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Objective: To explore rural physician–community engagement through three case studies in order to understand the role that these relationships can play in increasing community‐level resilience to climate change and ecosystem disruption. Design: Qualitative secondary case study analysis. Setting: Three Canadian rural communities (BC n = 2, Ontario n = 1). Participants: Rural family physicians and community members. Methods: Twenty‐eight semi‐structured virtual interviews, conducted between November 2021 and February 2022, were included. Communities were selected from the larger data set based on data availability, level of physician engagement and demographic factors. Thematic analysis was completed in NVivo using deductive coding. Main Findings: The presented qualitative case studies shed light on the strategies employed by physicians to establish and foster relationships within rural communities during challenging circumstances. In Community A, the implementation of a Primary Care Society (PCS) not only addressed physician shortages but also facilitated the development of strong continuity of care through proactive recruitment efforts. Community B showcased the adoption of an 'intentional physician community' model, emphasising collaboration and community consultation, resulting in effective communication of public health directives and innovative interdisciplinary action during the COVID‐19 pandemic. In Community C, engaged physicians and community advocates are aligned to contribute to the long‐term sustainability of the rural community, particularly in the context of food security and climate change vulnerabilities. Conclusion: These findings underscore the significance of trust building, transparent communication and collaboration in addressing health care challenges in rural areas and emphasise the need to recognise and support physicians as agents of change. [ABSTRACT FROM AUTHOR]

Objective We examine the effect of birth weight (BW) for gestational age (GA) on the temperatures reached during the treatment of neonatal hypoxic-ischemic encephalopathy (HIE) with therapeutic hypothermia (TH). Study Design Retrospective data of 1,736 neonates with HIE who received TH were extracted from the Canadian Neonatal Network database for neonates admitted from 2010 to 2017. Neonates were stratified into three BW groups: small for GA < 10th centile, large for GA > 90th centile, and according to GA 10th to 89th centile at a given gestation using Canadian population data norms. Results There was no significant difference in the lowest temperature reached, the likelihood of overshooting temperatures < 32.5°C during TH, or the change of encephalopathy stages among the three groups. Conclusion BW for GA did not appear to influence the temperatures neonates reached during hypothermia or encephalopathy stage following TH. Key Point Therapeutic hypothermia is well tolerated irrespective of weight for age SGA infants achieved and maintained target temperature similar to AGA and LGA babies Change in the Sarnat stage after hypothermia was similar across all birth weight groups [ABSTRACT FROM AUTHOR]

Objective: To identify and quantify factors that contribute to rural physicians' satisfaction with their jobs and life as a whole. Design: Cross-sectional, mailed survey. Study population: Family physicians practicing in rural communities eligible for British Columbia's Northern and Isolation Allowance. Main measures: Demographics, Domain satisfaction, Maslach Burnout Inventory, Beck Depression Inventory, and Life Satisfaction. Results: Stepwise multiple regressions reveal the greatest predicators of rural physician overall life satisfaction are satisfaction with jobs, personal relationships, health, finances, and absence of depression. These predictors account for 70% of the variation in rural physician overall life satisfaction. The greatest predictors of rural physician satisfaction with jobs and satisfaction with current place of residence/practice, on-call shifts, personal accomplishments, and absence of emotional exhaustion. The predictors account for 44% of the variation in rural physician job satisfaction.

Responses from 53% of 2,300 British Columbia physicians were used to create a list of 375 educationally influential physicians. These opinion leaders will serve as resources for formal and informal continuing medical education. (SK)

Background: Otolaryngology-Head and Neck Surgery (OHNS) electives provide medical students opportunities for knowledge acquisition, mentorship, and career exploration. Given the importance of electives on medical student education, this study examines OHNS clinical electives prior to their cancellation in 2020 due to the COVID-19 pandemic. Methods: An anonymous 29-question electronic survey was created using the program "Qualtrics." Themes included elective structure and organization, elective clinical and non-clinical teaching, evaluation of students, and the influence of electives on the Canadian Residency Match (CaRMS). The survey was distributed through the Canadian Society of Otolaryngology e-newsletter and e-mailed to all OHNS undergraduate and postgraduate program directors across Canada. Results: Forty-two responses were received. The vast majority of respondents felt that visiting electives were important and should return post-COVID-19 (97.6%). Most said they provide more in-depth or hands-on teaching (52.4% and 59.6%, respectively). However, there was great variability in the feedback, types of teaching and curriculum provided to elective students. It was estimated that 77% of current residents at the postgraduate program that responders were affiliated with participated in an elective at their program. Conclusions: Prior to the cancellation of visiting electives in 2020 due to the COVID-19 pandemic, electives played an important role in OHNS undergraduate medical education and career planning for students wishing to pursue a career in OHNS. Electives also provide the opportunity for the evaluation of students by OHNS postgraduate programs. [ABSTRACT FROM AUTHOR]

