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Cummings JR, Zhang X, Gandré C, Morsella A, Shields-Zeeman L, Winkelmann J, Allin S, Augusto GF, Cascini F, Cserháti Z, de Belvis AG, Eriksen A, Fronteira I, Jamieson M, Murauskienė L, Palmer WL, Ricciardi W, Samuel H, Scintee SG, Taube M, Vrangbæk K, van Ginneken E. Challenges facing mental health systems arising from the COVID-19 pandemic: Evidence from 14 European and North American countries. Health Policy 2023; 136:104878. [PMID: 37611521 DOI: 10.1016/j.healthpol.2023.104878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 06/28/2023] [Accepted: 07/04/2023] [Indexed: 08/25/2023]
Abstract
We assessed challenges that the COVID-19 pandemic presented for mental health systems and the responses to these challenges in 14 countries in Europe and North America. Experts from each country filled out a structured questionnaire with closed- and open-ended questions between January and June 2021. We conducted thematic analysis to investigate the qualitative responses to open-ended questions, and we summarized the responses to closed-ended survey items on changes in telemental health policies and regulations. Findings revealed that many countries grappled with the rising demand for mental health services against a backdrop of mental health provider shortages and challenges responding to workforce stress and burnout. All countries in our sample implemented new policies or initiatives to strengthen mental health service delivery - with more than two-thirds investing to bolster their specialized mental health care sector. There was a universal shift to telehealth to deliver a larger portion of mental health services in all 14 countries, which was facilitated by changes in national regulations and policies; 11 of the 14 participating countries relaxed regulations and 10 of 14 countries made changes to reimbursement policies to facilitate telemental health care. These findings provide a first step to assess the long-term challenges and re-organizational effect of the COVID-19 pandemic on mental health systems in Europe and North America.
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Affiliation(s)
- Janet R Cummings
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States.
| | - Xinyue Zhang
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States
| | - Coralie Gandré
- Institut de recherche et documentation en économie de la santé (IRDES), Paris, France; AP-HP, Hôpital Robert Debré, Paris, France
| | | | - Laura Shields-Zeeman
- Department of Public Mental Health, Trimbos Institute, Utrecht, the Netherlands; Interdisciplinary Social Science, Utrecht University, Utrecht, the Netherlands
| | | | - Sara Allin
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Gonçalo Figueiredo Augusto
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Centre, CHRC, NOVA University Lisbon, Lisbon, Portugal
| | | | - Zoltán Cserháti
- Semmelweis University, Health Services Management Training Centre, Budapest, Hungary
| | - Antonio Giulio de Belvis
- Università Cattolica del Sacro Cuore, Rome, Italy; Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Astrid Eriksen
- Department of Health Care Management, Technische Universität Berlin, Berlin, Germany
| | - Inês Fronteira
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Centre, CHRC, NOVA University Lisbon, Lisbon, Portugal; Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Margaret Jamieson
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Liubovė Murauskienė
- Department of Public Health, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | | | | | - Hadar Samuel
- Myers-JDC-Brookdale Institute, Jerusalem, Israel
| | | | - Māris Taube
- Department of Psychiatry and Narcology, Rīga Stradiņš University, Riga, Latvia
| | - Karsten Vrangbæk
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ewout van Ginneken
- European Observatory on Health Systems and Policies, Technische Universität Berlin, Berlin, Germany
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2
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Lavergne MR, Rudoler D, Peterson S, Stock D, Taylor C, Wilton AS, Wong ST, Scott I, McGrail KM, McCracken RK, Marshall EG, MacKenzie A, Katz A, Jamieson M, Hedden L, Grudniewicz A, Goldsmith LJ, Glazier RH, Burge F, Blackie D. Changes in comprehensiveness of services delivered by Canadian family physicians: Analysis of population-based linked data in 4 provinces. Can Fam Physician 2023; 69:550-556. [PMID: 37582603 PMCID: PMC10426375 DOI: 10.46747/cfp.6908550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
OBJECTIVE To describe changes in the comprehensiveness of services delivered by family physicians across service settings and service areas in 4 Canadian provinces, to identify which settings and areas have changed the most, and to compare the magnitude of changes by physician characteristics. DESIGN Descriptive analysis of province-wide, population-based billing data linked to population and physician registries. SETTING British Columbia, Manitoba, Ontario, and Nova Scotia. PARTICIPANTS Family physicians registered to practise in the 1999-2000 and 2017-2018 fiscal years. MAIN OUTCOME MEASURES Comprehensiveness was measured across 7 service settings (home care, long-term care, emergency departments, hospitals, obstetric care, surgical assistance, anesthesiology) and in 7 service areas consistent with office-based practice (prenatal and postnatal care, Papanicolaou testing, mental health, substance use, cancer care, minor surgery, palliative home visits). The proportion of physicians with activity in each setting and area are reported and the average number of service settings and areas by physician characteristics is described (years in practice, sex, urban or rural practice setting, and location of medical degree training). RESULTS Declines in comprehensiveness were observed across all provinces studied. Declines were greater for comprehensiveness of settings than for areas consistent with office-based practice. Changes were observed across all physician characteristics. On average across provinces, declines in the number of service settings and service areas were highest among physicians in practice 20 years or longer, male physicians, and physicians practising in urban areas. CONCLUSION Declining comprehensiveness was observed across all physician characteristics, pointing to changes in the practice and policy contexts in which all family physicians work.
