Planning and delivery of health services – an article review on urban aboriginal mobility in Canada: examining the association with healthcare utilization

Author: Ankit Dhawan

Abstract

An article from Social Science and Medicine, written by Snyder and Wilson (2012), examined the use of healthcare services by urban Aboriginal populations in Canada. Using the Behavioural Model of Health Services Use (BMHSU; Andersen & Newman, 1973), predisposing, enabling and need factors were organized and used for data analysis. Specifically, a comparison was made between conventional (physicians and nurses) and traditional (traditional healers) health service utilization in Toronto and Winnipeg (Snyder & Wilson, 2012). In addition to the geographical and educational factors, the results of the research recognized mobility as a significant predisposing complement to healthcare utilization.

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Storytelling and Asperger Syndrome: A Key for Social Integration

Author: Alain Nathan Sahin

Abstract

Storytelling is a universal way of communication between human beings. It is inhibited when neurodevelopmental disorders hinder human reciprocity, the understanding of body language, and nuances of language. Asperger Syndrome (AS), one of these disorders, is characterized by social impairment and repetitive patterns of behaviour. Messages cannot be conveyed through storytelling, which causes social isolation and withdrawal of individuals with AS from society. The development of the mirror neuron system in the brain, which incites imitation of peers, might be altered in AS by a mechanism that is not entirely understood. Because mirroring the emotions of others is key to understanding their feelings and perceptions of the world, the “theory of mind” is not formed in individuals with AS, as it normally would be. While studies have suggested this impediment, current views and evidence show that people with AS may use storytelling as a powerful tool to integrate themselves into society. Future research should investigate storytelling as an intervention to increase social interaction of individuals with AS.

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Coffee Does Not Cause Cancer, but Hot Drinks Might

Coffee drinkers can sip a little easier now that the World Health Organization has downgraded coffee’s cancer risk. Due to inadequate evidence and inconsistent findings, consumers no longer need to worry about their morning cup of Joe. In fact, drinking coffee may actually protect consumers from several chronic diseases.

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Obesity Begins in the Womb

If you were asked “how much weight should a woman gain during pregnancy?” you might posit a guess around 15 or 20 pounds. In reality, it’s not that simple. The amount depends on her pre-pregnancy body mass index (BMI). As such, in 2009, The Institute of Medicine (IOM) released gestational weight gain recommendations for each BMI category (Table 1). These recommendations were published to promote adequate foetal growth and reduce the risk of adverse pregnancy outcomes (Rasmussen & Yaktine, 2013). Total recommended weight gain during pregnancy ranges from 28-40 pounds for underweight women and 11-20 pounds for obese women (Rasmussen & Yaktine, 2013). However, many women are not meeting these guidelines and 58% of Canadian women are surpassing them (Ferraro et al., 2012). Currently, obesity is recognized as a global public health concern with no signs of slowing down (NCD Risk Factor Collaboration, 2016). Is gestational weight gain a contributing factor?

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Ins and outs of cancer screening

 

It’s estimated that approximately 2 in 5 Canadians will develop cancer during their lifetime, and that 1 in 4 will die from the disease1. Cancer affects or touches almost everyone in this country in some way, and a lot of research has gone into preventing and treating the disease. The overall 5-year survival rate for all cancers in Canada was 63% for 2006-20081. It’s well known that cancers that are caught early have a higher chance of successful treatment and survival. One of the ways that we can diagnose these early-stage cancers is through screening.

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MCR-1: The consequence of antibiotic misuse and evolving resistance

According to a recent paper published the Lancet, a superbug gene that confers resistance to colistin, an antibiotic used to treat Gram-negative bacterial infections when all other drugs fail, has been discovered in China (Liu et al., 2016; TheStar, 2016). The gene in question, called MCR-1, was found in E.coli in samples from meat, hospital patients, and livestock in southeastern China. Given that China is among the countries with the highest colistin use in agriculture, resistance to the drug may have originated in that part of the world; however, new reports show that the gene is not restricted to China as the following countries have similarly discovered MCR-1 in bacterial DNA: Algeria, Canada, Denmark, England, France, Laos, Portugal, Thailand, The Netherlands, and Wales (TheStar, 2016). Some of the bacterial DNA analyzed and found positive for the MCR-1 gene was derived from specimens archived before 2015; therefore, dissemination of the gene has outpaced discovery, and the issue at hand may already be an international crisis.

