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A small proportion of health care users are recognised to use a significantly higher proportion of health system resources, largely due to systemic, inequitable access and disproportionate health burdens. These high-resource health system users are routinely characterised as older, with multiple comorbidities, and reduced access to adequate health care. Geographic trends also emerge, with more rural and isolated regions demonstrating higher rates of high-resource use than others. Despite known geographical discrepancies in health care access and outcomes, health policy and research initiatives remain focused on urban population centers. To alleviate mounting health system pressure from high-resource users, their characteristics must be better understood within the context in which it arises. To examine this, a scoping review was conducted to provide an overview of characteristics of high-resource users in rural and remote communities in Canada and Australia. In total, 21 papers were included in the review. Using qualitative thematic coding, primary findings characterised rural high-resource users as those of an older age; with increased comorbid conditions and condition severity; lower socioeconomic status; and elevated risk behaviours.

Pelvic tilt affects acetabular anteversion, and thus total hip arthroplasty (THA) dislocation risk. The pubic symphysis-sacrococcygeal distance (PSCD) is an indicator of pelvic tilt, and a PSCD0 mm (ie, excessive posterior pelvic tilt) is associated with a 3.7-fold increase in postoperative dislocation rate. However, it is not known if the direct anterior (DA) approach might reduce this dislocation rate, specifically in high-risk populations such as negative PSCD.Standing anteroposterior radiographs were reviewed for 510 consecutive DA THAs to determine PSCD. Patients were separated into 2 groups: (1) PSCD0 mm (PSCD[+]) and (2) PSCD0 mm (PSCD[-]). Incidence of dislocation was determined. We recorded if patients had spinal deformity or lumbar fusion. Continuous variables were analyzed using Student's t-test, categorical variables were analyzed using Fisher's exact test, and a sample size calculation was performed.Three hundred fifty-eight hips (70.2%) were PSCD[+], while 152 hips (29.8%) were PSCD[-]. Three dislocations (3/510 hips, 0.6%) occurred. Two dislocators were in the PSCD[-] group (2/152 hips, 1.3%) and 1 dislocator was in the PSCD[+] group (1/358 hips, 0.3%) (P = .21). Twenty-four patients had degenerative scoliosis (24/510, 4.7%), of which 1 had a dislocation (1/24, 4.2%); 2 dislocations occurred in nonscoliosis patients (2/486, 0.4%) (P = .134). Twenty-seven patients had lumbar spinal fusion (27/510, 5.3%), of which there were no dislocations (0/27, 0.0%); all dislocations were in nonfusion patients (3/483, 0.6%) (P = 1.0).We demonstrate no increased risk for THA dislocation in patients with a PSCD0 mm who have undergone a DA approach. These data would suggest a protective effect of the DA approach against dislocation, even in historically high-risk populations.

Objective Comparing total joint arthroplasty (TJA) costs and patient-reported outcomes between a physician-owned hospital (POH) and a non-POH. Methods Costs for each 90-day TJA episode at both facilities were determined, and patients were asked to complete a patient satisfaction questionnaire. Results Average TJA episode cost was $19,039 at the POH, compared to $21,302 at the non-POH, a difference of $2,263 (p = 0.03), largely driven by decreased skilled nursing facility utilization in the POH group. There were no differences between groups for patient satisfaction. Conclusion TJA can be performed at reduced cost with comparable patient satisfaction at POHs, compared to non-POH facilities.

Objective To investigate the effect of accelerometry-based navigation (ABN) on early clinical outcomes after TKA. Methods 71 TKAs were performed via ABN and 37 TKAs via standard instrumentation (STD). Patients were assessed at the second post-operative visit to determine early KOOS, JR scores. Results At average 2.7 months, mean KOOS, JR in the ABN group was 68.5 (range 34.2–100) compared to 62.5 (range 20.9–84.6) in the STD group (p = 0.045). Tourniquet time averaged 65.2min (range 51–79min) in STD group, compared with 70.7min (range 53–108min) in ABN group (p = 0.029). Conclusion Early KOOS, JR scores are improved with ABN for TKA.

Objective Investigate the efficiency/accuracy of surgical automation versus manual component implantation in DA THA. Methods Retrospective review of 111 hips: 51 hips via automation and 60 hips via manual technique for DA THA. Results OR time averaged 8 min faster in the Automated group, compared to Manual group (p = 0.0009). Average femoral size was one size larger in the Automated group compared to Manual group (p = 0.007). No clinically significant differences were found between Manual and Automated groups for cup position or limb-length discrepancy. One calcar fracture occurred in the Automated group. Conclusion Surgical automation is efficient and accurate for DA THA.

