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Advance directives: the views of health care professionals.

https://arctichealth.org/en/permalink/ahliterature221256
Source
CMAJ. 1993 Apr 15;148(8):1331-8
Publication Type
Article
Date
Apr-15-1993
Author
M. Kelner
I L Bourgeault
P C Hébert
E V Dunn
Author Affiliation
Department of Behavioural Science, University of Toronto, Ont.
Source
CMAJ. 1993 Apr 15;148(8):1331-8
Date
Apr-15-1993
Language
English
Publication Type
Article
Keywords
Adult
Advance Directives - statistics & numerical data
Attitude of Health Personnel
Community Medicine
Family Practice
Female
Geriatrics
Hospitals, Teaching
Humans
Intensive Care
Interviews as Topic
Male
Medical Oncology
Medical Staff, Hospital - psychology
Middle Aged
Nursing Staff, Hospital - psychology
Ontario
Questionnaires
Abstract
This study examined the views and experiences of 20 physicians and 20 nurses at a major Canadian teaching hospital regarding the use of advance directives in clinical care.
The participants were purposively drawn from four clinical specialties: family and community medicine, oncology, intensive care and geriatrics. Detailed interviews were conducted in person. Content analysis was used to code the data, which were further analysed with both quantitative and qualitative techniques.
Thirty-nine of the 40 participants favoured the use of advance directives in clinical care; physicians had somewhat less positive attitudes than nurses toward such directives. Advance directives were thought by participants to be helpful in resolving disagreements between patients and their families about treatment options; in making patients more comfortable, both physically and psychologically, during the process of dying; and in opening up communication and trust among patients, their families and health care professionals. Concerns about the use of advance directives focused on the lack of clarity in some patients' instructions, the absence of legal status for directives, the possible interference with a practitioner's clinical judgement, the adequacy and appropriateness of patients' information about their circumstances, and the type of intervention (passive or active) requested by patients.
New regulations and legislation are making the use of advance directives more widespread. Health care professionals should participate in the development and implementation of these directives. Continuing professional education is essential in this regard.
Notes
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Cites: N Engl J Med. 1991 Mar 28;324(13):882-82000110
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Cites: CMAJ. 1990 Jan 1;142(1):23-61688397
Cites: JAMA. 1989 Nov 3;262(17):2415-92795827
PubMed ID
8462055 View in PubMed
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An estimation of Canada's public health physician workforce.

https://arctichealth.org/en/permalink/ahliterature150463
Source
Can J Public Health. 2009 May-Jun;100(3):199-203
Publication Type
Article
Author
Margaret L Russell
Lynn McIntyre
Author Affiliation
Department of Community Health Sciences, Faculty of Medicine, University of Calgary, 3330 Hospital Dr. NW, Calgary, AB T2N 4N1. mlrussel@ucalgary.ca
Source
Can J Public Health. 2009 May-Jun;100(3):199-203
Language
English
Publication Type
Article
Keywords
Canada
Certification
Civil Defense
Community Medicine - manpower
Data Collection
Disaster planning
Emergency Medicine - manpower
Health Manpower - statistics & numerical data
Humans
Occupational Medicine - manpower
Pediatrics - manpower
Physicians - supply & distribution
Public Health - education - manpower
Public Health Administration - manpower
Questionnaires
Abstract
Public health emergency planning includes a consideration of public health human resource requirements. We addressed the hypothetical question: How many public health physicians could Canada mobilize in the event of a public health emergency?
We used the 2004 National Physician Survey (NPS) to estimate the number of public health physicians in Canada. Using weighting to account for non-response, we estimated the numbers and population estimates of public health physicians who were active versus 'in reserve'. We explored the impact of using diverse definitions of public health physician based upon NPS questions on professional activity, self-reported degrees and certifications, and physician database classifications.
Of all Canadian physicians, an estimated 769 (1.3%) are qualified to practice public health by virtue of degrees and certifications relevant to public health, of whom 367 (48%) also report active 'community medicine/public health' practice. Even among Canada's 382 Community Medicine specialists, only 60% report active public health practice.
The estimation of the size of Canada's public health physician workforce is currently limited by the lack of a clear definition and appropriate monitoring. It appears that, even with a reserve public health physician workforce that would almost double its numbers, Canada's available workforce is only 40% of projected requirements. Public health emergency preparedness planning exercises should clearly delineate public health physician roles and needs, and action should be taken accordingly to enhance the numbers of Canadian public health physicians and their capacity to meet these requirements.
PubMed ID
19507722 View in PubMed
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Assessing Canadian medical students' familiarity with and interest in pursuing a career in community medicine.

