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Aboriginal patients on the road to kidney transplantation: is residence location a barrier?

https://arctichealth.org/en/permalink/ahliterature167757
Source
Kidney Int. 2006 Sep;70(5):826-8
Publication Type
Article
Date
Sep-2006
Author
K E Yeates
Author Affiliation
Department of Medicine, Queen's University, Kingston, Ontario, Canada. yeatesk@post.queensu.ca
Source
Kidney Int. 2006 Sep;70(5):826-8
Date
Sep-2006
Language
English
Publication Type
Article
Keywords
Canada
Health Services Accessibility - statistics & numerical data
Hospitals, Rural
Humans
Indians, North American
Kidney Failure, Chronic - ethnology - surgery
Kidney Transplantation - ethnology - statistics & numerical data - utilization
Rural Population
Tissue and Organ Procurement - methods
Transportation
Abstract
Aboriginal dialysis patients have reduced access to kidney transplantation. The reasons for this disparity are unknown. Tonelli et al. show that in Canada, residence location does not significantly impact on an Aboriginal dialysis patient's likelihood of receiving kidney transplantation. This Commentary explores the issue of decreased access and examines issues surrounding the findings of Tonelli et al.
Notes
Comment On: Kidney Int. 2006 Sep;70(5):924-3016788690
PubMed ID
16929330 View in PubMed
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Abridged version of the Society of Rural Physicians of Canada's discussion paper on rural hospital service closures.

https://arctichealth.org/en/permalink/ahliterature149706
Source
Can J Rural Med. 2009;14(3):111-4
Publication Type
Article
Date
2009
Author
Peter Hutten-Czapski
Author Affiliation
Society of Rural Physicians of Canada, Shawville, Que. phc@srpc.ca
Source
Can J Rural Med. 2009;14(3):111-4
Date
2009
Language
English
Publication Type
Article
Keywords
Canada
Cost Savings
Health Facility Closure
Hospitals, Rural - economics - supply & distribution
Humans
Quality of Health Care
Regional Health Planning
Rural Health Services
Rural Population
Societies, Medical
PubMed ID
19594995 View in PubMed
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The acceptability to older drivers of different types of licensing restriction.

https://arctichealth.org/en/permalink/ahliterature165854
Source
Accid Anal Prev. 2007 Jul;39(4):776-93
Publication Type
Article
Date
Jul-2007
Author
Shawn C Marshall
Malcolm Man-Son-Hing
Frank Molnar
Keith G Wilson
Richard Blair
Author Affiliation
Elisabeth Bruyère Research Institute, SCO Health Service, Ottawa, Ontario, Canada. smarshall@ottawahospital.on.ca
Source
Accid Anal Prev. 2007 Jul;39(4):776-93
Date
Jul-2007
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Aged, 80 and over
Automobile Driver Examination - legislation & jurisprudence
Automobile Driving - psychology - standards
Female
Humans
Interviews as Topic
Licensure - standards
Male
Ontario
Public Opinion
Rural Population
Urban Population
Abstract
The primary objective of this study was to determine the acceptability of various driving restrictions to older drivers. Licensed drivers aged 65 years or more living in the community in the Ottawa, Ontario area were recruited by means of posters and advertisements in regional and local newspapers. We recruited 86 subjects, 56 men and 30 women with a mean age of 75 years (50 urban and 36 rural residents). The subjects completed a one-hour interview with one of two trained study nurses during which their driving restriction preferences (utilities) were determined using a modified standard gamble technique. Highly endorsed restrictions included regular assessment by the Ministry of Transportation (mean utility 0.94), driving with vehicle adaptations (0.94) and daytime driving only (0.93). Less acceptable restrictions included avoidance of roads with a speed limit greater than 60 km/h (0.50), limitation of destinations (0.45), driving only within a 10-km radius of home (0.45) and requirement of another licensed driver in the vehicle (0.42). Our subjects' preferences appeared to be inversely related to the impact on autonomy and the ability to access the community. These findings may be useful to motor transport administrators in designing effective restricted licensing programs that are acceptable to older drivers.
PubMed ID
17196917 View in PubMed
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Access and intensity of use of prescription analgesics among older Manitobans.