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Optimism and health – Staying positive to stay healthy

“When life gives you lemons, make lemonade.” This proverbial phrase may sound cliché, but there is wisdom that can be extracted from this saying. When it comes to health and longevity, for instance, optimism may confer significant advantages over pessimism. A Dutch study that examined elderly men and women (aged 65-85 years) over a nine-year period showed that those individuals with the highest level of optimism, compared with the lowest, had a significantly lower likelihood of all-cause and cardiovascular mortality (Giltay, Geleijnse, Zitman, Hoekstra, & Schouten, 2004). Other research has also validated the findings of this study (Brummet, Helms, Dahlstrom, & Siegler, 2006; Maruta, Colligan, Malinchoc, & Offord, 2002). Given the benefits of optimism, it is important to understand the ways by which a positive disposition influences health.

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Bangers and mass confusion: do I have to give up bacon?

On October 26, 2015, The World Health Organization announced that processed meat is carcinogenic, and red meat probably is too.1 They defined processed meat as ‘meat that has been transformed through salting, curing, fermentation, smoking, or other processes to enhance flavour or improve preservation’. Before you decide to pass on the bacon or defiantly include it in every meal, let’s break down the report to understand the risk.

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Transmission of Human Papillomavirus Without Sexual Contact

Authors: Naweed Ahmed, Wakqas Kayani, Sahab Jamshidi, Suneil Bapat, Ahmed ImamovicPanteha Tavassol

Abstract

Human papillomavirus (HPV) is one of the most common sexually transmitted infections. There are four common HPV strains: 6, 11, 16, and 18. Strains 6 and 11 cause genital warts, while strains 16 and 18 are asymptomatic in males and may progress to cervical cancer in females. Although uncommon, a small percentage of males and females have been diagnosed with HPV without previous sexual contact. In this case report, we discuss a case conducted on a 15-year-old South Asian male who contracted an unknown low-risk strain of HPV with no history of sexual contact.

HPV is highly infectious, however in the majority of cases the immune system is able to clear the infection, preventing the appearance of genital warts. In cases such as these, it is important to help control the spread of viral infections. Several determinants of health are involved in and affect the transmission of HPV, including income and social status, social support networks, education and literacy, culture, social and physical environments, and health services. To aid in the prevention of HPV, sexual education should be taught at early ages within schools and the Gardasil® vaccine should be administered to both females and males at an early age to reduce the burden of disease and the incidence of HPV.

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Let’s talk about sex: navigating the social, political, and medical perspectives of sexual and reproductive health research

As health scientists and researchers, one of the questions we get asked the most often about our work is, “Okay, but why should I care about that?” As someone who specializes in sexual and reproductive health, I’ll admit that this is a pretty easy question to answer. Sex and reproduction are not only essential to our survival as a human race, but they are also important parts of our day-to-day lives.

Every year, there are more than 208 million pregnancies that occur worldwide; more than 40% of these pregnancies are unplanned (Singh, Sedgh, & Hussain, 2010). The World Health Organization reports that every day in 2013, 800 women around the world died due to complications with pregnancy and childbirth, even though the majority of these deaths could have been prevented (World Health Organization, 2015). Further, over 10% of women worldwide do not have access to or are not using an effective method of contraception.

On a more individual level, while making decisions about sexual activity and family planning may not be all that we do, it certainly influences every aspect of our lives. Our occupational, educational, financial, and social outcomes are all directly affected by if, when, and how we have children. Further, our parents’ choices about birth spacing and family size undoubtedly impacted our childhoods and influenced how we envision and interact with our (current or future) families.