https://arctichealth.org/en/permalink/ahliterature150464
Source
Can J Public Health. 2009 May-Jun;100(3):194-8
Publication Type
Article
Author
Monica M Hau
Ingrid V Tyler
Jane A Buxton
Lawrence J Elliott
Bart J Harvey
James C Hockin
David L Mowat
Author Affiliation
Community Medicine Residency Program, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5T 3M7.
Source
Can J Public Health. 2009 May-Jun;100(3):194-8
Language
English
Publication Type
Article
Keywords
Canada
Career Choice
Community Medicine
Focus Groups
Humans
Public Health
Questionnaires
Students, Medical
Abstract
Following the SARS outbreak, large gaps in the public health workforce have been identified. This study sought to understand the perceptions and attitudes of Canadian medical students with regard to public health to determine how this impacted their choice towards a career in Community Medicine (CM).
Five focus groups of 11-12 medical students from all years were recruited at McMaster University, Université de Sherbrooke, University of Toronto, University of Manitoba and the University of British Columbia. A professional facilitator was hired to conduct the focus groups using a unique computer-based facilitation system. Questions in both the focus group and an accompanying survey sought to determine medical students' understanding and exposure to public health and how this impacted their attitude and choice towards a career in community medicine. The transcripts were independently reviewed and analyzed by each of the authors to identify themes.
Four major themes related to choosing Community Medicine as a career were identified: 1) poor understanding of the role of Community Medicine specialists in public health practice, 2) perceived lack of clinical work and relevance of public health to clinical practice, 3) perceived lack of exclusivity of Community Medicine specialty, 4) incentives and disincentives to pursuing Community Medicine.
Better education of students on the role of CM specialists through increasing exposure to role models and demystifying inaccurate perceptions of CM through integration of public health with clinical medicine may potentially increase medical student entry into Community Medicine.
PubMed ID
19507721 View in PubMed
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Association between Weight Change and Mortality in Community Living Older People Followed for Up to 14 Years. The Hordaland Health Study (HUSK).

https://arctichealth.org/en/permalink/ahliterature289903
Source
J Nutr Health Aging. 2017; 21(8):909-917
Publication Type
Journal Article
Date
2017
Author
T R Haugsgjerd
J Dierkes
S E Vollset
K J Vinknes
O K Nygård
R Seifert
G Sulo
G S Tell
Author Affiliation
Teresa Risan Haugsgjerd, Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, 5018 Bergen, Norway; Email: Teresa.Haugsgjerd@uib.no, Tel: +47 40634711.
Source
J Nutr Health Aging. 2017; 21(8):909-917
Date
2017
Language
English
Publication Type
Journal Article
Keywords
Aged
Body Weight - physiology
Cohort Studies
Community Medicine
Female
Humans
Male
Mortality
Norway
Prospective Studies
Time Factors
Weight Gain
Abstract
To study the importance of weight change with regard to mortality in older people.
Prospective cohort study.
The cohort includes participants in the Hordaland Health Study, Norway, 1997-99 (N=2935, age 71-74 years) who had previously participated in a survey in 1992-93.
Participants with weight measured at both surveys were followed for mortality through 2012. Cox proportional hazards models were used to calculate risk of death according to changes in weight. Hazard ratios (HR) with 95% confidence intervals (CIs) for people with stable weight (± 3 kg were significantly associated with increased risk of mortality. Thus, weight should be routinely measured in older adults.
Notes
Cites: J Nutr. 2006 Jun;136(6 Suppl):1731S-1740S PMID 16702348
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Cites: J Nutr Health Aging. 2016 Apr;20(4):383-90 PMID 26999237
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PubMed ID
28972244 View in PubMed
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Blood pressure in acute stroke. The Copenhagen Stroke Study.