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Affiliation(s)
- M Ruth Lavergne
- Associate Professor in the Department of Family Medicine at Dalhousie University in Halifax, NS, and holds a Tier II Canada Research Chair in Primary Care.
| | - David Rudoler
- Assistant Professor in the Faculty of Health Sciences at Ontario Tech University in Oshawa and Research Chair at the Ontario Shores Centre for Mental Health Sciences in Whitby
| | - Sandra Peterson
- Research analyst in the Centre for Health Services and Policy Research at the University of British Columbia in Vancouver
| | - David Stock
- Senior health services researcher in the Department of Family Medicine at Dalhousie University
| | - Carole Taylor
- Data analyst in the Manitoba Centre for Health Policy at the University of Manitoba in Winnipeg
| | | | - Sabrina T Wong
- Senior investigator with the Division of Intramural Research of the National Institute of Nursing Research
| | - Ian Scott
- Associate Professor in the Department of Family Practice and Director of the Centre for Health Education Scholarship at the University of British Columbia
| | - Kimberlyn M McGrail
- Professor in the Centre for Health Services and Policy Research at the University of British Columbia
| | - Rita K McCracken
- Assistant Professor in the Department of Family Practice at the University of British Columbia
| | - Emily Gard Marshall
- Professor in the Department of Family Medicine and the Primary Care Research Unit at Dalhousie University and with the Nova Scotia Health Authority
| | - Adrian MacKenzie
- Project executive for Health Workforce Planning with the Nova Scotia Department of Health and Wellness, co-Investigator with the WHO/PAHO Collaborating Centre on Health Workforce Planning and Research, Adjunct Faculty in the Department of Community Health and Epidemiology at Dalhousie University, and an affiliate scientist with Nova Scotia Health
| | - Alan Katz
- Professor in the Department of Family Medicine and the Department of Community Health Sciences at the University of Manitoba
| | - Margaret Jamieson
- Doctoral candidate in the Institute of Health Policy Management and Evaluation at the University of Toronto
| | - Lindsay Hedden
- Assistant Professor in the Faculty of Health Sciences at Simon Fraser University in Burnaby, BC
| | - Agnes Grudniewicz
- Associate Professor in the Telfer School of Management at the University of Ottawa
| | - Laurie J Goldsmith
- Adjunct Professor in the Faculty of Health Sciences at Simon Fraser and the founder and Principal of GoldQual Consulting
| | - Richard H Glazier
- Senior core scientist with ICES, a Professor of Family and Community Medicine at the University of Toronto, and a family physician and scientist at St Michael's Hospital
| | - Fred Burge
- Professor and a faculty researcher in the Department of Family Medicine at Dalhousie University
| | - Doug Blackie
- Associate Faculty member at the School of Leadership Studies, Royal Roads University, Victoria, BC and a certified health care consultant
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3
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Panteli D, Polin K, Webb E, Allin S, Barnes A, Degelsegger-Márquez A, Ghafur S, Jamieson M, Kim Y, Litvinova Y, Nimptsch U, Parkkinen M, Rasmussen TA, Reichebner C, Röttger J, Rumball-Smith J, Scarpetti G, Seidler AL, Seppänen J, Smith M, Snell M, Stanimirovic D, Verheij R, Zaletel M, Busse R. Health and Care Data: Approaches to data linkage for evidence-informed policy. Health Syst Transit 2023; 25:1-248. [PMID: 37489953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
An indispensable prerequisite for answering research questions in health services research is the availability and accessibility of comprehensive, high-quality data. It can be assumed that health services research in the coming years will be increasingly based on data linkage, i.e., the linking, or connecting, of several data sources based on suitable common key variables. A range of approaches to data collection, storage, linkage and availability exists across countries, particularly for secondary research purposes (i.e., the use of data initially collected for other purposes), such as health systems research. The main goal of this review is to develop an overview of, and gain insights into, current approaches to linking data sources in the context of health services research, with the view to inform policy, based on existing practices in high-income countries in Europe and beyond. In doing so, another objective is to provide lessons for countries looking for possible or alternative approaches to data linkage. Thirteen country case studies of data linkage approaches were selected and analysed. Rather than being comprehensive, this review aimed to identify varied and potentially useful case studies to showcase different approaches to data linkage worldwide. A conceptual framework was developed to guide the selection and description of case studies. Information was first identified and collected from publicly available sources and a profile was then created for each country and each case study; these profiles were forwarded to appropriate country experts for validation and completion. The report presents an overview of the included countries and their case studies (Chapter 2), with key data per country and case study in the appendices. This is followed by a closer look at the possibilities of using routine data (Chapter 3); the different approaches to linkage (Chapter 4); the different access routes for researchers (Chapter 5); the use of data for research from electronic patient or health records (Chapter 6); foundational considerations related to data safety, privacy and governance (Chapter 7); recent developments in cross-border data sharing and the European Health Data Space (Chapter 8); and considerations of changes and responses catalysed by the COVID-19 pandemic as related to the generation and secondary use of data (Chapter 9). The review ends with overall conclusions on the necessary characteristics of data to inform research relevant for policy and highlights some insights to inspire possible future solutions - less or more disruptive - for countries looking to expand their use of data (Chapter 10). It emphasises that investing in data linkage for secondary use will not only contribute to the strengthening of national health systems, but also promote international cooperation and contribute to the international visibility of scientific excellence.
