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Access to primary care services in Canada falls short of comparable countries. (1) Despite increasing absolute numbers of family physicians, (2) evidence suggests that the volume of patient contacts and [...], Background: Lack of patient access to family physicians in Canada is a concern. The role of recent physician graduates in this problem of supply of primary care services has not been established. We sought to establish whether career stage or graduation cohort were related to family physician practice volume and continuity of care over time. Methods: We conducted a retrospective cohort study of family physician practice from 1997/98 to 2017/18. We collected administrative health and physician claims data in British Columbia, Manitoba, Ontario and Nova Scotia. We included all physicians who registered with their respective provincial regulatory colleges as having a medical specialty of family practice or who had billed the provincial health insurance system for patient care as family physicians, or both. We used regression models to isolate the effects of 3-year categories of years in practice (at all career stages), time period and cohort on patient contacts and physician-level continuity of care. Results: Between 1997/98 and 2017/18, the median number of patient contacts per provider per year fell by between 515 and 1736 contacts in the 4 provinces examined. Median contacts peaked at 27-29 years in practice in all provinces, and median physician-level continuity of care increased until 30 or more years in practice. We found no association between graduation cohort and patient contacts or physician-level continuity of care. Interpretation: Recent cohorts of family physicians practise similarly to their predecessors in terms of practice volumes and continuity of care. Because family physicians of all career stages showed declining patient contacts, we suggest that system-wide solutions to recent challenges in the accessibility of primary care in Canada are needed.

AbstractBackgroundInadequate response to first- and second-line pharmacological treatments for psychiatric disorders is commonly observed. Ketamine has demonstrated efficacy in treating adults with treatment-resistant depression (TRD), with additional off-label benefits reported for various psychiatric disorders. Herein, we performed a systematic review and meta-analysis to examine the therapeutic applications of ketamine across multiple mental disorders, excluding mood disorders.MethodsWe conducted a multidatabase literature search of randomized controlled trials and open-label trials investigating the therapeutic use of ketamine in treating mental disorders. Studies utilizing the same psychological assessments for a given disorder were pooled using the generic inverse variance method to generate a pooled estimated mean difference.ResultsThe search in OVID (MedLine, Embase, AMED, PsychINFO, JBI EBP Database), EBSCO CINAHL Plus, Scopus, and Web of Science yielded 44 studies. Ketamine had a statistically significant effect on PTSD Checklist for DSM-5 (PCL-5) scores (pooled estimate = ‒28.07, 95% CI = [‒40.05, ‒16.11], p < 0.001), Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) scores (pooled estimate = ‒14.07, 95% CI = [‒26.24, ‒1.90], p = 0.023), and Yale-Brown Obsessive Compulsive Scale (Y-BOCS) scores (pooled estimate = ‒8.08, 95% CI = [‒13.64, ‒2.52], p = 0.004) in individuals with PTSD, treatment-resistant PTSD (TR-PTSD), and obsessive compulsive disorder (OCD), respectively. For alcohol use disorders and at-risk drinking, there was disproportionate reporting of decreased urge to drink, increased rate of abstinence, and longer time to relapse following ketamine treatment.ConclusionsExtant literature supports the potential use of ketamine for the treatment of PTSD, OCD, and alcohol use disorders with significant improvement of patient symptoms. However, the limited number of randomized controlled trials underscores the need to further investigate the short- and long-term benefits and risks of ketamine for the treatment of psychiatric disorders.

AbstractObjectiveMany psychotropic drugs are highly associated with related weight gain. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are established anti-obesity and glucose-lowering agents. Preliminary evidence also indicates they are fit for purpose in mitigating psychotropic drug-related weight gain (PDWG). This systematic review aims to synthesize the extant evidence from randomized controlled trials (RCTs) on the effects of GLP-1RAs on weight change in persons experiencing PDWG.MethodsOnline databases (ie, PubMed, OVID Medline, Google Scholar) were searched to identify relevant studies from inception to January 1, 2024. Articles were screened by title, abstract, and full-text by three independent reviewers against inclusion and exclusion criteria.ResultsWe identified six studies with participants aged ≥18 (n=374) that were eligible for inclusion in our systematic review. Most studies reported a significant and clinically meaningful effect of GLP-1RAs on anthropometrics and/or metabolics. All RCTs replicated the finding of modest or greater effects of GLP-1RAs; the most studied agents were liraglutide and exenatide. There was insufficient literature to conduct a meta-analysis.ConclusionEvidence suggests that GLP-1RAs are effective in mitigating weight gain in persons prescribed psychiatric medication. It is hypothesized that GLP-1RAs may moderate weight change in persons prescribed psychiatric medication through direct effects on metabolism and cognitive processes implicated in hunger/satiety. Future studies should aim to explore the long-term safety, tolerability, and efficacy profiles of various GLP-1RAs in the treatment and prevention of abnormal weight and metabolic homeostasis in psychiatric populations.