Background: Small Canadian rural maternity services are struggling to maintain core staffing and remain open. Existing evidence states that having to travel to access maternity services is associated with adverse outcomes. The goal of this study is to systematically examine rural maternal and newborn outcomes across three Canadian provinces.Methods: We analyzed maternal newborn outcomes data through provincial perinatal registries in British Columbia, Alberta and Nova Scotia for deliveries that occurred between April 1st 2003 and March 31st 2008. All births were allocated to maternity service catchments based on the residence of the mothers. Individual catchments were stratified to service levels based on distance to access intrapartum maternity services or the model of maternity services available in the community. The amalgamation of analyses from each jurisdiction involved comparison of logistic regression effect estimates.Results: The number of singleton births included in the study is 150,797. Perinatal mortality is highest in communities that are greater than 4 h from maternity services overall. Rates of prematurity at less than 37 weeks gestation are higher for rural women without local access to services. Caesarean section rates are highest in communities served by general surgical models.Conclusion: Composite analysis of data from three Canadian provinces provides the strongest evidence to date demonstrating that we need to sustain small community maternity services with and without caesarean section capability. [ABSTRACT FROM AUTHOR]

A mathematical model is introduced to study the accelerating impact of HIV infection on the incidence rates of tuberculosis (TB) disease. A sexually active population (15–49 years) is followed cross-sectionally over a period of time. Beginning with the year in which HIV infection was probably first present in the population, the model calculates the growing yearly incidence rates of new TB disease in HIV-positive and in HIV-negative individuals. Model equations, derived by an actuarial method, are developed recursively. Input information required for the calculations indudes the age distribution of the study population, pre-HIV annual TB infection rates, annual HIV infection and mortality rates, and estimates of annual TB disease breakdown rates in the absence and in the presence of HIV infection. With correct input data, the model provides a useful blueprint for health agencies in designing effective programmes for curbing the future course of these dual epidemics in the population. [ABSTRACT FROM PUBLISHER]

A review of the current literature on issues of maternity care relevant to rural populations underpins 14 recommendations prepared and approved by 5 national physician, midwifery and nursing organizations. This review and these recommendations are intended to help rural obstetric care providers to continue to provide quality care for women in their communities. [ABSTRACT FROM AUTHOR]

Background: In the past fifteen years there has been a wave of closures of small maternity services in Canada and other developed nations which results in the need for rural parturient women to travel to access care. The purpose of our study is to systematically document newborn and maternal outcomes as they relate to distance to travel to access the nearest maternity services with Cesarean section capabililty. Methods: Study population is all women carrying a singleton pregnancy beyond 20 weeks and delivering between April 1, 2000 and March 31, 2004 and residing outside of the core urban areas of British Columbia. Maternal and newborn data was linked to specific geographic catchments by the B.C. Perinatal Health Program. Catchments were stratified by distance to nearest maternity service with Cesarean section capabililty if greater than 1 hour travel time or level of local service. Hierarchical logistic regression was used to test predictors of adverse newborn and maternal outcomes. Results: 49,402 cases of women and newborns resident in rural catchments were included. Adjusted odds ratios for perinatal mortality for newborns from catchments greater than 4 hours from services was 3.17 (95% CI 1.45-6.95). Newborns from catchments 2 to 4 hours, and 1 to 2 hours from services generated rates of 179 and 100 NICU 3 days per thousand births respectively compared to 42 days for newborns from catchments served by specialists. Conclusions: Distance matters: rural parturient women who have to travel to access maternity services have increased rates of adverse perinatal outcomes. [ABSTRACT FROM AUTHOR]

Background: The number of births attended by individual family physicians who practice intrapartum care varies. We wanted to determine if the practice-volume relations that have been shown in other fields of medical practice also exist in maternity care practice by family doctors. Methods: For the period April 1997 to August 1998, we analyzed all singleton births at a major maternity teaching hospital for which the family physician was the responsible physician. Physicians were grouped into 3 categories on the basis of the number of births they attended each year: fewer than 12, 12 to 24, and 25 or more. Physicians with a low volume of deliveries (72 physicians, 549 births), those with a medium volume of deliveries (34 physicians, 871 births) and those with a high volume of deliveries (46 physicians, 3024 births) were compared in terms of maternal and newborn outcomes. The main outcome measures were maternal morbidity, 5-minute Apgar score and admission of the baby to the neonatal intensive care unit or special care unit. Secondary outcomes were obstetric procedures and consultation patterns. Results: There was no difference among the 3 volume cohorts in terms of rates of maternal complications of delivery, 5-minute Apgar scores of less than 7 or admissions to the neonatal intensive care unit or the special care unit, either before or after adjustment for parity, pregnancy-induced hypertension, diabetes, ethnicity, lone parent status, maternal age, gestational age, newborn birth weight and newborn head circumference at birth. High- and medium-volume family physicians consulted with obstetricians less often than low-volume family physicians (adjusted odds ratio [OR] 0.586 [95% confidence interval, CI, 0.479-0.718] and 0.739 [95% CI 0.583-0.935] respectively). High- and medium-volume family physicians transferred the delivery to an obstetrician less often than low-volume family physicians (adjusted OR 0.668 [95% CI 0.542-0.823] and... [ABSTRACT FROM AUTHOR]

Analyzes the procedural skills practiced by family/ general practitioner in British Columbia. Difficulty of Canada rural communities in attracting and retaining Canadian family practice graduates; Comparison between the procedural skills of Canada and foreign-trained doctors; Lack of Canadian-trained doctors performing orthopedic care.