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Affiliation(s)
| | | | - Erin Webb
- European Observatory on Health Systems and Policies
| | | | | | | | | | | | - Yoon Kim
- Seoul National University College of Medicine
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4
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Marani H, Song MY, Jamieson M, Roerig M, Allin S. Public Officials' Engagement on Social Media During the Rollout of the COVID-19 Vaccine: A Content Analysis of Tweets. JMIR Infodemiology 2023. [PMID: 37315194 PMCID: PMC10361259 DOI: 10.2196/41582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Social media is an important way for governments to communicate with the public. This is particularly true in times of crisis such as the COVID-19 pandemic, during which time government officials had a strong role in promoting public health measures such as vaccines. OBJECTIVE In Canada, provincial COVID-19 vaccine rollout was delivered in three phases aligned with federal government COVID-19 vaccine guidance for priority populations. In this study, we examined how Canadian public officials used Twitter to engage with the public about vaccine rollout and how this engagement has shaped public response to vaccines across jurisdictions. METHODS We conducted a content analysis of tweets posted between December 28, 2020, and August 31, 2021. Leveraging social media artificial intelligence (AI) tool Brandwatch Analytics©, we constructed a list of public officials in three jurisdictions (Ontario, Alberta and British Columbia) organized across six public official types, then conducted an English/French keyword search for tweets about vaccine rollout and delivery that mentioned, retweeted, or replied to the public officials. We identified the top 30 tweets with the highest impressions in each jurisdiction in each of the three phases (approximately a 26-day window) of the vaccine rollout. The metrics of engagement (impressions, retweets, likes, and replies) from the top 30 tweets per phase in each jurisdiction were then extracted for additional annotation. We specifically annotated sentiment towards public officials' vaccine response (I.e., positive, negative, neutral) in each tweet, and also annotated the type of social media engagement. A thematic analysis of tweets was then conducted to add nuance to extracted data characterizing sentiment and interaction type. RESULTS Of the six categories of public officials, 142 prominent accounts were included from Ontario, Alberta and British Columbia. 270 tweets were included in the content analysis. Public officials mostly used Twitter for information provision (65.6%), followed by horizontal engagement (17.5%), citizen engagement (11.3%), and public service announcements (5.7%). Information provision by government bodies (e.g., provincial government and public health authorities) or municipal leaders are more prominent than tweets by other public official groups. Neutral sentiment accounted for 51.1% of all tweets, while positive sentiment (43.2%) was the second most common sentiment. In Ontario, 60% of the tweets were positive. Negative sentiment (e.g., public officials criticizing vaccine rollout) accounted for 12.6% of all tweets. CONCLUSIONS As governments continue to promote the uptake of the COVID-19 "booster" doses, findings from this study are useful in informing how governments can best utilize social media to engage with the public to achieve democratic goals. CLINICALTRIAL
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Affiliation(s)
- Husayn Marani
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, CA
- North American Observatory on Health Systems and Policies, University of Toronto, Toronto, CA
| | - Melodie Yunju Song
- North American Observatory on Health Systems and Policies, University of Toronto, Toronto, CA
| | - Margaret Jamieson
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, CA
- North American Observatory on Health Systems and Policies, University of Toronto, Toronto, CA
| | - Monika Roerig
- North American Observatory on Health Systems and Policies, University of Toronto, Toronto, CA
| | - Sara Allin
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, CA
- North American Observatory on Health Systems and Policies, University of Toronto, Toronto, CA
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5
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Lavergne MR, Rudoler D, Peterson S, Stock D, Taylor C, Wilton AS, Wong ST, Scott I, McGrail KM, McCracken R, Marshall EG, MacKenzie A, Katz A, Jamieson M, Hedden L, Grudniewicz A, Goldsmith LJ, Glazier RH, Burge F, Blackie D. Declining Comprehensiveness of Services Delivered by Canadian Family Physicians Is Not Driven by Early-Career Physicians. Ann Fam Med 2023; 21:151-156. [PMID: 36973051 PMCID: PMC10042570 DOI: 10.1370/afm.2945] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 10/24/2022] [Accepted: 10/27/2022] [Indexed: 03/29/2023] Open
Abstract
We describe changes in the comprehensiveness of services delivered by family physicians in 4 Canadian provinces (British Columbia, Manitoba, Ontario, Nova Scotia) during the periods 1999-2000 and 2017-2018 and explore if changes differ by years in practice. We measured comprehensiveness using province-wide billing data across 7 settings (home, long-term care, emergency department, hospital, obstetrics, surgical assistance, anesthesiology) and 7 service areas (pre/postnatal care, Papanicolaou [Pap] testing, mental health, substance use, cancer care, minor surgery, palliative home visits). Comprehensiveness declined in all provinces, with greater changes in number of service settings than service areas. Decreases were no greater among new-to-practice physicians.
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Affiliation(s)
- M. Ruth Lavergne
- Dalhousie University, Department of Family Medicine, Halifax, Nova Scotia, Canada (M. R. L., F. B.)
- Canada Research Chairs Program, Tier II Primary Care, Ottawa, Ontario, Canada (M. R. L.)
- CORRESPONDING AUTHOR: M. Ruth Lavergne Department of Family Medicine, Dalhousie University 402-1465 Brenton St Halifax, NS, B3J 3T4
| | - David Rudoler
- Ontario Tech University, Faculty of Health Sciences, Oshawa, Ontario, Canada (D. R.)
- Ontario Shores Centre for Mental Health Sciences, Whitby, Ontario, Canada (D. R.)
| | - Sandra Peterson
- The University of British Columbia, Centre for Health Services and Policy Research, Vancouver, British Columbia, Canada (S. P., S. T. W., K. M. M.)
| | - David Stock
- Dalhousie University, Department of Community Health and Epidemiology, Halifax, Nova Scotia, Canada (D. S., A. M.)
| | - Carole Taylor
- University of Manitoba, Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada (C. T.)
| | - Andrew S. Wilton
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (A. S. W., R. H. G.)
| | - Sabrina T. Wong
- The University of British Columbia, Centre for Health Services and Policy Research, Vancouver, British Columbia, Canada (S. P., S. T. W., K. M. M.)