AbstractObjectivePostpartum depression (PPD), now referred to as perinatal depression, is a prevalent and debilitating mood disorder that reduces health-related quality of life (HRQoL) and psychosocial functioning. Esketamine, which is efficacious in adults with treatment-resistant depression and individuals with depression and suicidality, is also analgesic in pain management during childbirth labour. Herein, we investigate the efficacy of prophylactic esketamine in reducing the incidence of PPD.MethodsWe performed a systematic review (i.e., PubMed, Scopus, and Ovid databases; inception to January 22, 2024) of randomized controlled trials that investigated the use of esketamine for PPD. We delimited our search to studies that prespecified the prevention of PPD with esketamine as the primary outcome. A meta-analysis was performed on PPD incidence rates using a random effects model.ResultsOur analysis consisted of seven studies that met our eligibility criteria. We found that esketamine was significantly associated with a decreased incidence of PPD diagnosis within one week of childbirth (OR = 0.30, 95% CI = [0.15, 0.60], p = 0.0047). We also observed that esketamine was significantly associated with a decreased incidence of PPD diagnosis between 4 to 6 weeks post-delivery (OR = 0.33, 95% CI = [0.18, 0.59], p = 0.0034).ConclusionOur results indicate that esketamine may have preventive antidepressant effects during the postpartum period. The aforementioned points have both mechanistic and clinically meaningful implications for the treatment of PPD.

ABSTRACTIntroductionMajor depressive disorder (MDD) is a common and debilitating mental illness. Postpartum depression (PPD) impacts women globally and is one of the most common complications of childbirth that is underdiagnosed and undertreated, adversely impacting the mental health of women, children, and partners.Available antidepressant medications require weeks to months before showing effect. In this setting, zuranolone, an oral neuroactive steroid and a positive allosteric modulator of GABAAreceptors, is an attractive alternative as a rapid-acting antidepressant treatment.Areas coveredThis article reviews zuranolone (SAGE217), focusing on available clinical studies in individuals with PPD and MDD. This paper adds to the extant literature by presenting the efficacy data as Number Needed to Treat (NNT) to facilitate indirect comparisons with other antidepressants.Expert opinionZuranolone is a novel rapid-acting (i.e. two week course) oral antidepressant for the treatment of adults with PPD with ongoing clinical trials evaluating its efficacy in adults with MDD. Zuranolone is well tolerated with no significant safety concerns in any clinical trials completed to date. Zuranolone will be scheduled by the Drug Enforcement Agency (DEA).

The purpose of this policy briefing is to examine our health care systems through the lens of the COVID-19 pandemic and identify how we can strengthen health care in Canada post-pandemic. The COVID-19 pandemic has provided compelling evidence that substantive changes to our health care systems are needed. Specifically, the pandemic has emphasized structural inequities on a broad scale within Canadian society. These include systemic racial and socioeconomic inequities that must be addressed broadly, including in the delivery of health care. We make recommendations about what we can do to emerge stronger from the pandemic. While these recommendations are not novel, how they are framed and contextualized differs because of the problems in our health care system that have been highlighted and exacerbated by the pandemic.The evidence is clear that socioeconomic circumstances, intergenerational trauma, adverse early life experiences, and educational opportunities are critical factors when it comes to health over the life course. Given the problems in the delivery of health care that the pandemic has revealed, we need a different approach. How health care was organized prior to the COVID-19 pandemic did not produce what people wanted and needed in terms of health care and outcomes. How do we emerge from COVID-19 with an effective, equitable, and resilient health care system for all Canadians?To address health inequities and emerge from the pandemic with strengthened health care in Canada, we must consider how Amartya Sen's capabilities framework on social well-being can be operationalized to achieve better health care and health outcomes. Specifically, we address the need to: strengthen primary care and improve access to primary care;utilize a community-embedded approach to care; andimplement better integration across the care continuum, including integration between primary care and public health.Coherent governance and leadership that are charged with realizing benefits through collaboration will maximize outcomes and promote sustainability. Only when we provide access to high-quality culturally competent care that is centered around the individual and their needs will we be able to make true headway in addressing these long-standing health inequities.