https://arctichealth.org/en/permalink/ahliterature150665
Source
Can J Clin Pharmacol. 2009;16(2):e322-30
Publication Type
Article
Date
2009
Author
Cheryl A Sadowski
Anita G Carrie
Ruby E Grymonpre
Colleen J Metge
Phillip St John
Author Affiliation
Faculty of Pharmacy & Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada. csadowski@pharmacy.ualberta.ca
Source
Can J Clin Pharmacol. 2009;16(2):e322-30
Date
2009
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Aged, 80 and over
Analgesics, Non-Narcotic - therapeutic use
Analgesics, Opioid - administration & dosage - therapeutic use
Chronic Disease
Cross-Sectional Studies
Drug Utilization - statistics & numerical data
Female
Health Services Accessibility
Humans
Male
Manitoba - epidemiology
Pain - drug therapy - epidemiology
Physician's Practice Patterns
Prescription Drugs
Residence Characteristics
Rural Population
Sex Factors
Urban Population
Abstract
Under-treatment of pain is frequently reported, especially among seniors, with chronic non-cancer pain most likely to be under-treated. Legislation regarding the prescribing/dispensing of opioid analgesics (including multiple prescription programs [MPP]) may impede access to needed analgesics.
To describe access and intensity of use of analgesics among older Manitobans by health region.
A cross-sectional study of non-Aboriginal non-institutionalized Manitoba residents over 65 years of age during April 1, 2002 to March 31, 2003 was conducted using the Pharmaceutical Claims data and the Cancer Registry from the province of Manitoba. Access to analgesics (users/1000/Yr) and intensity of use (using defined daily dose [DDD] methodology) were calculated for non-opioid analgesics, opioids, and multiple-prescription-program opioids [MPP-opioids]. Usage was categorized by age, gender, and stratified by cancer diagnosis. Age-sex standardized rates of prevalence and intensity are reported for the eleven health regions of Manitoba.
Thirty-four percent of older Manitobans accessed analgesics during the study period. Female gender, increasing age, and a cancer diagnosis were associated with greater access and intensity of use of all classes of analgesics. Age-sex standardized access and intensity measures revealed the highest overall analgesic use in the most rural / remote regions of the province. However, these same regions had the lowest use of opioids, and MPP-opioids among residents lacking a cancer diagnosis.
This population-based study of analgesic use suggests that there may be variations in use of opioids and other analgesics depending on an urban or rural residence. The impact of programs such as the MPP program requires further study to describe its impact on analgesic use.
PubMed ID
19483264 View in PubMed
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Access and utilization of health services by British Columbia's rural Aboriginal population.

https://arctichealth.org/en/permalink/ahliterature5977
Source
Int J Health Care Qual Assur Inc Leadersh Health Serv. 2005;18(2-3):xxvi-xxxi
Publication Type
Article
Date
2005
Author
Dennis Wardman
Ken Clement
Darryl Quantz
Author Affiliation
First Nations and Inuit Health Branch, Health Canada, Vancouver, Canada.
Source
Int J Health Care Qual Assur Inc Leadersh Health Serv. 2005;18(2-3):xxvi-xxxi
Date
2005
Language
English
Publication Type
Article
Keywords
Adult
British Columbia - ethnology
Ethnic Groups
Female
Health Services Accessibility
Health Services, Indigenous - utilization
Humans
Indians, North American
Male
Middle Aged
Rural Population
Abstract
PURPOSE: To provide a picture of the access and use of health services by Aboriginal British Columbians living in both reserve and off-reserve communities. DESIGN/METHODOLOGY/APPROACH: This project represents a collaborative effort between the University of British Columbia and multiple Aboriginal community partners. Between June and November 2003, 267 face-to-face interviews were conducted with Aboriginal persons in seven rural community organizations across the province. FINDINGS: This paper reports on the results of a survey of 267 Aboriginal clients. It was found that a substantial number of survey respondents accessed health services provided by an Aboriginal person. Although most respondents felt that services were available, they also identified a number of concerns. These revolved around the need to travel for services, as well as a lack of access to more specialized services. A number of self-reported barriers to service were also identified. These findings have several policy implications and will be useful to service planners. RESEARCH LIMITATIONS/IMPLICATIONS: Several questions for additional research were identified including the need to establish an inventory of service problem areas and investigating service and benefit policy and community awareness issues. ORIGINALITY/VALUE: This paper provides policy makers with knowledge on the rural Aboriginal population, a population that has faced long standing problems in accessing appropriate health services.
PubMed ID
15974508 View in PubMed
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Accessing maternity care in rural Canada: there's more to the story than distance to a doctor.