- National Institute of Nursing Research, Division of Intramural Research (this work was completed while at the University of British Columbia, School of Nursing, Vancouver, British Columbia, Canada) (S. T. W.)
| | - Ian Scott
- The University of British Columbia, Department of Family Practice, Vancouver, British Columbia, Canada (I. S., R. M.)
- The University of British Columbia, Centre for Health Education Scholarship, Vancouver, British Columbia, Canada (I. S.)
| | - Kimberlyn M. McGrail
- The University of British Columbia, Centre for Health Services and Policy Research, Vancouver, British Columbia, Canada (S. P., S. T. W., K. M. M.)
| | - Rita McCracken
- The University of British Columbia, Department of Family Practice, Vancouver, British Columbia, Canada (I. S., R. M.)
| | - Emily G. Marshall
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada (E. G. M., A. M.)
- Dalhousie University, Primary Care Research Unit, Department of Family Medicine, Halifax, Nova Scotia, Canada (E. G. M.)
| | - Adrian MacKenzie
- Dalhousie University, Department of Community Health and Epidemiology, Halifax, Nova Scotia, Canada (D. S., A. M.)
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada (E. G. M., A. M.)
| | - Alan Katz
- University of Manitoba, Department of Family Medicine, Winnipeg, Manitoba, Canada (A.K.)
- University of Manitoba, Department of Community Health Sciences, Winnipeg, Manitoba, Canada (A. K.)
| | - Margaret Jamieson
- University of Toronto, Institute of Health Policy Management and Evaluation, Toronto, Ontario, Canada (M. J., R. H. G.)
| | - Lindsay Hedden
- Simon Fraser University, Faculty of Health Sciences, Burnaby, British Columbia, Canada (L. H., L. J. G.)
| | - Agnes Grudniewicz
- University of Ottawa, Telfer School of Management, Ottawa, Ontario, Canada (A. G.)
| | - Laurie J. Goldsmith
- Simon Fraser University, Faculty of Health Sciences, Burnaby, British Columbia, Canada (L. H., L. J. G.)
- GoldQual Consulting, Ontario, Canada (L. J. G.)
| | - Richard H. Glazier
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (A. S. W., R. H. G.)
- University of Toronto, Institute of Health Policy Management and Evaluation, Toronto, Ontario, Canada (M. J., R. H. G.)
- St Michael’s Hospital, Toronto, Ontario, Canada (R. H. G.)
- University of Toronto, Department of Family and Community Medicine, Toronto, Ontario, Canada (R. H. G.)
| | - Fred Burge
- Dalhousie University, Department of Family Medicine, Halifax, Nova Scotia, Canada (M. R. L., F. B.)
| | - Doug Blackie
- Royal Roads University, School of Leadership Studies, Victoria, British Columbia, Canada (D. B.)
- Doug Blackie Consulting, Inc, Edmonton, Alberta, Canada (D. B.)
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6
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Rudoler D, Peterson S, Stock D, Taylor C, Wilton D, Blackie D, Burge F, Glazier RH, Goldsmith L, Grudniewicz A, Hedden L, Jamieson M, Katz A, MacKenzie A, Marshall E, McCracken R, McGrail K, Scott I, Wong ST, Lavergne MR. Changes over time in patient visits and continuity of care among graduating cohorts of family physicians in 4 Canadian provinces. CMAJ 2022; 194:E1639-E1646. [PMID: 36511867 PMCID: PMC9828986 DOI: 10.1503/cmaj.220439] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Lack of patient access to family physicians in Canada is a concern. The role of recent physician graduates in this problem of supply of primary care services has not been established. We sought to establish whether career stage or graduation cohort were related to family physician practice volume and continuity of care over time. METHODS We conducted a retrospective cohort study of family physician practice from 1997/98 to 2017/18. We collected administrative health and physician claims data in British Columbia, Manitoba, Ontario and Nova Scotia. We included all physicians who registered with their respective provincial regulatory colleges as having a medical specialty of family practice or who had billed the provincial health insurance system for patient care as family physicians, or both. We used regression models to isolate the effects of 3-year categories of years in practice (at all career stages), time period and cohort on patient contacts and physician-level continuity of care. RESULTS Between 1997/98 and 2017/18, the median number of patient contacts per provider per year fell by between 515 and 1736 contacts in the 4 provinces examined. Median contacts peaked at 27-29 years in practice in all provinces, and median physician-level continuity of care increased until 30 or more years in practice. We found no association between graduation cohort and patient contacts or physician-level continuity of care. INTERPRETATION Recent cohorts of family physicians practise similarly to their predecessors in terms of practice volumes and continuity of care. Because family physicians of all career stages showed declining patient contacts, we suggest that system-wide solutions to recent challenges in the accessibility of primary care in Canada are needed.