https://arctichealth.org/en/permalink/ahliterature10014
Source
Cerebrovasc Dis. 2002;13(3):204-9
Publication Type
Article
Date
2002
Author
H S Jørgensen
H. Nakayama
H R Christensen
H O Raaschou
J P Kampmann
T S Olsen
Author Affiliation
Department of Neurology, Gentofte Hospital, Bispebjerg Hospital, Copenhagen, Denmark. hsj@dadlnet.dk
Source
Cerebrovasc Dis. 2002;13(3):204-9
Date
2002
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Blood Pressure - physiology
Cerebrovascular Accident - complications - physiopathology
Community Medicine
Comparative Study
Denmark - epidemiology
Female
Humans
Ischemic Attack, Transient - physiopathology
Male
Middle Aged
Multivariate Analysis
Myocardial Ischemia - complications - physiopathology
Patient Admission
Prospective Studies
Research Support, Non-U.S. Gov't
Severity of Illness Index
Statistics
Time Factors
Abstract
This study examines blood pressure (BP) and independent factors related to BP in the acute phase of stroke. The study is part of the community-based Copenhagen Stroke Study. In a multivariate regression model we analyzed the impact of clinical and medical factors on admission BP. BP declined with increasing time from stroke onset with a total of 8/4 mm Hg. Independent factors related to diastolic BP were ischemic heart disease (-3.9 mm Hg), male gender (2.2 mm Hg), known hypertension prior to stroke (8.6 mm Hg), and primary hemorrhage (9.7 mm Hg). Independent factors related to systolic BP were age (3.6 mm Hg/10-year increase), atrial fibrillation (-7.2 mm Hg), ischemic heart disease (-6.0 mm Hg), intracerebral hemorrhage (13.3 mm Hg), and known hypertension prior to stroke (16.3 mm Hg). No independent relations were seen between BP and diabetes, claudication, previous stroke, smoking, daily alcohol consumption, initial stroke severity and lesion size. The increase in BP in the acute phase of stroke is a uniform response to the ischemic event per se. BP is not related to stroke severity. Several factors are independently related to the BP level in acute stroke. The clinical significance of this is yet to be tested, but these factors may contribute to the seemingly complex relation between BP and outcome.
PubMed ID
11914539 View in PubMed
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Boundaries and overlap: Community medicine or public health doctors and primary care physicians.

https://arctichealth.org/en/permalink/ahliterature147414
Source
Can Fam Physician. 2009 Nov;55(11):1102-1103.e5
Publication Type
Article
Date
Nov-2009
Author
Margaret L Russell
Lynn McIntyre
Author Affiliation
Department of Community Health Sciences, University of Calgary, 3330 Hospital Dr NW, Calgary, AB T2N 4N1. mlrussel@ucalgary.ca
Source
Can Fam Physician. 2009 Nov;55(11):1102-1103.e5
Date
Nov-2009
Language
English
Publication Type
Article
Keywords
Canada
Community Medicine - organization & administration
Delivery of Health Care - organization & administration
Humans
Physicians, Family
Public Health - manpower
Questionnaires
Abstract
To explore the boundaries and overlap of practice profiles of primary care physicians (PCPs), including FPs and GPs, and community medicine specialists (CMs), particularly in the area of community-oriented clinical care.
Analysis of data from the 2004 National Physician Survey. Analyses included frequencies, cross-tabulations, and chi(2) statistics.
Canada.
Primary care physicians and CMs who responded to the 2004 National Physician Survey.
For PCPs and CMs, we compared main work and patient care settings, areas of professional activity, and credentials to practise public health or family medicine. Among CMs, we examined the most commonly treated conditions and services provided for evidence of community-oriented clinical care.
Data were available for 154 CMs and 11 041 PCPs. The most common work setting for CMs was government or public health agencies, while for PCPs it was offices, clinics, or community care settings, including community hospitals. Among CMs, 59.7% indicated that community medicine or public health practice was an area of professional activity and 13.0% indicated that they participated in primary care. The corresponding proportions for PCPs were 15.3% and 78.2%, respectively. Generally, CMs engaged in a mixture of individual-level and population-level practice activities, although the former was not distinguished by increased clinical prevention, health promotion, or disease prevention services. Of CMs who indicated that primary care was an area of professional activity, 55.0% had the relevant credentials, compared with only 1.9% of PCPs who conversely indicated that community medicine or public health was an area of professional activity.
In Canada CMs and PCPs have distinct practice profiles, despite some overlaps. Further role and practice profile refinement for both physician groups has implications for training, credentialing, and deployment within the health care system.
Notes
Cites: J Fam Pract. 1982 Sep;15(3):485-927108463
Cites: N Z Med J. 1994 Sep 28;107(986 Pt 2):388-4337936474
Cites: Can J Public Health. 2009 May-Jun;100(3):199-20319507722
Cites: Milbank Q. 2005;83(3):457-50216202000
Cites: Can J Cardiol. 2005 Nov;21(13):1157-6216308589
Cites: Can Fam Physician. 2005 May;51:640-2, 647-915934260
PubMed ID
19910598 View in PubMed
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Bridging the gap in population health for rural and Aboriginal communities: a needs assessment of public health training for rural primary care physicians.