PurposeMeat consumption has a variety of implications in society. While various types of meat-restricted diets exist to address this, not enough is known about how the average meat consumer views different avenues to lessening their intake. In response, this study aims to assess US omnivores’ impressions of three meat-restricted diets.Design/methodology/approachAn online survey was administered to a cross-sectional, census-balanced sample from Nielsen of 30,000+ US adults. Omnivores (N = 928) were randomized into one of the three conditions where they were asked about their perceptions of a vegetarian diet, a reduced-meat diet or a chicken-free diet as individuals not currently following that dietary pattern.FindingsThe findings showed that omnivores had a more favorable perception of a reduced-meat diet on a greater number of study variables as compared to the vegetarian or chicken-free diets. The research also demonstrated that a majority of omnivores were in the precontemplation stage of cognitive change, suggesting that most American omnivores are not actively demonstrating a readiness to alter their meat consumption in the ways presented.Originality/valueThis research is the first to examine the comparative trends around these three diets among omnivores. It also speaks to how the desirability of meat restriction varies by type of approach, i.e. elimination or reduction, and if the latter, what type. The findings may be of relevance for efforts to reduce global meat consumption for ethical, health, or environmental reasons.

As the healthcare system has modernized, it has also become rich with complexity. This complexity continues to foster the creation of wicked problems that at first consideration appear inherently insoluble. To compound matters, policy-makers and decision-makers continue to view the healthcare system in a reductionistic, linear manner. This paper advocates that all stakeholders within the system (policy-makers, providers, and patients) become comfortable with complexity as a determinant of health, and offers tools for productively working with complexity, instead of trying to solve it. These tools include complexity heuristics, adjusting to an emergent decision-making paradigm, and easing the anxiety associated with ambiguity and paradox by becoming antifragile. By adopting these methods, the health determinant of complexity within the Canadian healthcare system can be effectively handled. This will lead to sustainable and scalable interventions, strong patient-partners in care, and efficient use of monetary and human resources.

Total hip arthroplasty (THA) in patients with severe chronic pubic diastasis from either congenital or acquired causes presents an exceptionally difficult challenge that has rarely been addressed in the arthroplasty literature. The purpose of this paper is to present a series of THAs in patients with severe chronic pubic diastasis, asking the following research questions: (1) What is the survivorship and clinical outcomes after THA in patients with severe chronic pubic diastasis? And (2) What is the rate of complications after THA surgery in this challenging patient population? We additionally describe our algorithm for preoperative planning and rationale for surgical technique and implant position.We retrospectively queried the prospective arthroplasty database of 2 high-volume referral centers, yielding 6 THA in 4 patients with severe chronic pubic diastasis (minimum 8 cm) with a mean follow-up of 2.7 years. We recorded baseline demographic and intraoperative variables, as well as survivorship, patient-reported outcomes (Hip disability and Osteoarthritis Outcome Score for Joint Replacement score), and incidence of complications.There were no failures reported (100% survivorship) at a mean follow-up of 2.7 years. Mean Hip disability and Osteoarthritis Outcome Score for Joint Replacement scores improved from 36.0 preoperatively to 82.8 postoperatively. There were no infections, dislocations, fractures, or any major complications in the postoperative period.THA for patients with severe chronic pubic diastasis remains a rare but challenging reconstructive procedure. Excellent outcomes can be achieved with adequate preparation, particularly regarding the acetabular component position. Understanding the nature of the hemipelvis deformity and meticulous templating using "normalized" views of the hip are important components to a successful preoperative plan.

Description, HIV spreading relies on a key component of antiviral immunity that tethers nascent virions to the surface of infected cells., BST2 is an interferon-inducible antiviral host protein antagonized by HIV-1 Vpu that entraps nascent HIV-1 virions on the cell surface. Unexpectedly, we find that HIV-1 lacking Nef can revert to full replication competence simply by losing the ability to antagonize BST2. Using gene editing together with cell sorting, we demonstrate that even the propagation of wild-type HIV-1 is strikingly dependent on BST2, including in primary human cells. HIV-1 propagation in BST2−/− populations can be fully rescued by exogenous BST2 irrespective of its capacity to signal and even by an artificial BST2-like protein that shares its virion entrapment activity but lacks sequence homology. Counterintuitively, our results reveal that HIV-1 propagation is critically dependent on basal levels of virion tethering by a key component of innate antiviral immunity.