Traces the history of the disease tuberculosis (TB) in Canada. High mortality rate in the pre-chemotherapy era; Change in epidemiology in the post-chemotherapy era; How TB came to Canada and its effect on various population groups; Measures taken to control, prevent and treat TB; Evidence that mycobacterial diseases closely resembling TB existed in the pre-Columbian Americas; Low prevalence which the largest proportion of Canadian-born non aboriginal people exhibit; Overall mortality rate in 1908.

AbstractA 1992 chart review in the Haida Village of Skidegate, Haida Gwaii/Queen Charlotte Islands, Canada, revealed that 17% of the unscreened population aged 35 or over have been diagnosed with diabetes. The Haida Gwaii Diabetes Project was designed to develop a culturally sensitive community-based participatory action approach to the management of noninsulin-dependent diabetes (NIDDM). Phase One included obtaining community support, conducting a chart review, holding clinics to measure biophysical indicators, conducting focus groups, and planning response activities with the communities. A list of activities was developed, based on the focus group results. In addition, the project team developed a set of operating principles that ensured and reinforced collaboration. Phase Two included implementing and monitoring planned response activities, and holding exit clinics. The best attended activities were trials of traditional herbal medicine and traditional diet, and an exercise programme. While participation levels were not high enough for causal conclusions, a significant decrease in total cholesterol (0.45; P = 0.005) and rise in HDL (-0.097; P = 0.05) was found for participants for whom paired values were available. Diabetes intervention research in First Nations settings involves small numbers of participants, making it difficult to quantitatively assess outcomes. To increase participation it is advisable to open activities to the whole community, to tie planned activities into other scheduled community events, and to share findings concerning managing illnesses of acculturation with other communities. [ABSTRACT FROM AUTHOR]

Studies the prevalence of respiratory diseases among grain elevator workers in Vancouver, British Columbia. Effects of smoking habit on disease prevalence; Correlation between lung function and age; Effects of gain dust on lung function.

Information is presented about the September 23-24, 2010 symposium sponsored by the Centre for Rural Health Research, Rural Coordination Centre of British Columbia (BC), and Perinatal Services BC, held in Vancouver, BC. for general practitioner anesthetists (GPAs). Topics included sustainable care for Aboriginal patients in rural areas, the concept of a virtual birthing room, and establishment of a GPAs registry.

The article comments on the sustainability of rural maternity care services without general practitioner surgeons in Canada. With the closure of maternity services in British Columbia, many believe that local maternity care services are compromised in these areas. In most cases, caesarian section capability is seen as the factor that sustain maternity services. And with the lack or absences of surgeons in rural centers, these services are vulnerable to closure.

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The article focuses on the similarity of the initiatives of primary care research in Canada and the U.S. One element common to both countries is the establishment of practice-based research networks, which recognize that primary care practices are the natural laboratories for primary care research and typically comprise a number of community-based practices that are linked with academic institutions. Therefore, high-quality research can develop within a collaborative framework that includes academic and community based researchers.

Compares the respiratory health of pulpmill workers with those of the rail yard workers in British Columbia. Rate of wheezing and chest tightness cases in pulpmill workers; Cases of airflow obstruction in smokers working in bleach plants; Presence of chlorine as an environmental contaminant.

Examines fluoride exposure of workers in an aluminum smelter in British Columbia. Implications of the exposure for the musculoskeletal system, hemopoietic tissue, liver and renal function; Increase in density, calcification ligaments and periosteal changes in workers employed for ten years; Evidence of skeletal fluorosis in exposed workers.

Tobacco was brought to Europe by Christopher Columbus, who discovered it in Cuba in October, 1492. Spread of tobacco consumption was initiated by the French diplomat Jean Nicot de Villemain, who in 1560 recommended it in the form of powdered tobacco leaves to the French Queen Catherine de Medice to combat her migraine headaches, and introduced the term Nicotiana tobaccum. Tobacco consumption greatly rose after the I World War, and after the II World War it became very common, especially among man. In the first half of the 20th century the sale of tobacco products rose by 61%, and cigarettes dominated the market of tobacco products. At the beginning of the 20th century cigarettes constituted only 2% of the total sale of tobacco products, while in the middle of the 20th century--more than 80%. Although the first epidemiological papers indicating that "smoking is connected with the shortening of life span" were published in the first half of the 20th century, not until 1950 did Hill and Doll in Great Britain, and Wynder and Graham in USA in 1951 show a statistically significant correlation between cigarettes smoking and lung cancer occurrence. Many controversies according the use of tobacco accompanied it from the beginning of its presence in Europe. The conflicting opinions according to its influence to health coexisted in the 16th to 19th centuries. In this period, especially in the 19th century dominated moral and religious arguments against tobacco. In the 20th century however, and particularly in its second part, development in medical research was enhanced by civil voluntary actions against advertisement and passive smoking. This lead to the significant limitation of tobacco expansion in Europe, USA and Canada in the end of the 20th century.