Yet despite the fact that sexual and reproductive health issues affect us all, talking about these topics continues to be a challenge. There is an ongoing debate between the social, political, and medical perspectives with regards to issues such as contraception, abortion, HIV/AIDS, and more. For example, changes made in 2015 to Ontario’s sexual health curriculum for public school students resulted in province-wide protests and some parents choosing to remove their children from school.

From a medical perspective, there is a substantial body of evidence that shows that access to high-quality, safe family planning services and sexual health education is beneficial not just for individuals, but for societies as a whole. Indeed, when abortion is legalized, we see significant drops in the rate of maternal mortality (Cates, Grimes, & Schulz, 2003; Khan, Wojdyla, Say, Gülmezoglu, & Van Look, 2006). With access to contraception, rates of unplanned pregnancy and teenage births are reduced (Peipart, Madden, Allsworth, & Secura, 2012; Singh et al., 2010). And when sexual education is comprehensive, we see increased condom use, lower pregnancy rates, and a decrease in sexual risk taking among youth (Kirby, Laris, & Rolleri, 2007; Starkman & Rajani, 2002).

But as researchers, it is no easy feat to navigate the complex relationships between evidence-based medicine, stigma, and social attitudes and acceptability. Even if the evidence base is available, how do we convince policy makers to incorporate these facts?

In the summer of 2015, Health Canada finally approved mifepristone, the gold-standard of medication abortion that has been widely used around the world for almost two decades (Foster et al., 2009). Yet, after an unprecedentedly long decision making process, the approved regimen for the medication was not consistent with the most up-to date medical evidence (World Health Organization Task Force on Post-ovlulatory Methods of Fertility Regulation, 2003). Health Canada also stipulated that mifepristone could only be prescribed by physicians, despite a large body of evidence that demonstrates it can be safely provided by a variety of advanced practice clinicians (Berer, 2009; Foster et al., 2015).

The mifepristone ruling is but one example of the competing perspectives in sexual and reproductive health research and policymaking. It reminds us that even in Canada – a developed country where abortion has been decriminalized for more than 25 years – the social context matters. This is not intended to be discouraging. As health scientists, it is these complexities that must drive us to continue asking, investigating, and pushing for evidence-based health care. These are the challenges that mean we should all “care about that”.

 

References

Berer, B. (2009). Provision of abortion by mid-level providers: international policy, practice and perspectives. Bulletin of the World Health Organization, 87, 58–63.

Cates, W., Grimes, D. A., & Schulz, K. F. (2003). The public health impact of legal abortion: 30 years later. Perspectives on Sexual and Reproductive Health, 35(1), 25-28.

Foster, A. M., Jackson, C. B., LaRoche, K. J., Simmonds, K., & Taylor, D. (2015). From qualified physician to licensed health care professional: the time has come to change mifepristone’s label. Contraception, 92(2), 200-202.

Khan, K. S., Wojdyla, D., Say, L., Gülmezoglu, A.M., & Van Look, P. F. A. (2006). WHO analysis of causes of maternal death: a systematic review. Lancet, 367, 1066-1074.

Kirby, D. B., Laris, B. A., & Rolleri, L. A. (2007). Sex and HIV education programs: Their impact on sexual behaviors of young people throughout the world. Journal of Adolescent Health, 40, 206-217.

Peipart, J. F., Madden, T., Allsworth, J. E., & Secura, G. M. (2012). Preventing unintended pregnancies by providing no-cost contraception. Obstetrics & Gynecology, 120(6), 1291-1297.

Singh, S., Sedgh, G., & Hussain, R. (2010). Unintended pregnancy: worldwide levels, trends, and outcomes. Studies in Family Planning, 41(4), 241–250.

Starkman, N., & Rajani, N. (2002). The case for comprehensive sex education. Aids Patient Care & STDs, 16(7), 313-318.

World Health Organization Task-force on Post-ovulatory Methods of Fertility Regulation. (2003). Medical abortion at 57 to 63 days’ gestation with a lower dose of mifepristone and gemeprost. Acta Obstetricia et Gynecologica Scandinavica, 80(5), 447-451.gestation with a lower dose of mifepristone and gemeprost. Acta Obstetricia et Gynecologica Scandinavica, 80(5), 447-451.

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