Objective Complementary and alternative medicine (CAM) seems to be frequently used among patients with inflammatory bowel disease (IBD). We aimed to determine the prevalence and indicators of CAM use in Austrian IBD patients. Methods In a multicentre cross-sectional study, adult patients with IBD attending 18 Austrian outpatient clinics completed a multi-item questionnaire that recorded use of CAM as well as medical and socioeconomic characteristics. Patients were recruited between June 2014 and June 2015. The study outcome was the prevalence of CAM use and its socioeconomic and disease-related associations. Results A total of 1286 patients (Crohn's disease 830, ulcerative colitis 435, IBD unclassified 21; females 651) with a median age of 40 years (interquartile range 31-52 years) and a median disease duration of 10 years (4-18 years) were analysed. The prevalence of previous and/or current CAM use was 50.7%, with similar results for Crohn's disease and ulcerative colitis. In the multivariable analysis, female gender and a university education were independent socioeconomic indicators of CAM use. IBD-related indicators were longer duration of the disease and previous and/or current treatment with steroids and TNF-α inhibitors. Conclusion CAM use for IBD is frequent in Austrian IBD patients and associated with female gender, higher educational level of university degree, longer duration of the disease, and treatment with steroids and TNF-α inhibitors.

Gallstone ileus is a rare but significant cause of bowel obstruction. An 82-year-old female was admitted to the hospital with abdominal pain and was initially treated for a possible urinary tract infection. Following a surgical review and based on history, clinical examination as well as radiological findings, a diagnosis of gallstone ileus was made. The patient was prepared for surgery; however, whilst awaiting theatre, she spontaneously passed the obstructing gallstone with full resolution of bowel obstruction symptoms. The usual treatment for gallstone ileus is surgical management with an enterolithotomy; nevertheless, this case highlights the importance of close monitoring and adapting a management plan to fit an evolving clinical scenario.

Canadians living in rural communities are diverse, with individual communities defined by unique strengths and challenges that impact their health needs. Understanding rural health needs is a complex undertaking, with many challenges pertaining to engagement, research, and policy development. In order to address these challenges, it is imperative to understand the unique characteristics of rural communities as well as to ensure that the voices of rural and remote communities are prioritized in the development and implementation of rural health research programs and policy. Effective community engagement is essential in order to establish rural-normative programs and policies to improve the health of individuals living in rural, remote, and northern communities. This report was informed by a community engagement workshop held in Golden Lake, Ontario in October 2019. Workshop attendees were comprised of residents from communities within the Madawaska Valley, community health care professionals, students and researchers from Carleton University in Ottawa, Ontario, and international researchers from Australia, Sweden, and Austria. The themes identified throughout the workshop included community strengths and initiatives that are working well, challenges and concerns faced by the community in the context of health, and suggestions to build on strengths and address challenges to improve the health of residents in the Madawaska Valley.

Acetabular exposure for direct anterior (DA) total hip arthroplasty (THA) can be performed using hands-free, self-retaining retractors. No current study quantitatively compares this self-retaining technique with the traditional manual technique. In 65 consecutive DA THA hips, two “best-view” digital photographs were taken of the exposure—one using Charnley/self-retaining retractors and one using a traditional three-retractor manual technique. Percent exposure of the polyethylene liner was calculated. Percent acetabular exposure averaged 80.0% using the Charnley/self-retaining technique, compared with 73.1% using the manual technique ( P =.0002). A hands-free technique provides superior acetabular exposure compared with the manual technique. Increasing body mass index predicts decreasing exposure with both techniques. [ Orthopedics . 2021;44(2):e309–e313.]

