Canadian Journal of Rural Medicine最新文献

{"title":"Underserved community versus underserved disease.","authors":"Kathleen Ellen Walsh","doi":"10.4103/cjrm.cjrm_7_23","DOIUrl":"10.4103/cjrm.cjrm_7_23","url":null,"abstract":"","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":"28 3","pages":"141-142"},"PeriodicalIF":1.1,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9862247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"President's Message - Gender and rural medicine.","authors":"Sarah Lespérance","doi":"10.4103/cjrm.cjrm_23_23","DOIUrl":"10.4103/cjrm.cjrm_23_23","url":null,"abstract":"","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":"28 3","pages":"105"},"PeriodicalIF":1.1,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9862241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Results of a mixed-methods study on barriers to physician recruitment in Newfoundland and Labrador.","authors":"Monica Kidd,&nbsp;Nicholas Fairbridge,&nbsp;Andrew O'Keefe,&nbsp;Gerard Farrell","doi":"10.4103/cjrm.cjrm_56_22","DOIUrl":"https://doi.org/10.4103/cjrm.cjrm_56_22","url":null,"abstract":"<p><strong>Background: </strong>Like many rural and remote parts of Canada, the province of Newfoundland and Labrador (NL) struggles to maintain a skilled healthcare workforce. As many as 20% of people in the province are thought to be without a primary care physician. The purpose of this study was to determine the barriers recent Memorial University of Newfoundland medical alumni have faced in establishing medical practice in NL.</p><p><strong>Methods: </strong>An online survey followed by question-standardised focus group sessions.</p><p><strong>Results: </strong>Two hundred and ninety-one physicians who graduated from Memorial University of Newfoundland medical school between the years of 2003 and 2018 completed the survey. Nearly 80% of respondents recalled that NL was their preferred practice location at some point during training: 79.4% (n = 231) at the beginning of medical school and 77.7% (n = 226) at the beginning of residency training. However, at the time of the survey, only 160 (55.0%) respondents were working in NL. Respondents reported significant cultural and systemic barriers in trying to work in NL, including ineffective recruitment offices, lack of transparency in communication with health authorities, inequitable distribution of resources and workloads, lack of appropriate resources to support new positions, and return-of-service agreements that are not honoured or followed-up.</p><p><strong>Conclusion: </strong>Our study outlines a number of ways in which recruitment and retention could be improved, ultimately improving provincial health care and helping to fulfil the mandate of the medical school.</p>","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":"28 3","pages":"116-122"},"PeriodicalIF":1.1,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9807923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Une perte toujours présente.","authors":"Peter Hutten-Czapski","doi":"10.4103/1203-7796.379555","DOIUrl":"10.4103/1203-7796.379555","url":null,"abstract":"","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":"28 3","pages":"104"},"PeriodicalIF":1.1,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9862239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Urban-rural divide in COVID-19 infection and vaccination rates in healthcare workers in British Columbia, Canada.","authors":"Annalee Yassi,&nbsp;Stephen Barker,&nbsp;Karen Lockhart,&nbsp;Deanne Taylor,&nbsp;Devin Harris,&nbsp;Harsh Hundal,&nbsp;Jennifer M Grant,&nbsp;Arnold Ikedichi Okpan,&nbsp;Sue Pollock,&nbsp;Stacy Sprague,&nbsp;Chad Kim Sing","doi":"10.4103/cjrm.cjrm_24_22","DOIUrl":"https://doi.org/10.4103/cjrm.cjrm_24_22","url":null,"abstract":"<p><strong>Introduction: </strong>Healthcare workers (HCWs) play a critical role in responding to the COVID-19 pandemic. Early in the pandemic, urban centres were hit hardest globally; rural areas gradually became more impacted. We compared COVID-19 infection and vaccine uptake in HCWs living in urban versus rural locations within, and between, two health regions in British Columbia (BC), Canada. We also analysed the impact of a vaccine mandate for HCWs.</p><p><strong>Methods: </strong>We tracked laboratory-confirmed SARS-CoV-2 infections, positivity rates and vaccine uptake in all 29,021 HCWs in Interior Health (IH) and all 24,634 HCWs in Vancouver Coastal Health (VCH), by occupation, age and home location, comparing to the general population in that region. We then evaluated the impact of infection rates as well as the mandate on vaccination uptake.</p><p><strong>Results: </strong>While we found an association between vaccine uptake by HCWs and HCW COVID-19 rates in the preceding 2-week period, the higher rates of COVID-19 infection in some occupational groups did not lead to increased vaccination in these groups. By 27 October 2021, the date that unvaccinated HCWs were prohibited from providing healthcare, only 1.6% in VCH compared with 6.5% in IH remained unvaccinated. Rural workers in both areas had significantly higher unvaccinated rates compared with urban dwellers. Over 1800 workers, comprising 6.7% of rural HCWs and 3.6% of urban HCWs, remained unvaccinated and set to be terminated from their employment. While the mandate prompted a significant increase in uptake of second doses, the impact on the unvaccinated was less clear.</p><p><strong>Conclusions: </strong>As rural areas often suffer from under-staffing, loss of HCWs could have serious impacts on healthcare provision as well as on the livelihoods of unvaccinated HCWs. Greater efforts are needed to understand how to better address the drivers of rural-related vaccine hesitancy.</p>","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":"28 2","pages":"47-58"},"PeriodicalIF":1.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9233410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgery in the western Canadian Arctic: The relative impact of family physicians with enhanced surgical skills working collaboratively with specialist surgeons.","authors":"Ryan Falk,&nbsp;Dawnelle Topstad","doi":"10.4103/cjrm.cjrm_44_22","DOIUrl":"https://doi.org/10.4103/cjrm.cjrm_44_22","url":null,"abstract":"<p><strong>Introduction: </strong>Little is known about the surgical needs of rural, remote or circumpolar populations in Canada; these same regions are also home to half of all Indigenous people in the country. In the present study, we sought to understand the relative impact of family physicians with enhanced surgical skills (FP-ESS) and Specialist Surgeons in the surgical care of a mostly Indigenous rural and remote community in the western Canadian Arctic.