Background:Most research on medication adherence has focused on secondary nonadherence and persistence to therapy. Medication prescriptions that are never filled by patients (primary nonadherence) remain understudied in the general population.Methods:We linked prescribing data from primary care electronic medical records to comprehensive pharmacy dispensing claims between January 2013 and April 2019 in British Columbia (BC) to estimate primary nonadherence, defined as failure to dispense a new medication or its equivalent within 6 months of the prescription date. We used hierarchical multivariable logistic regression to determine prescriber, patient and medication factors associated with primary nonadherence among community-dwelling patients in primary care.Results:Among 150 565 new prescriptions to 34 243 patients, 17% of prescriptions were never filled. Primary nonadherence was highest for drugs prescribed mostly on an as-needed basis, including topical corticosteroids (35.1%) and antihistamines (23.4%). In multivariable analysis, primary nonadherence was lower for prescriptions issued by male prescribers (odds ratio [OR] 0.66, 95% confidence interval [CI] 0.50–0.88). Primary nonadherence decreased with patient age (OR 0.91, 95% CI 0.90–0.92 for each additional 10 years) but increased with polypharmacy among patients aged 65 years or older. Patients filled more than 82% of their medication prescriptions within 2 weeks after their primary care provider visit.Interpretation:The prevalence of primary nonadherence to new prescriptions was 17%. Interventions to address primary nonadherence could target older patients with multiple medication use and within the first 2 weeks of the prescription issue date.

Increasing evidence shows that strengthening the foundation of primary health care will lead to improved health and provide better management for people with one or more chronic conditions. (1) In [...], Background: Group medical visits, whereby health care professionals meet with groups of patients who have the same disease, have been introduced in primary care as a way to meet the increasing demand for health care delivery to patients with chronic diseases. We performed a systematic review and meta-analysis of the evidence on the effectiveness of such visits for patients with diabetes. Methods: We conducted a systematic review of all relevant studies published from 1947 to February 2012 identified in a search of electronic databases and grey literature. We included randomized controlled trials (RCTs) and observational studies published in English that included patients aged 16-80 years with type 1 or 2 diabetes and that had group medical visits as the intervention. These studies were assessed for methodologic quality. We included data only from the RCTs in the meta-analysis. Results: Of the 94 studies identified, we selected 26 that met our inclusion criteria, 13 of which were RCTs. Group medical visits had a positive effect on clinical and patient-reported outcomes, with significant reductions in glycated hemoglobin (Hb[A.sub.1c] reduction -0.46%, 95% confidence interval -0.80% to -0.31%). We were unable to assess the effect of group medical visits on processes of care because of an insufficient number of RCTs that reported on this outcome. Interpretation: Group medical visits for patients with diabetes were found to be effective in terms of reducing Hb[A.sub.1c]. The results of our meta-analysis suggest that wider implementation of group medical visits for patients with diabetes will have a positive effect on patient outcomes.

[ILLUSTRATION OMITTED] SABRINA HAD BEEN preparing for this for weeks. The small girl, with the statuesque figure and her hair pulled tightly back into a high ponytail, surrounded by a [...]

[ILLUSTRATION OMITTED] ELLIE LEAVED FROM the incubator warmness of her covers to get ready for the day that lay ahead. The sun was rising and the day was still in [...]

Objective. To determine whether socioeconomic disparities exist in the financial burden of out-of-pocket (OOP) health care expenditures for families with children, and whether health insurance coverage decreases financial burden for low-income families. Data Source. The Household Component of the 2001 Medical Expenditure Panel Survey. Study Design. Cross-sectional family-level analysis. We used bivariate statistics to examine whether financial burden varied by poverty level. Multivariate regression models were used to assess whether family insurance coverage was associated with level of financial burden for low-income families. The main outcome was financial burden, defined as the proportion of family income spent on OOP health care expenditures, including premiums, for all family members. Data Collection/Extraction. We aggregated annual OOP expenditures for all members of 4,531 families with a child < 18 years old. Family insurance coverage was categorized as follows: (1) all members publicly insured all year, (2) all members privately insured all year, (3) all members uninsured all year, (4) partial coverage, or (5) mix of public and private with no uninsured periods. Principal Findings. A regressive gradient was noted for financial burden across income groups, with families with incomes < 100 percent of the Federal Poverty Level (FPL) spending a mean of $119.66 OOP per $1,000 of family income and families with incomes 100-199 percent FPL spending $66.30 OOP per $1,000, compared with $37.75 for families with incomes >400 percent FPL. For low-income families ( Conclusions. Socioeconomic disparities exist in the financial burden of OOP health care expenditures for families with children. For low-income families, full-year public coverage provides significantly greater protection from financial burden than full-year private coverage. Key Words. Financial burden, family coverage, health care costs, health care financing/insurance/premiums, socioeconomic disparities, Socioeconomic disparities have been documented for children and adults in access to and use of health care, and in health outcomes (Agency for Healthcare Research and Quality 2003). Socioeconomic disparities [...]

Wang and colleagues provided a timely estimate of the sizeable surgical backlog in Ontario created by coronavirus disease 2019 (COVID-19) and the substantial investment of resources required to clear it. [...]

Existing literature overlooks the role of gender and race on research productivity, particularly in the context of primary care research. This study examines how gender and race influence the research productivity of primary care researchers in Canada, addressing a gap in existing literature.