Introduction: Despite the promises of universal health care in most developed countries, health inequities remain prevalent within and between rural and remote communities. Remote health technologies are often promoted as solutions to increase health system efficiency, to enhance quality of care, and to decrease gaps in access to care for rural and remote communities. However, there is mixed evidence for these interventions, particularly related to how they are received and perceived by health providers and by patients. Health technologies do not always adequately meet the needs of patients or providers. To examine this, a broad-based scoping review was conducted to provide an overview of patient and provider perspectives of eHealth initiatives in rural communities. The unique objective of this review was to prioritize the voices of patients and providers in discussing the disparities between health interventions and needs of people in rural communities. eHealth initiatives were reviewed for rural communities of Australia and Canada, two countries that have similar geographies and comparable health systems at the local level. Methods: Searches were performed in PubMed, Scopus, and Web of Science with results limited from 2000 to 2018. Keywords included combinations of 'eHealth', 'telehealth', 'telemedicine', 'electronic health', and 'rural/remote'. Individual patient and provider perspectives on health care were identified, followed by qualitative thematic coding based on the type of intervention, the feedback provided, the affected population, geographic location, and category of individual providing their perspective. Quotes from patients and providers are used to illustrate the identified benefits and disadvantages of eHealth technologies. Results: Based on reviewed literature, 90.1% of articles reported that eHealth interventions were largely positive. Articles noted decreased travel time (18%), time/cost saving (15.1%), and increased access to services (13.9%) as primary benefits to eHealth. The most prevalent disadvantages of eHealth were technological issues (24.5%), lack of face-to-face contact (18.6%), limited training (10.8%), and resource disparities (10.8%). These results show where existing eHealth interventions could improve and can inform policymakers and providers in designing new interventions. Importantly, benefits to eHealth extend beyond geographic access. Patients reported ancillary benefits to eHealth that include reduced anxiety, disruption on family life, and improved recovery time. Providers reported closer connections to colleagues, improved support for complex care, and greater eLearning opportunity. Barriers to eHealth are recognized by patient and providers alike to be largely systemic, where lack of rural high-speed internet and unreliability of installed technologies were significant. Conclusion: Regional and national governments are seen as the key players in addressing these technical barriers. This scoping review diverges from many reviews of eHealth with the use of first-person perspectives. It is hoped that this focus will highlight the importance of patient voices in evaluating important healthcare interventions such as eHealth and associated technologies.

The small size coupled with remoteness of rural communities in Canada, Australia, and Sweden introduce challenges in accessing sufficient health services (1-3). The sparse health services in rural areas impose “the tyranny of distance” on rural and remote populations, necessitating lengthy travel times to receive care. Despite the increased challenges rural communities face, a dearth of research on rural health persists, particularly rural youth health (4,5). A broad scoping review was undertaken to identify literature regarding rural youth health in Canada, Australia, and Sweden. The studies were coded according to population focus, health focus, access, and general. The scoping review produced the Rural Youth Health Scoping Review Database, which provides an overview of the available research on rural youth health.

Purpose of Review The purpose of this review was to evaluate the available literature to determine what may be considered urgent indications for total hip arthroplasty, in the unprecedented setting of the worldwide COVID-19 pandemic. Recent Findings SARS-CoV-2 is a novel coronavirus currently presenting in the form of a global pandemic, referred to as COVID-19. In this setting, multiple states have issued executive orders prohibiting “elective” surgery, including arthroplasty, in order to preserve healthcare resources. However, during this unprecedented reduction in elective surgery, there is likely to be some controversy as to what constitutes a purely “elective” procedure, versus an “urgent” procedure, particularly regarding hip arthroplasty. We reviewed the available literature for articles discussing the most commonly encountered indications for primary, conversion, and revision hip arthroplasty. Based upon the indications discussed in these articles, we further stratified these indications into “elective” versus “urgent” categories. Summary In patients presenting with hip arthroplasty indications, the decision to proceed urgently with surgery should be based upon (a) the potential harm incurred by the patient if the surgery was delayed and (b) the potential risk incurred by the patient in the context of COVID-19 if surgery was performed. The authors present a decision-making algorithm for determining surgical urgency in three patients who underwent surgery in this context. Urgent total hip arthroplasty in the setting of the COVID-19 pandemic is a complex decision-making process, involving clinical and epidemiological factors. These decisions are best made in coordination with a multidisciplinary committee of one’s peers. Region-specific issues such as hospital resources and availability of PPE may also inform the decision-making process.

