the pharmaceutical agent RU-486 (Mifegymiso). This drug can cause medical abortions, and is used as an alternative to surgery for early abortions. It will be marketed as Mifegymiso in Canada and as approved, contains two active ingredients – mifepristone and misoprostol. Mifepristone blocks the production of progesterone, which is required to sustain a pregnancy. Misoprostol causes uterine contraction. Studies show that the combination drug Mifegymiso is 95-98% effective in causing a miscarriage (1).

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Electronic Health Records: Patient Care Quality

Author: Rebecca Xu

Abstract

The advancement of technology has led to its integration in widespread fields, impacting areas such as communications, heavily. While there is concern that the introduction of information technology into healthcare renders the medical practice impersonal, its implementation has a positive effect on patient care quality. The exchange of health information via an electronic medium, such as the electronic health record (EHR), is known as health information technology (HIT) and has been the focus of many studies. Many supporters of HIT promote the benefits associated with the general rise in technology, such as the increase in convenience and efficiency of information storage; but others are hesitant, often citing privacy and security breaches as primary concerns. Studies show that despite various initial qualms about EHR integration, once the integration is complete, the quality of patient care increases.

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The Angelina Jolie Effect: The Problem and Promise of Personalized Medicine

Following the decision for a preventative double mastectomy in 2013, Angelina Jolie announced this past March that she has had her ovaries and fallopian tubes removed in an effort to prevent cancer. A blood test showing a mutation in the BRCA1 gene gave her an 87 per cent risk of breast cancer and a 50 per cent risk of ovarian cancer.

Especially in cases for cancer, cardiovascular, and neurodegenerative diseases, precision or personalized medicine (PM) is a promising approach that identifies disease biomarkers for prevention and prediction of therapeutic measures and lifestyle changes. By using a blood, skin, or tissue sample to examine an individual’s DNA, clinicians are able to uncover defects or mutations that are known to be associated with a type of hereditary disease and can allow for early action and improved health outcomes (Canadian Cancer Society, 2015).

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Global health priorities: health systems strengthening and Ebola

Ebola has been prominently featured in the news for the past several months. The outbreak continues to grow in number and geographic scope of cases, and many people are wondering how it got so out of control in the first place. The hardest-hit countries are Liberia, Guinea, and Sierra Leone, with a total of 8376 confirmed, probable, or suspected cases reported up to October 10 (World Health Organization, 2014).

The current epidemic began in Guinea, a developing country in West Africa. Poor public health infrastructure made this an ideal location for the outbreak to spread. There are only 0.1 doctors per 1000 people in Guinea, compared to 2.07/1000 people in Canada (CIA World Factbook, 2014). Approximately $67 per person is spent each year on health in Guinea; in Canada, this number is $4676 per person per year (World Health Organization, 2014). It is clear that poverty is a factor here. Guinea’s health system was simply not able to contain the initial Ebola outbreak – but let’s scratch beneath the surface to find a more nuanced explanation.

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