RÉSUMÉ:Les médecins de famille (MF) et le personnel de soins de santé à domicile (PSD) canadiens rencontrent d’importants obstacles lorsqu’ils doivent collaborer pour la prestation de soins aux patients qu’ils ont en commun. Cette étude à méthodologie mixte visait à évaluer la qualité et la viabilité de l’utilisation de l’audioconférence sécurisée dans une optique d’amélioration de la planification des soins pour ces patients. Les données primaires incluaient les résultats d’un sondage réalisé avant et après l’intervention, ainsi que des entretiens semi-structurés et des groupes de discussion post-intervention. Des méthodes statistiques non paramétriques ont été utilisées pour analyser les résultats du sondage, et les données qualitatives ont fait l’objet d’une analyse thématique de contenu. Les résultats des analyses quantitatives et qualitatives ont ensuite été intégrés afin de faire ressortir les inférences reflétant les approches des MF et du PSD relatives aux obstacles et aux avantages de la planification interdisciplinaire des soins. Les MF et le PSD ont montré que des obstacles structurels limitent leur capacité à collaborer. Le PSD et les MF ont également convenu que les rencontres entre les intervenants des deux services étaient bénéfiques pour les patients et que l’utilisation de l’audioconférence constituait une méthode efficiente de planification collaborative des soins. Les limites comprenaient la petite taille de l’échantillon et la courte période d’intervention, compte tenu de l’ampleur des changements attendus.ABSTRACT:Canadian family physicians (FPs) and home health staff (HHS) experience significant barriers to patient-related collaboration about patients they share. This mixed-methods study sought to determine the quality and sustainability of secure audio conferencing as a way to increase care planning about shared patients. Primary data sources included pre-and post-study administration of a published survey and post-study semi-structured interviews and focus groups. Non-parametric statistical procedures were used to analyze survey results and thematic content analysis was undertaken for qualitative data. Results from both quantitative and qualitative analysis were integrated into the overall analysis, in order to draw inferences reflecting both approaches to barriers and benefits of collaborative care planning for FPs and HHS. Both FPs and HHS provided evidence that structural barriers impede their ability to collaborate. HHS and FPs also agreed that joint conferences were beneficial for patients, and that the use of audio conferencing provided an efficient method of collaborative care planning. Limitations included a small sample size and short timeline for the intervention period, given the magnitude of the expected change.

ABSTRACTWe document community responses to the COVID-19 pandemic among Inuit living in the province of Manitoba, Canada. This study was conducted by the Manitoba Inuit Association and a Council of Inuit Elders, in partnership with researchers from the University of Manitoba. We present findings from 12 health services providers and decision-makers, collected in 2021.Although Public Health orders led to the closure of the Manitoba Inuit Association’s doors to community events and drop-in activities, it also created opportunities for the creation of programming and events delivered virtually and through outreach. The pandemic exacerbated pre-existing health and social system’s shortcomings (limited access to safe housing, food insecurity) and trauma-related tensions within the community. The Manitoba Inuit Association achieved unprecedented visibility with the provincial government, receiving bi-weekly reports of COVID-19 testing, results and vaccination rates for Inuit. We conclude that after over a decade of advocacy received with at best tepid enthusiasm by federal and provincial governments, the Manitoba Inuit Association was able effectively advocate for Inuit-centric programming, and respond to Inuit community’s needs, bringing visibility to a community that had until then been largely invisible. Still, many programs have been fueled with COVID-19 funding, raising the issue of sustainability.

ABSTRACTAcross Canada, the COVID-19 pandemic placed considerable stress on territorial and provincial healthcare systems. For Nunavut, the need to continue to provide access to critical care to its citizens meant that medical travel to provincial points of care (Edmonton, Winnipeg and Ottawa) had to continue through the pandemic. This complexity created challenges related to the need to keep Nunavut residents safe while accessing care, and to manage the risk of outbreaks in Nunavut resultant from patients returning home. A number of strategies were adopted to mitigate risk, including the expansion of virtual care, self-isolation requirements before returning from Winnipeg, and a level of cross-jurisdictional coordination previously unprecedented. Structural limitations in Nunavut however limited opportunities to expand virtual care, and to allow providers from Manitoba to access the Nunavut’s electronic medical records of patients requiring follow up. Thus, known and long-standing issues exacerbated vulnerabilities within the Nunavut healthcare system. We conclude that addressing cross-jurisdictional issues would be well served by the development of a more formal Nunavut-Manitoba agreement (with similar agreements with Ontario and Alberta), outlining mutual obligations and accountabilities.

Immigrants of Chinese ethnicity and young people (between 18 and 30 years of age) are known to access health services less frequently and may be at greater risk for experiencing unmet health needs. The purpose of this study was to examine the health beliefs, health behaviors, primary care access, and perceived unmet healthcare needs of Chinese young adults.