Introduction Patients with inflammatory bowel disease (IBD) suffer from various symptoms, impairing their quality of life and often affecting psychosocial issues. This may lead to the need for additional psychological care. This study investigated patients' subjective need for integrated psychosomatic support and psychotherapy and indicators for it. Materials and methods This is a cross‐sectional multicentre study in Austrian IBD patients who were in routine care at 18 IBD outpatient clinics. Patients filled in an anonymous, validated questionnaire (Assessment of the Demand for Additional Psychological Treatment Questionnaire [ADAPT]) assessing the need for psychological care. The ADAPT gives two separate scores: the need for integrated psychosomatic support and for psychotherapy. In addition, health‐related quality of life and the use of complementary and alternative medicine as well as clinical and socio‐demographic variables were queried. Multivariable regression analysis was performed to estimate the effect of the previously mentioned variables on the need for additional psychological care. Results Of 1286 patients, 29.7% expressed a need for additional psychological care, 19.6% expressed a need for integrated psychosomatic support and 20.2% expressed a need for psychotherapy. In the multivariable analysis, the two strongest indicators for the need for both types of psychological care were the use of complementary and alternative medicine (for integrated psychosomatic support: odds ratio = 1.64, 95% confidence interval 1.13–2.39, p = 0.010; for psychotherapy: odds ratio = 1.74, 95% confidence interval 1.20–2.53, p = 0.004), and a low health‐related quality of life score (for integrated psychosomatic support: odds ratio = 0.95, 95% confidence interval 0.94–0.96, p, Key summary What is already known? Despite ongoing improvement of treatment options, patients may not respond to treatment or may develop side effects. Due to this burden of disease, patients may also suffer from psychological symptoms, such as depressionIn our previous study in 2008, we found that 31% of patients with inflammatory bowel disease (IBD) expressed a subjective need for psychological interventions What are the significant and/or new findings of the study? Despite improvements in therapy, around 30% of patients with IBD express a subjective need for psychological interventionsThis subjective need for psychological interventions is associated with complementary and alternative medicine use and low quality of life

Background The association between fine particulate matter and cardiovascular disease has been convincingly demonstrated. The role of traffic‐related air pollutants is less clear. To better understand the role of traffic‐related air pollutants in cardiovascular disease development, we examined associations between NO 2 , carotid atherosclerotic plaque, and cardiometabolic disorders associated with cardiovascular disease. Methods and Results Cross‐sectional analyses were conducted among 2227 patients (62.9±13.8 years; 49.5% women) from the Stroke Prevention and Atherosclerosis Research Centre (SPARC) in London, Ontario, Canada. Total carotid plaque area measured by ultrasound, cardiometabolic disorders, and residential locations were provided by SPARC medical records. Long‐term outdoor residential NO 2 concentrations were generated by a land use regression model. Associations between NO 2 , total carotid plaque area, and cardiometabolic disorders were examined using multiple regression models adjusted for age, sex, smoking, and socioeconomic status. Mean NO 2 was 5.4±1.6 ppb in London, Ontario. NO 2 was associated with a significant increase in plaque (3.4 mm 2 total carotid plaque area per 1 ppb NO 2 ), exhibiting a linear dose‐response. NO 2 was also positively associated with triglycerides, total cholesterol, and the ratio of low‐ to high‐density lipoprotein cholesterol ( P 2 and total carotid plaque area ( P Conclusions Our results demonstrate that even low levels of traffic‐related air pollutants are linked to atherosclerotic plaque burden, an association that may be partially attributable to pollution‐induced diabetes mellitus. Our findings suggest that reducing ambient concentrations in cities with NO 2 below current standards would result in additional health benefits. Given the billions of people exposed to traffic emissions, our study supports the global public health significance of reducing air pollution.

This study examined three meat-restricted diets (N = 865)-a vegetarian diet, a reduced-meat diet, and a chicken-free diet-with a focus on the differences in lived dietary experiences operationalized using measures such as satisfaction with food-related life and the theory of planned behavior. The data comes from an online survey of a census-balanced sample of 30,000+ U.S. residents. The findings showed that meat reducers are a larger group than suspected and that there was a statistically significant difference in dietary experiences with vegetarians reporting better experiences with their diet. This research speaks to how the type of meat restriction impacts lived experiences.