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Affiliation(s)
- David Rudoler
- Faculty of Health Sciences (Rudoler), Ontario Tech University, Oshawa, Ont.; Ontario Shores Centre for Mental Health Sciences (Rudoler), Whitby, Ont.; Centre for Health Services and Policy Research (Peterson, McGrail, Wong), The University of British Columbia, Vancouver, BC; Department of Community Health and Epidemiology (Stock, MacKenzie), Dalhousie University, Halifax, NS; Manitoba Centre for Health Policy (Taylor), University of Manitoba, Winnipeg, Man.; Institute for Clinical Evaluative Sciences (Wilton, Glazier), Toronto, Ont.; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; Department of Family Medicine (Burge, Lavergne), Dalhousie University, Halifax, NS; St. Michael's Hospital (Glazier), Toronto, Ont.; Faculty of Health Sciences (Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Institute of Health Policy Management and Evaluation (Jamieson), University of Toronto, Toronto, Ont.; Departments of Family Medicine (Katz) and Community Health Sciences (Katz), Winnipeg, Man.; Nova Scotia Health Authority (MacKenzie, Marshall), Halifax, NS; Department of Family Medicine (Marshall), Primary Care Research Unit, Dalhousie University, Halifax, NS; Department of Family Practice (McCracken, Scott), and Centre for Health Education Scholarship (Scott), and School of Nursing (Wong), The University of British Columbia, Vancouver, BC; National Institute of Nursing Research (Wong), Bethesda, Md.; Tier II Primary Care (Lavergne), Canada Research Chairs Program, Ottawa, Ont
| | - Sandra Peterson
- Faculty of Health Sciences (Rudoler), Ontario Tech University, Oshawa, Ont.; Ontario Shores Centre for Mental Health Sciences (Rudoler), Whitby, Ont.; Centre for Health Services and Policy Research (Peterson, McGrail, Wong), The University of British Columbia, Vancouver, BC; Department of Community Health and Epidemiology (Stock, MacKenzie), Dalhousie University, Halifax, NS; Manitoba Centre for Health Policy (Taylor), University of Manitoba, Winnipeg, Man.; Institute for Clinical Evaluative Sciences (Wilton, Glazier), Toronto, Ont.; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; Department of Family Medicine (Burge, Lavergne), Dalhousie University, Halifax, NS; St. Michael's Hospital (Glazier), Toronto, Ont.; Faculty of Health Sciences (Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Institute of Health Policy Management and Evaluation (Jamieson), University of Toronto, Toronto, Ont.; Departments of Family Medicine (Katz) and Community Health Sciences (Katz), Winnipeg, Man.; Nova Scotia Health Authority (MacKenzie, Marshall), Halifax, NS; Department of Family Medicine (Marshall), Primary Care Research Unit, Dalhousie University, Halifax, NS; Department of Family Practice (McCracken, Scott), and Centre for Health Education Scholarship (Scott), and School of Nursing (Wong), The University of British Columbia, Vancouver, BC; National Institute of Nursing Research (Wong), Bethesda, Md.; Tier II Primary Care (Lavergne), Canada Research Chairs Program, Ottawa, Ont
| | - David Stock
- Faculty of Health Sciences (Rudoler), Ontario Tech University, Oshawa, Ont.; Ontario Shores Centre for Mental Health Sciences (Rudoler), Whitby, Ont.; Centre for Health Services and Policy Research (Peterson, McGrail, Wong), The University of British Columbia, Vancouver, BC; Department of Community Health and Epidemiology (Stock, MacKenzie), Dalhousie University, Halifax, NS; Manitoba Centre for Health Policy (Taylor), University of Manitoba, Winnipeg, Man.; Institute for Clinical Evaluative Sciences (Wilton, Glazier), Toronto, Ont.; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; Department of Family Medicine (Burge, Lavergne), Dalhousie University, Halifax, NS; St. Michael's Hospital (Glazier), Toronto, Ont.; Faculty of Health Sciences (Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Institute of Health Policy Management and Evaluation (Jamieson), University of Toronto, Toronto, Ont.; Departments of Family Medicine (Katz) and Community Health Sciences (Katz), Winnipeg, Man.; Nova Scotia Health Authority (MacKenzie, Marshall), Halifax, NS; Department of Family Medicine (Marshall), Primary Care Research Unit, Dalhousie University, Halifax, NS; Department of Family Practice (McCracken, Scott), and Centre for Health Education Scholarship (Scott), and School of Nursing (Wong), The University of British Columbia, Vancouver, BC; National Institute of Nursing Research (Wong), Bethesda, Md.; Tier II Primary Care (Lavergne), Canada Research Chairs Program, Ottawa, Ont.