ABSTRACTThere is a notable lack of research related to trends in Inuit accessing health services throughout the land known as Canada. Given Nunavut’s reliance on specialised services provided in the Northwest Territories, Alberta, Manitoba, and Ontario, this gap is particularly problematic, making it more difficult for Nunangat to proactively plan new programs for emerging needs, and for provinces to respond to those needs. The Qanuinngitsiarutiksaitstudy aimed to address this gap by developing detailed profiles of Inuit accessing health services in Manitoba. We used administrative data routinely collected by Manitoba agencies, to support the development of Inuit-centric services. It was conducted in partnership with the Manitoba Inuit Association, and Inuit Elders from Nunavut Canada and Manitoba. We focused on two interrelated cohorts: Kivallirmiut (Inuit from the Kivalliq region of Nunavut) who come to Winnipeg to access specialised services; and Manitobamiut (Inuit already living in Manitoba). Findings show that health services are primarily accessed in Winnipeg. Half of health services accessed by Kivallirmiut are for in-patient care at facilities with the Winnipeg Regional Health Authority. The other half are for advanced out-patient care including specialist consults. For Kivallirmiut, hospitalisation for pregnancy and birth are the most prevalent reasons for hospitalisation, followed by diseases of the respiratory system. Noteworthy, rates of hospitalisation for conditions treatable in primary healthcare for Kivallirmiut are considerably lower than those for Manitobans living in the northern part of the province (where comparable constraints exist). For Inuit adults, rates of hospitalisation for these conditions are comparable to those of Manitobans living in small communities. Inuit living in Manitoba are most often hospitalised for mental health reasons, although other reasons are nearly as prevalent. Our results support the need for more Inuit-centric health programming in Winnipeg.

The Canadian Primary Care Sentinel Surveillance Network (CPCSSN) is Canada's first national chronic disease surveillance system based on electronic health record (EHR) data. The purpose of this study was to develop and validate case definitions and case-finding algorithms used to identify 8 common chronic conditions in primary care: chronic obstructive pulmonary disease (COPD), dementia, depression, diabetes, hypertension, osteoarthritis, parkinsonism, and epilepsy.

Résumé:Cette étude a exploré comment les immigrants âgés d’origine sud-asiatique, parlant le pendjabi (quatre groupes de discussion; 33 participants) de Surrey en Colombie-Britannique, perçoivent leur santé buccale et les problèmes connexes. L’analyse a relevé deux thèmes généraux: les interprétations de la condition bucco-dentaire et les défis de santé buccodentaire. Le thème des interprétations avait quatre sous-thèmes: les dommages causés par le wai, les perturbations causé par la carie, l’adaptation aux prothèses dentaires, et qualité de vie; alors que le thème des défi s considérés: remèdes à domicile, dentisterie occidentale; et difficultés d’accès aux dentistes. Les participants ont expliqué les maladies buccodentaires en termes d’une infection systémique (resha) et ont dit préféré les remèdes faits maison pour diminuer les écarts de chaleur (wai) dans la bouche. Nous concluons que les immigrants âgés d’origine sud-asiatique parlant le pendjabi interprète la santé et les maladies bucco-dentaires dans un contexte mixte de traditions occidentales et Ayurvédique, et gèrent leur santé buccale au moyen de remèdes traditionnels faits maison, complémentés au besoin par des soins d’urgence dispensés au Canada.Abstract:This study explored how older Punjabi-speaking South-Asian immigrants (four focus groups; 33 participants) in Surrey, British Columbia, perceive oral health and related problems. Content analysis revealed two umbrella themes: (a) interpretations of mouth conditions and (b) challenges to oral health. The umbrella themes had four sub-themes: damage caused by heat (wai), disturbances caused by caries, coping with dentures, and quality of life. Three challenges were considered: home remedies, Western dentistry, and difficulties accessing dentists. Participants explained oral diseases in terms of a systemic infection (resha), and preferred to decrease imbalances of waiin the mouth with home remedies from India. We conclude that older Punjabi-speaking immigrants interpret oral health and disease in the context of both Western and Ayurvedic traditions, and that they manage dental problems with a mix of traditional remedies supplemented, if possible, by elective oral health care in India, and by emergency dental care in Canada.