https://arctichealth.org/en/permalink/ahliterature164068
Source
Can J Rural Med. 2007;12(2):81-8
Publication Type
Article
Date
2007
Author
Jane A Buxton
Veronic Ouellette
Alison Brazier
Carl Whiteside
Rick Mathias
Meena Dawar
Andrea Mulkins
Author Affiliation
The Department of Health Care and Epidemiology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
Source
Can J Rural Med. 2007;12(2):81-8
Date
2007
Language
English
Publication Type
Article
Keywords
British Columbia
Clinical Competence
Communication
Community Medicine
Community-Institutional Relations
Cultural Characteristics
Focus Groups
Humans
Indians, North American
Interviews as Topic
Physicians, Family - economics - education
Population Groups
Public Health - education
Rural Health Services
Sampling Studies
Abstract
The literature identifies significant inequalities in the health status of rural and Aboriginal populations, compared with the general population. Providing rural primary care physicians with public health skills could help address this issue since the patterns of mortality and morbidity suggest that prevention and health promotion play an important role. However, we were unable to identify any community needs assessment for such professionals with dual skills that had been performed in Canada.
We conducted key informant interviews and focus groups in 3 rural and Aboriginal communities in British Columbia (chosen through purposive sampling). We analyzed transcripts following standard qualitative iterative methodologies to extract themes and for discussing content.
There was broad support for a program to train primary care physicians in public health. The characteristics identified as necessary in such a physician included a long-term commitment to the community with partnership building, advocacy, communication and cultural sensitivity skills. The communities we studied identified some priority challenges, most notably that the current remuneration structure does not support physicians engaging in public health or research.
There is great potential and support for the training of rural primary care practitioners in public health to improve population health and engage communities in this process.
PubMed ID
17442135 View in PubMed
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Bridging the gaps between departments on community and family medicine: the Calgary experience.

https://arctichealth.org/en/permalink/ahliterature251523
Source
J Community Health. 1976;1(3):205-15
Publication Type
Article
Date
1976
Author
D. Steinman
Source
J Community Health. 1976;1(3):205-15
Date
1976
Language
English
Publication Type
Article
Keywords
Ambulatory Care
Canada
Community Medicine - education
Curriculum
Faculty, Medical
Family Practice - education
Humans
Medicine
Outpatient Clinics, Hospital
Primary Health Care - methods
Research
Specialization
Abstract
Current emphasis on innovation in primary care has revealed conflicts between generalist clinicians and professionals in community medicine. Several problems are now evident in the combination of community medicine and family medicine. Three elements of a planned institutional approach to overcome problems in primary health care education at the University of Calgary, Faculty of Medicine, are discussed: the introduction of an integrated curriculum, de-emphasis of departments, and a center for ambulatory care.
PubMed ID
1002863 View in PubMed
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65 records – page 1 of 7.