Background Firefighters, police, and armed services may be exposed to hazards such as combustion by-products and shift work. Methods The CanCHEC cohort linked 1991 census data to the Canadian cancer registry for follow up. Cox proportional hazards modeling was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) to estimate risks for firefighter, police, or armed forces compared to workers in other occupations. Results The cohort of 1 108 410 men included 4535 firefighters, 10 055 police, and 9165 armed forces. For firefighters, elevated risks were noted for Hodgkin's lymphoma (HR: 2.89, 95%CI: 1.29-6.46), melanoma (HR: 1.67, 95%CI: 1.17-2.37), and prostate cancer (HR: 1.18, 95%CI: 1.01-1.37). Police had elevated risks for melanoma (HR:1.69, 95%CI: 1.32-2.16) and prostate cancer (HR:1.28, 95%CI: 1.14-1.42). No significant associations were found for armed forces workers. Conclusions Canadian firefighters, police, and armed services, may be at an increased risk of developing certain cancers. Results suggested that a healthy worker effect may influence risk estimates.

Die regionale Grunstromkennzeichnung nach EEG 2017 stellt eine Erweiterung der Kennzeichnungsmoglichkeiten fur Grunstrom dar. Dieser Beitrag geht der Frage nach, inwieweit die Implementierung von regionalen Grunstromprodukten unter Verwendung der regionalen Grunstromkennzeichnung gemas EEG 2017 zur Starkung des regionalen Markenkerns deutscher Stromvertriebe dienlich sein kann und welches die bestmogliche Alternative zur Erhohung des regionalen Markenkerns fur diese Stromvertriebe darstellt. Dazu werden zuerst die bereits existierenden Moglichkeiten zur Grunstromvermarktung mit regionalem Bezug im Detail diskutiert und dargelegt, welche weiteren Vermarktungsmodelle durch die regionale Grunstromkennzeichnung ermoglicht werden. Zum anderen werden die Kriterien identifiziert, mit denen die verschiedenen Grunstromvermarktungsmodelle mit Regionalbezug – mit Blick auf deren Potenzial zur Erhohung des regionalen Markenkerns – miteinander verglichen werden sollten. Die Ergebnisse der Analyse zeigen, dass die regionale Grunstromkennzeichnung nach EEG 2017 dazu genutzt werden kann, die bereits vor der Einfuhrung des EEG 2017 bestehenden Optionen zur Vermarktung von regional erzeugtem Strom systematisch aufzuwerten.

In diesem Beitrag wird – in Erganzung eines vorangegangenen Beitrages zum Thema (Teil 1: Grundlagen und Potenzialanalyse) – eine Multikriterien-Analyse durchgefuhrt, wobei die Entscheidungstrager in den Analyseprozess mit einbezogen wurden. Aus der Multikriterien-Analyse werden Handlungsempfehlungen bzgl. der Alternativen zur regionalen Grunstromvermarktung abgeleitet (vgl. Teil 1). Fur die multikriterielle Entscheidungsanalyse wurde eine hybride Multikriterien-Methode entwickelt, welche die Vorteile zweier Methoden miteinander paart. Konkret wurde die Bewertung der Alternativen und die Gewichtung der Kriterien mit der sogenannten Multi-Attribute Global Inference of Quality (MAGIQ) Methode vorgenommen, wahrend die Berechnung des Analyseergebnisses uber eine optimierte Form der Weighted Aggregated Sum Product Assessment (WASPAS) Methode erfolgte. Die Ergebnisse der multikriteriellen Entscheidungsanalyse zeigen, dass die regionale Grunstromkennzeichnung nach EEG 2017 dazu genutzt werden kann, die bereits vor der Einfuhrung des EEG 2017 bestehenden Optionen zur Vermarktung von regional erzeugtem Strom aufzuwerten. So belegen Grunstromvermarktungsmodelle, die eine Kombination der regionalen Grunstromkennzeichnung nach EEG 2017 mit bestehenden Optionen zur Vermarktung von regional erzeugtem Strom vorsehen, im Ergebnis der durchgefuhrten multikriteriellen Entscheidungsanalyse die ersten drei Range.

Supplemental material, sj-pdf-1-ueg-10.1177_2050640620946874 for Use of complementary and alternative medicine and low quality of life associate with the need for psychological and psychotherapeutic interventions in inflammatory bowel disease by Maximilian Kutschera, Thomas Waldhör, Hans Peter Gröchenig, Thomas Haas, Heimo Wenzl, Pius Steiner, Robert Koch, Thomas Feichtenschlager, Gerald Eckhardt, Andreas Mayer, Andreas Kirchgatterer, Othmar Ludwiczek, Reingard Platzer, Pavol Papay, Johanna Gartner, Harry Fuchssteiner, Paul-Gerhard Peters, Gerhard Reicht, Gabriele Moser, Clemens Dejaco, Harald Vogelsang, Christian Primas, Gottfried Novacek and Wolfgang Miehsler in United European Gastroenterology Journal