Background: Comfort care without transport to hospital was not traditionally a paramedic practice. The novel Paramedics Providing Palliative Care at Home Program includes a new clinical practice guideline, medications, a database to manage and share goals of care, and palliative care training. This study determined essential elements for implementation, scale and spread of this Program. Methods: Deliberative dialogues, a qualitative method, were held with diverse stakeholders/experts in one province with the Program (Nova Scotia, March 2018) and one without (British Columbia, July 2018). The Consolidated Framework for Implementation Research (CFIR) informed the discussion guide and was used in a framework analysis. Four team members analyzed the data independently; themes were derived by consensus with the broader research team. Results: CFIR constructs framed several key elements. Inter-sectoral communication is critical but challenged by privacy concerns and the siloed structure of the health system. Locally adapted training is an essential characteristic of the intervention; cost is a factor. A shift in mindset away from traditional paramedic roles is required; this can be facilitated by paramedic champions and a positive implementation climate. Early engagement of diverse stakeholders and planning for sustainability is key. Conclusion: This framework analysis using CFIR constructs can guide successful scale and spread of the program. The constructs of Outer setting: Cosmopolitanism, Characteristics of the intervention: Adaptability, Inner Setting: Implementation climate, and Processes: Engagement, and Planning, emerged as essential. [ABSTRACT FROM AUTHOR]

Neonatology and informatics are relatively new subspecialties to the health field; however both have made rapid developments over a considerably short period of time. Significant improvements have been made to the care of neonates resulting in a rapid rate of survival of sick and premature neonates. Along with improvements in care there has been the development of technology and with it the field of informatics. This paper offers a review of the development of nursing informatics and its application in changing practice in a tertiary neonatal intensive care unit (NICU).

Objective: To examine the essential and potentially inappropriate use of antipsychotics across income groups.Method: Linked health, pharmaceutical use, and income data from British Columbia were analyzed to examine antipsychotic use in 2 study cohorts. In the first cohort, the essential use of antipsychotics was assessed among adults who had a recorded diagnosis of schizophrenia in a 2-year period, 2004–2005. In the second cohort, potentially inappropriate use of antipsychotics was examined in people with no recorded diagnosis of schizophrenia or bipolar disorders in 2004–2005. The second cohort was also composed exclusively of seniors with a dementia-related diagnosis who are either in long-term care or living in the community. Income-related differences in antipsychotic use in these 2 cohorts were assessed using logistic regression, controlling for health and sociodemographic characteristics known to influence medicine use.Results: Among adults, the prevalence of essential antipsychotic use was high (85%), with higher odds of use evident among those in the middle-income group. Among seniors, the prevalence of potentially inappropriate antipsychotic treatment is 23%, with prevalence higher in long-term care (56%) than in the community (13%). No income-related differences were found in long-term care; however, in the community, higher odds of use were found in low-income seniors.Conclusion: People from low-income households have slightly lower levels of essential antipsychotic use and are more likely to receive potentially inappropriate antipsychotic treatment.

The primary purpose of this study was to describe parental satisfaction with the quality of care received in the Neonatal Follow-up Clinic (NFC). Study participants included 218 mothers and 215 high-risk children who were part of a larger study to develop an NFC-specific instrument, the Parent Satisfaction Questionnaire for Neonatal Follow-up (PSQ-NFU), to measure parental satisfaction with quality of care. Parents completed the 16-item PSQ-NFU while waiting for their child’s NFC appointment. A high mean parental satisfaction score of 93.5 (SD = 12.3) was reported (possible scores range from 16 [least satisfied] to 112 [most satisfied]). Hierarchical multiple linear regression analysis revealed that study site was significantly associated with parental satisfaction scores (p< 0.001); and, abnormal neurodevelopmental status of the child contributed to lower parental satisfaction scores, but only in combination with study site (p= 0.029). Future studies of families of varying ethic and socioeconomic backgrounds in different NFC settings would add to the current knowledge.

Current policy directions place increasing expectations on patients to actively engage in their care, especially in chronic disease management. We examined relationships between patient activation and multiple dimensions of primary healthcare (PHC), including access, utilization, responsiveness, interpersonal communication, and satisfaction for patients with and without chronic illness.

Anti-reflective layers benefit CD and profile control in high resolution lithography. Traditionally, they have not been applied to implant levels because the required CD control was less stringent than for other layers. When present a traditional BARC film interferes with the doping process unless removed using a costly dry BARC open etch. Nevertheless, as implant features move to evermore challenging k1 values, reflection control becomes more unavoidable; firstly to control residual standing wave structures on the resist profile and secondly to maintain acceptable CD dimensions on substrates which exhibit large reflectivity variations at both the cross-wafer and the wafer-to-wafer level. An important consideration for this application is to monitor and minimize intermixing between the resist and DBARC layers. Any method to do so must be sensitive to layers less than 10 nm thickness. The use of ellipsometry is investigated in this work to show the degree to which intermixing, if any, is detectable. A method and its requirements are described that predicts intermixing down to Angstrom thickness. Cross-section SEM shows the effect from an optimized process (no intermixing).