https://arctichealth.org/en/permalink/ahliterature155499
Source
Health Care Women Int. 2008 Sep;29(8):863-83
Publication Type
Article
Date
Sep-2008
Author
Rebecca Sutherns
Ivy Lynn Bourgeault
Author Affiliation
Health Sciences, University of Ottawa, Ottawa, Ontario, Canada.
Source
Health Care Women Int. 2008 Sep;29(8):863-83
Date
Sep-2008
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Alberta
Female
Health Care Surveys
Health Services Accessibility
Humans
Maternal Health Services - methods - trends
Medically underserved area
Needs Assessment
Ontario
Pregnancy
Prenatal Care - methods - trends
Quality of Health Care
Risk assessment
Rural Health Services - standards - trends
Rural Population
Abstract
Drawing upon a comparative, qualitative study of the experiences of rural women accessing maternity care in two Canadian provinces, we demonstrate that availability of services, having economic and informational resources to access the services offered, and the appropriateness of those services in terms of gender, continuity of care, confidentiality, quality of care, and cultural fit are key to an accurate understanding of health care access. We explore the implications of living rurally on each of these dimensions, thereby revealing both gaps in and solutions to rural maternity care access that narrower, proximity-based definitions miss.
PubMed ID
18726796 View in PubMed
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Access to water in the countries of the former Soviet Union.

https://arctichealth.org/en/permalink/ahliterature76288
Source
Public Health. 2006 Apr;120(4):364-72
Publication Type
Article
Date
Apr-2006
Author
M. McKee
D. Balabanova
K. Akingbade
J. Pomerleau
A. Stickley
R. Rose
C. Haerpfer
Author Affiliation
European Centre on Health of Societies in Transition & Health System Development Programme, School of Hygiene and Tropical Medicine, University of London, London WC1E 7HT, UK. martin.mckee@lshtm.ac.uk
Source
Public Health. 2006 Apr;120(4):364-72
Date
Apr-2006
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Cross-Sectional Studies
Female
Humans
Male
Middle Aged
Research Support, Non-U.S. Gov't
Rural Population
Sanitation - statistics & numerical data
USSR
Urban Population
Water Supply - statistics & numerical data
Abstract
BACKGROUND: During the Soviet period, authorities in the USSR invested heavily in collective farming and modernization of living conditions in rural areas. However, many problems remained, including poor access to many basic amenities such as water. Since then, the situation is likely to have changed; economic decline has coincided with migration and widening social inequalities, potentially increasing disparities within and between countries. AIM: To examine access to water and sanitation and its determinants in urban and rural areas of eight former Soviet countries. METHODS: A series of nationally representative surveys in Armenia, Belarus, Georgia, Moldova, Kazakhstan, Kyrgyzstan, Russia and Ukraine was undertaken in 2001, covering 18,428 individuals (aged 18+ years). RESULTS: The percentage of respondents living in rural areas varied between 27 and 59% among countries. There are wide urban-rural differences in access to amenities. Even in urban areas, only about 90% of respondents had access to cold running water in their home (60% in Kyrgyzstan). In rural areas, less than one-third had cold running water in their homes (44% in Russia, under 10% in Kyrgyzstan and Moldova). Between one-third and one-half of rural respondents in some countries (such as Belarus, Kazakhstan and Moldova) obtained their water from wells and similar sources. Access to hot running water inside the homes was an exception in rural households, reflecting the lack of modern heating methods in villages. Similarly, indoor access to toilets is common in urban areas but rare in rural areas. Access to all amenities was better in Russia compared with elsewhere in the region. Indoor access to cold water was significantly more common among rural residents living in apartments, and in settlements served by asphalt roads rather than dirt roads. People with more assets or income and living with other people were significantly more likely to have water on tap. In addition, people who had moved in more recently were more likely to have an indoor water supply. CONCLUSIONS: This was the largest single study of its kind undertaken in this region, and demonstrates that a significant number of people living in rural parts of the former Soviet Union do not have indoor access to running water and sanitation. There are significant variations among countries, with the worse situation in central Asia and the Caucasus, and the best situation in Russia. Access to water strongly correlates with socio-economic characteristics. These findings suggest a need for sustained investment in rebuilding basic infrastructure in the region, and monitoring the impact of living conditions on health.
PubMed ID
16473378 View in PubMed
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Acute abdominal pain among elderly patients.