| | - Carole Taylor
- Faculty of Health Sciences (Rudoler), Ontario Tech University, Oshawa, Ont.; Ontario Shores Centre for Mental Health Sciences (Rudoler), Whitby, Ont.; Centre for Health Services and Policy Research (Peterson, McGrail, Wong), The University of British Columbia, Vancouver, BC; Department of Community Health and Epidemiology (Stock, MacKenzie), Dalhousie University, Halifax, NS; Manitoba Centre for Health Policy (Taylor), University of Manitoba, Winnipeg, Man.; Institute for Clinical Evaluative Sciences (Wilton, Glazier), Toronto, Ont.; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; Department of Family Medicine (Burge, Lavergne), Dalhousie University, Halifax, NS; St. Michael's Hospital (Glazier), Toronto, Ont.; Faculty of Health Sciences (Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Institute of Health Policy Management and Evaluation (Jamieson), University of Toronto, Toronto, Ont.; Departments of Family Medicine (Katz) and Community Health Sciences (Katz), Winnipeg, Man.; Nova Scotia Health Authority (MacKenzie, Marshall), Halifax, NS; Department of Family Medicine (Marshall), Primary Care Research Unit, Dalhousie University, Halifax, NS; Department of Family Practice (McCracken, Scott), and Centre for Health Education Scholarship (Scott), and School of Nursing (Wong), The University of British Columbia, Vancouver, BC; National Institute of Nursing Research (Wong), Bethesda, Md.; Tier II Primary Care (Lavergne), Canada Research Chairs Program, Ottawa, Ont
| | - Drew Wilton
- Faculty of Health Sciences (Rudoler), Ontario Tech University, Oshawa, Ont.; Ontario Shores Centre for Mental Health Sciences (Rudoler), Whitby, Ont.; Centre for Health Services and Policy Research (Peterson, McGrail, Wong), The University of British Columbia, Vancouver, BC; Department of Community Health and Epidemiology (Stock, MacKenzie), Dalhousie University, Halifax, NS; Manitoba Centre for Health Policy (Taylor), University of Manitoba, Winnipeg, Man.; Institute for Clinical Evaluative Sciences (Wilton, Glazier), Toronto, Ont.; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; Department of Family Medicine (Burge, Lavergne), Dalhousie University, Halifax, NS; St. Michael's Hospital (Glazier), Toronto, Ont.; Faculty of Health Sciences (Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Institute of Health Policy Management and Evaluation (Jamieson), University of Toronto, Toronto, Ont.; Departments of Family Medicine (Katz) and Community Health Sciences (Katz), Winnipeg, Man.; Nova Scotia Health Authority (MacKenzie, Marshall), Halifax, NS; Department of Family Medicine (Marshall), Primary Care Research Unit, Dalhousie University, Halifax, NS; Department of Family Practice (McCracken, Scott), and Centre for Health Education Scholarship (Scott), and School of Nursing (Wong), The University of British Columbia, Vancouver, BC; National Institute of Nursing Research (Wong), Bethesda, Md.; Tier II Primary Care (Lavergne), Canada Research Chairs Program, Ottawa, Ont
| | - Doug Blackie
- Faculty of Health Sciences (Rudoler), Ontario Tech University, Oshawa, Ont.; Ontario Shores Centre for Mental Health Sciences (Rudoler), Whitby, Ont.; Centre for Health Services and Policy Research (Peterson, McGrail, Wong), The University of British Columbia, Vancouver, BC; Department of Community Health and Epidemiology (Stock, MacKenzie), Dalhousie University, Halifax, NS; Manitoba Centre for Health Policy (Taylor), University of Manitoba, Winnipeg, Man.; Institute for Clinical Evaluative Sciences (Wilton, Glazier), Toronto, Ont.; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; Department of Family Medicine (Burge, Lavergne), Dalhousie University, Halifax, NS; St. Michael's Hospital (Glazier), Toronto, Ont.; Faculty of Health Sciences (Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Institute of Health Policy Management and Evaluation (Jamieson), University of Toronto, Toronto, Ont.; Departments of Family Medicine (Katz) and Community Health Sciences (Katz), Winnipeg, Man.; Nova Scotia Health Authority (MacKenzie, Marshall), Halifax, NS; Department of Family Medicine (Marshall), Primary Care Research Unit, Dalhousie University, Halifax, NS; Department of Family Practice (McCracken, Scott), and Centre for Health Education Scholarship (Scott), and School of Nursing (Wong), The University of British Columbia, Vancouver, BC; National Institute of Nursing Research (Wong), Bethesda, Md.; Tier II Primary Care (Lavergne), Canada Research Chairs Program, Ottawa, Ont
| | - Fred Burge
- Faculty of Health Sciences (Rudoler), Ontario Tech University, Oshawa, Ont.; Ontario Shores Centre for Mental Health Sciences (Rudoler), Whitby, Ont.; Centre for Health Services and Policy Research (Peterson, McGrail, Wong), The University of British Columbia, Vancouver, BC; Department of Community Health and Epidemiology (Stock, MacKenzie), Dalhousie University, Halifax, NS; Manitoba Centre for Health Policy (Taylor), University of Manitoba, Winnipeg, Man.; Institute for Clinical Evaluative Sciences (Wilton, Glazier), Toronto, Ont.; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; Department of Family Medicine (Burge, Lavergne), Dalhousie University, Halifax, NS; St. Michael's Hospital (Glazier), Toronto, Ont.; Faculty of Health Sciences (Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Institute of Health Policy Management and Evaluation (Jamieson), University of Toronto, Toronto, Ont.; Departments of Family Medicine (Katz) and Community Health Sciences (Katz), Winnipeg, Man.; Nova Scotia Health Authority (MacKenzie, Marshall), Halifax, NS; Department of Family Medicine (Marshall), Primary Care Research Unit, Dalhousie University, Halifax, NS; Department of Family Practice (McCracken, Scott), and Centre for Health Education Scholarship (Scott), and School of Nursing (Wong), The University of British Columbia, Vancouver, BC; National Institute of Nursing Research (Wong), Bethesda, Md.; Tier II Primary Care (Lavergne), Canada Research Chairs Program, Ottawa, Ont