Objectives.To identify and review innovations relevant to improving access, quality, efficiency and/or effectiveness in the organization and delivery of health care services in rural and remote areas.Study design.Literature review.Methods.Key bibliographic databases that index health research were searched: MEDLINE, EMBASE and CINAHL. Other databases relevant to Arctic health were also accessed. Abstracts were assessed for relevancy and full articles were reviewed and categorized according to emergent themes.Results.Many innovations in delivering services to rural and remote areas were identified, particularly in the public health realm. These innovations were grouped into 4 key themes: organizational structure of health services; utilization of telehealth and ehealth; medical transportation; and public health challenges.Conclusions.Despite the challenges facing rural and remote regions, there is a distinctly positive message from this broad literature review. Evidence-based initiatives exist across a range of areas — which include operational efficiency and integration, access to care, organizational structure, public health, continuing education and workforce composition — that have the potential to positively impact health care quality and health-related outcomes.

Most “homestay” high school students come to Canada from East Asian countries such as China, Korea and Japan to attend school while living with another family. Our objectives were to examine: 1 ) the characteristics of homestay youth compared to immigrant and Canadian-bom East Asian youth and 2) whether their health risk behaviours are similar to immigrant or Canadian-born East Asian youth. We used the 2003 British Columbia Adolescent Health Survey to examine characteristics of East Asian youth and their health risk behaviours, including sexual behaviours, substance abuse, abuse history, and health status. Homestay students were those not born or raised in Canada and not living with their parent(s) or in foster care. Multivariate models tested for the independent association of student group, controlling for age. Homestay students (weighted n=3,085) were older, on average, than immigrant or Canadian-born youth and spoke a language other than English at home (p<0.001 ). Multivariate analyses showed that homestay students were more likely to engage in sexual behaviours than other youth and over 4 times more likely to have used cocaine. Female homestay students were 3 times more likely to be a victim of sexual abuse and were also 3 times more likely to use a substance prior to sex. Homestay students remain a forgotten and extremely vulnerable group of youth, in part because they have special living arrangements. No one is currently held accountable for their health or safety. In the absence of health policy about homestay students, public health officials and providers have a central rale in ensuring the former’s health is not threatened. La plupart des élèves du secondaire hébergés en milieu familial viennent au Canada de pays d’Asie de l’Est (Chine, Corée, Japon) pour fréquenter l’école tout en vivant dans une autre famille. Nos objectifs étaient d’examiner: 1) les caractéristiques des jeunes hébergés en milieu familial comparativement aux jeunes immigrants et aux jeunes d’origine est-asiatique nés au Canada et 2) leurs comportements présentant des risques pour la santé, pour voir s’ils sont semblables à ceux des jeunes immigrants ou des jeunes d’origine est-asiatique nés au Canada. À l’aide de l’enquête sur la santé des adolescents de la Colombie-Britannique (British Columbia Adolescent Health Survey, 2003), nous avons examiné les caractéristiques des jeunes Asiatiques de l’Est et leurs comportements présentant des risques pour la santé (comportements sexuels, toxicomanie, antécédents d’abus et état de santé). Les élèves hébergés en milieu familial étaient ceux qui n’étaient pas nés et n’avaient pas grandi au Canada et qui ne vivaient ni avec un ou deux parents, ni en famille d’accueil. Des modèles multivariés ont contrôlé l’association indépendante des groupes d’élèves en tenant compte des effets de l’âge. Les élèves hébergés en milieu familial (nombre pondéré n=3085) étaient plus vieux en moyenne que les jeunes immigrants ou les jeunes nés au Canada, et ils parlaient une langue autre que l’anglais à la maison (p<0,001 ). Des analyses multivariées ont montré que les élèves hébergés en milieu familial étaient plus susceptibles de s’adonner à des comportements sexuels que les autres jeunes et plus de 4 fois plus susceptibles d’avoir consommé de la cocaïne. Les filles hébergées en milieu familial étaient 3 fois plus susceptibles d’avoir été victimes de violence sexuelle et 3 fois plus susceptibles de consommer de l’alcool ou de la drogue avant d’avoir des relations sexuelles. Les élèves hébergés en milieu familial forment un groupe extrêmement vulnérable qui est encore négligé, en partie en raison de leurs conditions de logement particulières. Personne n’a actuellement de comptes à rendre sur leur santé et leur sécurité. En l’absence d’une politique de santé pour les élèves hébergés en milieu familial, les autorités et les intervenants de la santé publique ont un rôle crucial à jouer pour veiller à ce que la santé de ces jeunes ne soit pas menacée.