Rural and remote communities in both Australia and Canada have a higher burden of mental illness relative to their urban counterparts. Suicide rates, particularly, are higher across all age groups among men in rural communities as compared to metropolitan areas. Mental health issues are especially present in younger populations within these communities. Additionally, rural and remote communities tend to have higher proportions of Indigenous origin individuals, who face additional challenges and service barriers. Rural and remote communities often encounter significant barriers to accessing mental health care. Individuals from these communities may be serviced solely by general health care providers that are not trained in mental health treatment. Travelling away from the community to alleviate this issue only further hinders accessibility as these individuals must travel larger distances to access specialized health services. When services are accessed, those from rural and remote communities are met with longer wait times than their urban counterparts. With no specialized treatment within the rural or remote community and inaccessible treatment outside the community, mental health care must shift to informal caregivers and the community as a whole. Rural and remote communities are often not trained in mental health care. Interventions to address rural and remote youth mental health are needed to equip communities with the tools and skills to overcome access barriers and support community members. A review of recent literature related to rural and remote youth mental health interventions was conducted. The aim of the review is to characterize these mental health interventions in Australia and Canada and examine how they relate to youth.

Rural and remote communities comprise around32% and 22% of Australia’s and Canada’s population. However, only 14% and 16% of family physicians in Australia and Canada, respectively, practice in these communities, resulting in a disproportion in access as compared with urban areas. An erosion of health services occurs when the number of physicians and other health care providers in a region is insufficient or these professionals are non-existent. Even when existing in a rural and remote region, providers are often overburdened. Inaccessibility to services in rural and remote communities’ results in poor health outcomes for all involved. In Canada, 1 in 7 physicians will leave rural practice within two years. Strategies to address these turnover rates and the lessening interest in entering rural practice have focused on supporting recruitment and retention initiatives (RnR) to first bring physicians into rural practice and then encourage physicians to continue in rural practice beyond the short-term. These programs have so far been insufficient or ineffective to address the lack of physicians in rural and remote areas. A review of recent literature related to RnR initiatives focused on rural physicians in Australia and Canada was conducted to investigate the strengths and limitations of initiatives. Further, this review critically examines the short and long-term feasibility of initiatives and develops a conceptual framework for designing or examining RnR initiatives.

A review of recent literature related to eHealth technologies in Canada and Australia was conducted to better understand specific barriers and enablers for the uptake, acceptability, and success of eMental health programs. It has been shown that the more “rural” or “remote” a community, the access to mental health services decreases. By mitigating barriers and promoting enablers, successful eMental health integration can increase access to mental health services for rural residents. eMental health aims to bridge the gap between rural and urban mental health services by introducing electronic methods such as teleconferencing or videoconferencing for psychological services, virtual referral to psychiatrists, and sharing of electronic records. Successful integration of the technology remains a challenging task, with key actors, enablers, and barriers all influencing its success.

Objectives Shift work with circadian disruption is a suspected human carcinogen. Additional population-representative human studies are needed and large population-based linkage cohorts have been explored as an option for surveillance shift work and cancer risk. This study uses a surveillance linkage cohort and job-exposure matrix to test relationships. Methods We estimated associations between shift work and breast, ovarian, and prostate cancer using the population-based Canadian Census Health and Environment Cohort (CanCHEC), linking the 1991 Canadian census to national cancer registry and mortality databases. Prevalence estimates from population labour survey data were used to estimate and assign probability of night, rotating, or evening shifts by occupation and industry. Cohort members were assigned to high (>50%), medium (>25 to 50%), low (>5 to 25%), or no ( Results The cohort included 1 098 935 men and 939 520 women. Hazard ratios (HRs) indicated null or inverse relationships comparing high probability to no exposure for prostate cancer: HR = 0.96, 95% confidence interval (CI) = 0.91–1.02; breast cancer: HR = 0.94, 95% CI = 0.90–0.99; and ovarian cancer: HR = 0.99, 95% CI = 0.87–1.13. Conclusions This study showed inverse and null associations between shift work exposure and incidence of prostate, breast, or ovarian cancer. However, we explore limitations of a surveillance cohort, including a possible healthy worker survivor effect and the possibility that this relationship may require the nuanced exposure detail in primary collection studies to be measurable.