https://arctichealth.org/en/permalink/ahliterature81108
Source
Gerontology. 2006;52(6):339-44
Publication Type
Article
Date
2006
Author
Laurell H.
Hansson L-E
Gunnarsson U.
Author Affiliation
Department of Surgery, Mora Hospital, Mora, Sweden. helena.laurell@kirurgi.uu.se
Source
Gerontology. 2006;52(6):339-44
Date
2006
Language
English
Publication Type
Article
Keywords
Abdominal Pain - diagnosis - etiology - mortality
Adult
Age Factors
Aged
Aged, 80 and over
Diagnosis, Differential
Diagnostic Errors
Emergency medical services
Female
Humans
Length of Stay
Male
Middle Aged
Mortality
Rural Population
Sex Factors
Sweden
Triage
Abstract
BACKGROUND: Diagnosis of acute abdominal pain in older persons is a challenge, with the age-related increase in concurrent diseases. In most western countries the number of elderly people is constantly rising, which means that an increasing proportion of patients admitted for abdominal pain at the emergency department are elderly. OBJECTIVE: To characterize differences in clinical presentation and diagnostic accuracy between younger and more elderly patients with acute abdominal pain. METHODS: Patients admitted to Mora Hospital with abdominal pain of up to seven days' duration were registered according to a detailed schedule. From 1st February 1997 to 1st June 2000, 557 patients aged 65-79 years and 274 patients aged > or = 80 years were registered. Patients aged 20-64 years (n = 1,458) served as a control group. RESULTS: A specific diagnosis, i.e. other than 'nonspecific abdominal pain', was established in 76 and 78% of the patients aged 65-79 and > or = 80 years respectively, and in 64% of those aged 20-64 (p or = 65 years. Rebound tenderness (p or = 65 years, C-reactive protein did not differ between patients operated on and those not, contrary to the finding in patients
PubMed ID
16905885 View in PubMed
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Administrative claims data analysis of nurse practitioner prescribing for older adults.