Following the introduction of hospital early postpartum discharge (EPD), public health nurses (PHNs) have provided large-scale in-home follow-up to promote the safety and well-being of mothers and babies. Given high numbers of births per year, this program has affected PHNs’ practice. This descriptive qualitative study aimed to explore PHNs’ perceptions of EPD and its effects on their practice. Data were collected in focus groups (n=24) consisting of PHNs in four community health areas (CHAs) in the Winnipeg Regional Health Authority (WRHA). Audiotaped data were transcribed, entered into Microsoft Word XP, and analyzed using constant comparison. The female participants had a mean of 10 years of PHN experience. Three main themes and 10 subthemes were identified. The main themes were: passion for the PHN role, influence of EPD on practice, and building a PHN future. The subthemes included: valuing public health nursing, building capacity and developing relationships, changes in practice, erosion of health promotion, a new role, proper tools, continuity of care, relationships with community partners, and resources to support public health programs. The PHNs indicated the introduction of EPD altered their practice by reducing their role in community-level intervention and health promotion activities. Although they identified benefits from undertaking EPD activities, they wanted resources and funding shifted into the public health system to better support PHNs’ increase in scope of practice and historical roles in promoting the health of individuals, families and communities. Depuis l’introduction dans les hôpitaux du congé précoce en post-partum (CPP), les infirmières hygiénistes font un suivi à domicile à grande échelle pour promouvoir la sécurité et le bien-être des mères et des bébés. Étant donné le grand nombre de naissances par année, ce programme a eu des répercussions sur l’exercice des soins infirmiers de santé publique. Notre étude qualitative descriptive porte sur les perceptions des infirmières hygiénistes à l’égard du CPP et de ses effets sur leur pratique professionnelle. Les données ont été recueillies à la faveur de groupes de discussion (n=24) composés d’infirmières hygiénistes de quatre secteurs sanitaires de l’Office régional de la santé de Winnipeg (ORSW). Les données, enregistrées sur bande sonore, ont été transcrites, entrées dans Microsoft Word XP et analysées en dressant une comparaison des constantes. Les participantes avaient en moyenne 10 ans d’expérience en tant qu’infirmières hygiénistes. L’analyse des données a permis de dégager trois grands thèmes (la passion pour le métier d’infirmière hygiéniste; l’influence du CPP sur les pratiques; l’avenir du métier) et 10 sous-thèmes (la considération envers les services infirmiers de santé publique; le renforcement des capacités et des relations; les changements dans la pratique; l’érosion de la promotion de la santé; un nouveau rôle; les bons outils; le suivi des soins; les relations avec les partenaires communautaires; et les ressources disponibles pour les programmes de santé publique). Selon les infirmières hygiénistes, l’introduction du CPP a modifié leur pratique professionnelle en réduisant leur participation aux activités d’intervention communautaire et de promotion de la santé. Bien que les activités liées au CPP aient leurs avantages, les infirmières voudraient que l’on achemine des ressources et des fonds vers le réseau de la santé publique pour mieux appuyer l’élargissement de leur champ d’activité et leur rôle traditionnel de promotion de la santé individuelle, collective et familiale.

To examine the psychometric adequacy of two existing instruments, the Functional Status Questionnaire (FS IIR) and the Parent Behavior Checklist (PBC), in two ethnic minority groups. Age-specific items that were not relevant for children ages 1 to 5 were removed from the FS IIR and PBC. Measures were administered to 196 Latino and African American parents of children aged 1 to 5. Reliability, variability, item-convergence, and factor structure were examined. The results highlight common pitfalls in using existing measures in populations other than those on which they were originally developed. Both measures were modified resulting in all scales having low or acceptable reliability. Construct validity was supported for both the FS IIR and the PBC through confirmation of hypothesized relationships. In both ethnic groups, factor analyses supported the hypothesized factor solutions for the FS IIR and the PBC. Use of measures in minority groups requires researchers to be cognizant of the issues of psychometric adequacy in all groups. The psychometric properties of the FS IIR and the PBC were generally acceptable for Hispanics and African Americans, but each had some problems in at least one psychometric characteristic in one or both groups. Different factor loadings for some items for Hispanics and African Americans suggest different interpretation of items between the two cultural groups.

To analyze why U.S. legislation for direct Medicare reimbursement to advanced practice nurses (APNs) was approved during the 105th congressional session. Help in understanding the complexities of policy making and in strategizing future policy activities is needed. Given their vast numbers, nurses are a formidable group with potential to influence policy.

The objective was to analyze the evidence available in the scientific literature on the concept of vulnerability, in theoretical perspectives and its use, in Primary Health Care. An integrative literature review was carried out with the inclusion criteria: articles in English, full text, peerreviewed, related to vulnerability and primary health care, with the explicit concept of vulnerability, and published until July 31, 2020. The electronic databases accessed were by crossing the descriptors “vulnerability,” “vulnerabilities,” “primary health care,” “primary healthcare,” and “primary care.” The final sample consisted of 19 articles. The thematic analysis produced 2 themes: “Theoretical foundations of the concept of vulnerability” and “The use of the concept of vulnerability in PHC.” In the second theme, 2 sub-themes emerged: Evaluation of health policies, programs, and services and Classification of individuals, groups, and families. There was a plurality of theoretical foundations for the concept of vulnerability and a smaller scope of its use in Primary Health Care. It is expected that the study will subsidize public policymakers and health teams in the design of services and actions aimed at vulnerable populations and in situations of vulnerability.