High rates of lower respiratory tract infection (LRTI), including bronchiolitis and pneumonia, have been reported in Inuit infants living in arctic Canada. We examined rates of LRTI in First Nations Canadian infants living in the Sioux Lookout Zone, in Northern Ontario.
A retrospective review of hospital admissions for LRTI during a 5-year period, in patients
To assess the current prevalence of depression and anxiety among Ontario family medicine residents, and to describe their coping strategies.
Surveys mailed to residents integrated DSM-IV diagnostic criteria and a previously validated Patient Health Questionnaire.
Ontario family medicine programs from June to August 2002.
Residents entering, advancing in, or graduating from residency programs: approximately 216 yearly for a total of 649 residents.
Types and frequency of coping skills used by residents; prevalence of depressive and anxiety disorders.
Response rate for residents entering programs was 46% and for graduating residents was 30% (37% response rate overall). Prevalence of depressive disorders was 20% (13% major depressive disorders, 7% other depressive syndromes)(odds ratio [OR] 3.4, confidence interval [CI] 2.7 to 7.5, P
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Our objective was to understand the perinatal knowledge and experiences of First Nations women from northwestern Ontario who travel away from their remote communities to give birth.
A systematic review of MEDLINE, HealthSTAR, HAPI, Embase, AMED, PsycINFO and CINAHL was undertaken using Medical Subject Headings and keywords focusing on Canadian Aboriginal (First Nations, Metis and Inuit) prenatal education and care, and maternal health literacy. This qualitative study using semistructured interviews was conducted in a rural hospital and prenatal clinic that serves First Nations women. Thirteen women from remote communities who had travelled to Sioux Lookout, Ont., to give birth participated in the study.
We identified 5 other qualitative studies that explored the birthing experiences of Aboriginal women. The studies documented a negative experience for women who travelled to access intrapartum maternity care. While in Sioux Lookout to give birth, our participants also experienced loneliness and missed their families. They were open to the idea of a culturally appropriate doula program and visits in hospital by First Nations elders, but they were less interested in access to tele-visitation with family members back in their communities. We found that our participants received most of their prenatal information from family members.
First Nations women who travel away from home to give birth often travel great cultural and geographic distances. Hospital-based maternity care programs for these women need to achieve a balance of clinical and cultural safety. Programs should be developed to lessen some of the negative consequences these women experience.
Epidural steroid injections (ESIs) are a safe and accessible therapy for chronic low back pain, one of the most common and challenging chronic conditions seen in primary care. However, the indications for and effectiveness of ESI remain controversial. In rural settings with limited public transportation infrastructure, such a mobility-limiting condition can have even more negative effects on quality of life and function. Furthermore, diagnostic and specialist services are often limited. A paucity of safe, effective and accessible treatments leads to heavy reliance on oral analgesics, especially opioids, which have well-known complications.
We reviewed the use of ESI for the 2 most common types of chronic low back pain in those with neurologic symptoms: lumbar disc herniation (LDH) and lumbar spinal stenosis (LSS). We did a retrospective chart review of all patients who underwent ESI between Jan. 1, 2005, and Feb. 25, 2010, at our rural hospital in northwestern Ontario.
During the study period, 123 ESIs were administered to 65 patients. After the first injection, 40 patients (62%) reported improvement, 10 (15%) reported worsening or no change, and 15 (23%) had no follow-up documented.
Some patients with neurologic compromise from LDH or LSS have improvement in symptoms after ESI. A prospective study is underway to more rigorously assess the effectiveness of this treatment.
To understand and describe the menopause experiences and perspectives of First Nations women residing in northwestern Ontario.
Phenomenologic approach using in-depth qualitative interviews.
Sioux Lookout, Ont, and 4 surrounding First Nations communities.
Eighteen perimenopausal and postmenopausal First Nations women, recruited by convenience and snowball sampling techniques.
Semistructured interviews were audiotaped and transcribed. Themes emerged through a crystallization and immersion analytical approach. Triangulation of methods was used to ensure reliability of findings.
This study confirms the hypothesis that menopause is generally not discussed by First Nations women, particularly with their health care providers. The generational knowledge gained by the women in this study suggests that a variety of experiences and symptoms typical of menopause from a medical perspective might not be conceptually linked to menopause by First Nations women. The interview process and initial consultation with translators revealed that there is no uniform word in Ojibway or Oji-Cree for menopause. A common phrase is "that time when periods stop," which can be used by caregivers as a starting point for discussion. Participants' interest in the topic and their desire for more information might imply that they would welcome the topic being raised by health care providers.
This study speaks to the importance of understanding the different influences on a woman's menopause experience. Patient communication regarding menopause might be enhanced by providing women with an opportunity or option to discuss the topic with their health care providers. Caregivers should also be cautious of attaching preconceived ideas to the meaning and importance of the menopause experience.
Cites: J Womens Health Gend Based Med. 2000;9 Suppl 2:S27-3810714743
The rate of cholecystectomy in northwestern Ontario is double the provincial rate. This paper explores the demographics of cholecystectomy and the role for rural endoscopic retrograde cholangiopancreatography (ERCP) services in the central part of this region.
We conducted a literature review of ERCP services and cholecystectomy rates, as well as a hospital chart review of patients who underwent laparoscopic cholecystectomies in Sioux Lookout, Ont. We contacted surgeons and gastroenterologists from referral centres in Winnipeg, Man., and Thunder Bay, Ont., for the charts of patients from our catchment area who underwent ERCP.
Patients in our region who require urgent and emergent surgery are flown by fixed-wing aircraft to referral centres in Winnipeg and Thunder Bay for assessment and surgery. The rate of ERCP in our population is 150 in 100 000, which is threefold that of other populations, and our cholecystectomy rate is the highest in Ontario.
Substantial savings in transportation expenses would offset the development costs of an ERCP program and provide more integrated patient care. The volume of patients would support maintenance of competency. This rural area with a high rate of gallbladder disease would benefit from the development of a rural ERCP program.
Seven epidemiologically unrelated cases of invasive Haemophilus influenzae type a (Hia) disease were identified in First Nations communities of Northwestern Ontario, Canada, in 2004-2008. In all cases, Hia was isolated from blood. The clinical presentation in most of the cases was moderately severe and all patients responded to antibiotic therapy. Laboratory analysis of Hia isolates from Northwestern Ontario indicated striking similarities in their phenotypic and genotypic characteristics. The findings are discussed in the context of current epidemiology of invasive Hia disease. Our data along with some published studies by others suggest an increased susceptibility to this infection among North American indigenous populations.
A high incidence of invasive non-type b Haemophilus influenzae disease was found in Northwestern Ontario, Canada; H. influenzae type a was the most prevalent serotype (42%). Clinical and demographic analyses indicate that aboriginal children aged