https://arctichealth.org/en/permalink/ahliterature149161
Source
J Adv Nurs. 2009 Oct;65(10):2077-87
Publication Type
Article
Date
Oct-2009
Author
Andrea L Murphy
Ruth Martin-Misener
Charmaine Cooke
Ingrid Sketris
Author Affiliation
School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada. andrea.murphy@dal.ca
Source
J Adv Nurs. 2009 Oct;65(10):2077-87
Date
Oct-2009
Language
English
Publication Type
Article
Keywords
Aged
Anti-Infective Agents - therapeutic use
Anti-Inflammatory Agents, Non-Steroidal - therapeutic use
Drug Prescriptions - economics - nursing - statistics & numerical data
Female
Health Services Research
Health Services for the Aged
Humans
Insurance, Pharmaceutical Services - statistics & numerical data
Male
Nova Scotia - epidemiology
Nurse Practitioners - statistics & numerical data
Nurse's Practice Patterns - statistics & numerical data - trends
Pharmacoepidemiology
Retrospective Studies
Rural Population
Abstract
This paper is a report of a study to identify the patterns of prescribing by primary health care nurse practitioners for a cohort of older adults.
The older adult population is known to receive complex pharmacotherapy. Monitoring prescribing to older adults can inform quality improvement initiatives. In comparison to other countries, research examining nurse practitioner prescribing in Canada is limited. Nurse practitioner prescribing for older adults is relatively unexplored in the international literature. Although commonly used to study physician prescribing, few studies have used claims data from drug insurance programmes to investigate nurse practitioner prescribing.
Drug claims for prescriptions written by nurse practitioners from fiscal years 2004/05 to 2006/07 for beneficiaries of the Nova Scotia Seniors' Pharmacare programme were analysed. Data were retrieved and analysed in May 2008. Prescribing was described for each drug using the World Health Organization Anatomical Therapeutic Chemical code classification system by usage and costs for each fiscal year.
Antimicrobials and non-steroidal anti-inflammatory drugs consistently represented the top ranked groups for prescription volume and cost. Over the three fiscal years, antimicrobial prescription rates declined relative to rates of other groups of medications. Prescription volume per nurse doubled and cost per prescription increased by approximately 20%.
Prescription claims data can be used to characterize the prescribing trends of nurse practitioners. Research linking patient characteristics, including diagnoses, to prescriptions is needed to assess prescribing quality. Some potential areas of improvement were identified with antimicrobial and non-steroidal antiinflammatory selection.
PubMed ID
19674174 View in PubMed
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[Adolescent sexuality in rural Norway 1997-2001]

https://arctichealth.org/en/permalink/ahliterature63361
Source
Tidsskr Nor Laegeforen. 2004 Jul 1;124(13-14):1769-71
Publication Type
Article
Date
Jul-1-2004
Author
Hans-Johan Breidablik
Eivind Meland
Author Affiliation
Kommunelegekontoret i Sula, 6030 Langevåg. hans.breidablik@sula.kommune.no
Source
Tidsskr Nor Laegeforen. 2004 Jul 1;124(13-14):1769-71
Date
Jul-1-2004
Language
Norwegian
Publication Type
Article
Keywords
Adolescent
Adolescent Behavior - psychology
Adult
Contraception Behavior - psychology
English Abstract
Female
Humans
Male
Norway
Pregnancy
Pregnancy in Adolescence - prevention & control - statistics & numerical data
Pregnancy, Unwanted - statistics & numerical data
Questionnaires
Rural Population
Sexual Behavior - psychology
Abstract
BACKGROUND: In order to understand and prevent unwanted health consequences related to sexual behaviour, we need to know the status and changes of sexual behaviour in adolescence. MATERIAL AND METHOD: In 1997 and 2001, surveys were conducted including a total of 1665 adolescents and young adults aged 15 to 24 (response rate > 90%) in secondary schools in a small town in a rural district in Norway. We analysed frequencies for boys and girls and estimated the change in median age of first intercourse. Logistic regression analyses of median age and other health-related parameters were performed. RESULTS: A greater proportion of the respondents reported sexual experience in 2001 than in 1997. Girls have their first intercourse at a younger age than boys, often with older partners. 21% of the girls had experienced unwanted sexual situations. Use of contraception has increased, though insignificantly. Still, 11% of sexually active girls had had unwanted pregnancies. First intercourse during adolescence is clearly associated with other forms of behaviour that compromise health. However, a great and stable majority report a stable partner during adolescence. CONCLUSIONS: In accordance with other studies we find changes in sexual behaviour over a short period of time among adolescents in rural Norway. Stable sexual relations may still be a protective factor.
PubMed ID
15229663 View in PubMed
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627 records – page 1 of 63.