</p><p><strong>Methods: </strong>A descriptive and retrospective quantitative study was conducted to determine the number and range of procedures performed for the defined catchment population of the Beaufort Delta Region of the Northwest Territories, as well as the type of surgical provider and location of that service, over the 5 years from 1 April, 2014, to 31 March, 2019.</p><p><strong>Results: </strong>FP-ESS physicians in Inuvik performed 79% of all endoscopic and 22% of all surgical procedures, which accounted for nearly half of the total procedures performed. Over 50% of all procedures were performed locally (47.7% by FP-ESS and 5.6% by visiting specialist surgeons). For surgical cases alone, nearly one-third were performed locally, one-third in Yellowknife and the remaining one-third out-of-territory.</p><p><strong>Conclusions: </strong>This networked model reduces the overall demand on surgical specialists, who can better focus their efforts on surgical care that is beyond the scope of FP-ESS. With nearly half of the procedural needs of this population being met locally by FP-ESS, there are decreased health-care costs, better access and more surgical care closer to home.</p>","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":"28 2","pages":"66-72"},"PeriodicalIF":1.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9233412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors and Prediction Models for Unplanned Hospital Readmissions at a Pediatric Tertiary Centre","authors":"Amir Wachtel, M. Irvine, Jennifer Rurak, D. Courtemanche","doi":"10.33844/cjm.2023.6028","DOIUrl":"https://doi.org/10.33844/cjm.2023.6028","url":null,"abstract":"Unplanned Hospital Readmissions (UHRs) are associated with increased morbidity and mortality, and may be preventable. This study identified factors associated with pediatric UHRs and developed prediction models. UHRs for pediatric patients from 2007-2009 and 2017-2019 at British Columbia Children’s Hospital were retrospectively reviewed. Factors for UHRs were analyzed, and prediction models were derived and tested. 5.26% (411/8387) of patients from 2007-2009 and 3.95% (329/8316) from 2017-2019 experienced at least one UHR. Varying by time period, factors for UHRs included: home health authority, age, previous ER visits, preadmission comorbidities, admission type, in-hospital interventions, and intensive care unit stay. Prediction models had areas under the receiver operating characteristic curve of .61 (2007-2009) and .67 (2017-2019). This study identified variables associated with UHRs. Differences in predictor variables between two time periods suggest that UHRs may not reflect quality of care, and future prediction models need to be iteratively refined.","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":"128 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76610300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Message de la présidente. Un Program national de compétences et formation avancées pour la pratique en milieu rural.","authors":"Sarah Lesperance","doi":"10.4103/1203-7796.372318","DOIUrl":"https://doi.org/10.4103/1203-7796.372318","url":null,"abstract":"","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":"28 2","pages":"46"},"PeriodicalIF":1.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9227798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Remplacez-moi... S'il vous plaît.","authors":"Peter Hutten-Czapski","doi":"10.4103/1203-7796.372316","DOIUrl":"https://doi.org/10.4103/1203-7796.372316","url":null,"abstract":"","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":"28 2","pages":"44"},"PeriodicalIF":1.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9227797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systematic review of the use of metformin compared to insulin for the management of gestational diabetes: Implications for low-resource settings.","authors":"Ribal Kattini,&nbsp;Len Kelly,&nbsp;Ruben Hummelen","doi":"10.4103/cjrm.cjrm_40_22","DOIUrl":"https://doi.org/10.4103/cjrm.cjrm_40_22","url":null,"abstract":"<p><strong>Introduction: </strong>This systematic review examines the effectiveness of metformin treatment compared to insulin treatment for gestational diabetes within the context of a low-resource environment.</p><p><strong>Methods: </strong>Electronic data searches of Medline, EMBASE, Scopus and Google scholar databases from 1 January, 2005 to 30 June, 2021 were performed using medical subject headings: 'gestational diabetes or pregnancy diabetes mellitus' AND 'Pregnancy or pregnancy outcomes' AND 'Insulin' AND 'Metformin Hydrochloride Drug Combination/or Metformin/or Hypoglycemic Agents' AND 'Glycemic control or blood glucose'. Randomized controlled trials were included if: participants were pregnant women with gestational diabetes mellitus (GDM); the interventions were metformin and/or insulin. Studies among women with pre-gestational diabetes, non-randomised control trials or studies with a limited description of the methodology were excluded. Outcomes included adverse maternal outcomes: weight gain, C-section, pre-eclampsia and glycaemic control and adverse neonatal outcomes: birth weight, macrosomia, pre-term birth and neonatal hypoglycaemia. The revised Cochrane Risk of Bias Assessment for randomised trials was used for the evaluation of bias.</p><p><strong>Results: </strong>We screened 164 abstracts and 36 full-text articles. Fourteen studies met the inclusion criteria. The studies provide moderate to high-quality evidence demonstrating the effectiveness of metformin as an alternative therapy to insulin. Risk of bias was low; multiple countries and robust sample sizes improved external validity. All studies were from urban centres with no rural data.</p><p><strong>Conclusion: </strong>These recent high quality studies comparing metformin to insulin for the treatment of GDM generally found either improved or equivalent pregnancy outcome and good glycaemic control for most patients, although many required insulin supplementation. Its ease of use, safety and efficacy suggest metformin may simplify the management of gestational diabetes, particularly in rural and other low-resource environments.</p>","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":"28 2","pages":"59-65"},"PeriodicalIF":1.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9233413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}