| | - Richard H Glazier
- Faculty of Health Sciences (Rudoler), Ontario Tech University, Oshawa, Ont.; Ontario Shores Centre for Mental Health Sciences (Rudoler), Whitby, Ont.; Centre for Health Services and Policy Research (Peterson, McGrail, Wong), The University of British Columbia, Vancouver, BC; Department of Community Health and Epidemiology (Stock, MacKenzie), Dalhousie University, Halifax, NS; Manitoba Centre for Health Policy (Taylor), University of Manitoba, Winnipeg, Man.; Institute for Clinical Evaluative Sciences (Wilton, Glazier), Toronto, Ont.; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; Department of Family Medicine (Burge, Lavergne), Dalhousie University, Halifax, NS; St. Michael's Hospital (Glazier), Toronto, Ont.; Faculty of Health Sciences (Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Institute of Health Policy Management and Evaluation (Jamieson), University of Toronto, Toronto, Ont.; Departments of Family Medicine (Katz) and Community Health Sciences (Katz), Winnipeg, Man.; Nova Scotia Health Authority (MacKenzie, Marshall), Halifax, NS; Department of Family Medicine (Marshall), Primary Care Research Unit, Dalhousie University, Halifax, NS; Department of Family Practice (McCracken, Scott), and Centre for Health Education Scholarship (Scott), and School of Nursing (Wong), The University of British Columbia, Vancouver, BC; National Institute of Nursing Research (Wong), Bethesda, Md.; Tier II Primary Care (Lavergne), Canada Research Chairs Program, Ottawa, Ont
| | - Laurie Goldsmith
- Faculty of Health Sciences (Rudoler), Ontario Tech University, Oshawa, Ont.; Ontario Shores Centre for Mental Health Sciences (Rudoler), Whitby, Ont.; Centre for Health Services and Policy Research (Peterson, McGrail, Wong), The University of British Columbia, Vancouver, BC; Department of Community Health and Epidemiology (Stock, MacKenzie), Dalhousie University, Halifax, NS; Manitoba Centre for Health Policy (Taylor), University of Manitoba, Winnipeg, Man.; Institute for Clinical Evaluative Sciences (Wilton, Glazier), Toronto, Ont.; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; Department of Family Medicine (Burge, Lavergne), Dalhousie University, Halifax, NS; St. Michael's Hospital (Glazier), Toronto, Ont.; Faculty of Health Sciences (Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Institute of Health Policy Management and Evaluation (Jamieson), University of Toronto, Toronto, Ont.; Departments of Family Medicine (Katz) and Community Health Sciences (Katz), Winnipeg, Man.; Nova Scotia Health Authority (MacKenzie, Marshall), Halifax, NS; Department of Family Medicine (Marshall), Primary Care Research Unit, Dalhousie University, Halifax, NS; Department of Family Practice (McCracken, Scott), and Centre for Health Education Scholarship (Scott), and School of Nursing (Wong), The University of British Columbia, Vancouver, BC; National Institute of Nursing Research (Wong), Bethesda, Md.; Tier II Primary Care (Lavergne), Canada Research Chairs Program, Ottawa, Ont
| | - Agnes Grudniewicz
- Faculty of Health Sciences (Rudoler), Ontario Tech University, Oshawa, Ont.; Ontario Shores Centre for Mental Health Sciences (Rudoler), Whitby, Ont.; Centre for Health Services and Policy Research (Peterson, McGrail, Wong), The University of British Columbia, Vancouver, BC; Department of Community Health and Epidemiology (Stock, MacKenzie), Dalhousie University, Halifax, NS; Manitoba Centre for Health Policy (Taylor), University of Manitoba, Winnipeg, Man.; Institute for Clinical Evaluative Sciences (Wilton, Glazier), Toronto, Ont.; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; Department of Family Medicine (Burge, Lavergne), Dalhousie University, Halifax, NS; St. Michael's Hospital (Glazier), Toronto, Ont.; Faculty of Health Sciences (Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Institute of Health Policy Management and Evaluation (Jamieson), University of Toronto, Toronto, Ont.; Departments of Family Medicine (Katz) and Community Health Sciences (Katz), Winnipeg, Man.; Nova Scotia Health Authority (MacKenzie, Marshall), Halifax, NS; Department of Family Medicine (Marshall), Primary Care Research Unit, Dalhousie University, Halifax, NS; Department of Family Practice (McCracken, Scott), and Centre for Health Education Scholarship (Scott), and School of Nursing (Wong), The University of British Columbia, Vancouver, BC; National Institute of Nursing Research (Wong), Bethesda, Md.; Tier II Primary Care (Lavergne), Canada Research Chairs Program, Ottawa, Ont
| | - Lindsay Hedden
- Faculty of Health Sciences (Rudoler), Ontario Tech University, Oshawa, Ont.; Ontario Shores Centre for Mental Health Sciences (Rudoler), Whitby, Ont.; Centre for Health Services and Policy Research (Peterson, McGrail, Wong), The University of British Columbia, Vancouver, BC; Department of Community Health and Epidemiology (Stock, MacKenzie), Dalhousie University, Halifax, NS; Manitoba Centre for Health Policy (Taylor), University of Manitoba, Winnipeg, Man.; Institute for Clinical Evaluative Sciences (Wilton, Glazier), Toronto, Ont.; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; Department of Family Medicine (Burge, Lavergne), Dalhousie University, Halifax, NS; St. Michael's Hospital (Glazier), Toronto, Ont.; Faculty of Health Sciences (Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Institute of Health Policy Management and Evaluation (Jamieson), University of Toronto, Toronto, Ont.; Departments of Family Medicine (Katz) and Community Health Sciences (Katz), Winnipeg, Man.; Nova Scotia Health Authority (MacKenzie, Marshall), Halifax, NS; Department of Family Medicine (Marshall), Primary Care Research Unit, Dalhousie University, Halifax, NS; Department of Family Practice (McCracken, Scott), and Centre for Health Education Scholarship (Scott), and School of Nursing (Wong), The University of British Columbia, Vancouver, BC; National Institute of Nursing Research (Wong), Bethesda, Md.; Tier II Primary Care (Lavergne), Canada Research Chairs Program, Ottawa, Ont
| | - Margaret Jamieson
- Faculty of Health Sciences (Rudoler), Ontario Tech University, Oshawa, Ont.; Ontario Shores Centre for Mental Health Sciences (Rudoler), Whitby, Ont.; Centre for Health Services and Policy Research (Peterson, McGrail, Wong), The University of British Columbia, Vancouver, BC; Department of Community Health and Epidemiology (Stock, MacKenzie), Dalhousie University, Halifax, NS; Manitoba Centre for Health Policy (Taylor), University of Manitoba, Winnipeg, Man.; Institute for Clinical Evaluative Sciences (Wilton, Glazier), Toronto, Ont.; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; Department of Family Medicine (Burge, Lavergne), Dalhousie University, Halifax, NS; St. Michael's Hospital (Glazier), Toronto, Ont.; Faculty of Health Sciences (Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Institute of Health Policy Management and Evaluation (Jamieson), University of Toronto, Toronto, Ont.; Departments of Family Medicine (Katz) and Community Health Sciences (Katz), Winnipeg, Man.; Nova Scotia Health Authority (MacKenzie, Marshall), Halifax, NS; Department of Family Medicine (Marshall), Primary Care Research Unit, Dalhousie University, Halifax, NS; Department of Family Practice (McCracken, Scott), and Centre for Health Education Scholarship (Scott), and School of Nursing (Wong), The University of British Columbia, Vancouver, BC; National Institute of Nursing Research (Wong), Bethesda, Md.; Tier II Primary Care (Lavergne), Canada Research Chairs Program, Ottawa, Ont
| | - Alan Katz
- Faculty of Health Sciences (Rudoler), Ontario Tech University, Oshawa, Ont.; Ontario Shores Centre for Mental Health Sciences (Rudoler), Whitby, Ont.; Centre for Health Services and Policy Research (Peterson, McGrail, Wong), The University of British Columbia, Vancouver, BC; Department of Community Health and Epidemiology (Stock, MacKenzie), Dalhousie University, Halifax, NS; Manitoba Centre for Health Policy (Taylor), University of Manitoba, Winnipeg, Man.; Institute for Clinical Evaluative Sciences (Wilton, Glazier), Toronto, Ont.; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; Department of Family Medicine (Burge, Lavergne), Dalhousie University, Halifax, NS; St. Michael's Hospital (Glazier), Toronto, Ont.; Faculty of Health Sciences (Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Institute of Health Policy Management and Evaluation (Jamieson), University of Toronto, Toronto, Ont.; Departments of Family Medicine (Katz) and Community Health Sciences (Katz), Winnipeg, Man.; Nova Scotia Health Authority (MacKenzie, Marshall), Halifax, NS; Department of Family Medicine (Marshall), Primary Care Research Unit, Dalhousie University, Halifax, NS; Department of Family Practice (McCracken, Scott), and Centre for Health Education Scholarship (Scott), and School of Nursing (Wong), The University of British Columbia, Vancouver, BC; National Institute of Nursing Research (Wong), Bethesda, Md.; Tier II Primary Care (Lavergne), Canada Research Chairs Program, Ottawa, Ont
| | - Adrian MacKenzie
- Faculty of Health Sciences (Rudoler), Ontario Tech University, Oshawa, Ont.; Ontario Shores Centre for Mental Health Sciences (Rudoler), Whitby, Ont.; Centre for Health Services and Policy Research (Peterson, McGrail, Wong), The University of British Columbia, Vancouver, BC; Department of Community Health and Epidemiology (Stock, MacKenzie), Dalhousie University, Halifax, NS; Manitoba Centre for Health Policy (Taylor), University of Manitoba, Winnipeg, Man.; Institute for Clinical Evaluative Sciences (Wilton, Glazier), Toronto, Ont.; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; Department of Family Medicine (Burge, Lavergne), Dalhousie University, Halifax, NS; St. Michael's Hospital (Glazier), Toronto, Ont.; Faculty of Health Sciences (Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Institute of Health Policy Management and Evaluation (Jamieson), University of Toronto, Toronto, Ont.; Departments of Family Medicine (Katz) and Community Health Sciences (Katz), Winnipeg, Man.; Nova Scotia Health Authority (MacKenzie, Marshall), Halifax, NS; Department of Family Medicine (Marshall), Primary Care Research Unit, Dalhousie University, Halifax, NS; Department of Family Practice (McCracken, Scott), and Centre for Health Education Scholarship (Scott), and School of Nursing (Wong), The University of British Columbia, Vancouver, BC; National Institute of Nursing Research (Wong), Bethesda, Md.; Tier II Primary Care (Lavergne), Canada Research Chairs Program, Ottawa, Ont
| | - Emily Marshall
- Faculty of Health Sciences (Rudoler), Ontario Tech University, Oshawa, Ont.; Ontario Shores Centre for Mental Health Sciences (Rudoler), Whitby, Ont.; Centre for Health Services and Policy Research (Peterson, McGrail, Wong), The University of British Columbia, Vancouver, BC; Department of Community Health and Epidemiology (Stock, MacKenzie), Dalhousie University, Halifax, NS; Manitoba Centre for Health Policy (Taylor), University of Manitoba, Winnipeg, Man.; Institute for Clinical Evaluative Sciences (Wilton, Glazier), Toronto, Ont.; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; Department of Family Medicine (Burge, Lavergne), Dalhousie University, Halifax, NS; St. Michael's Hospital (Glazier), Toronto, Ont.; Faculty of Health Sciences (Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Institute of Health Policy Management and Evaluation (Jamieson), University of Toronto, Toronto, Ont.; Departments of Family Medicine (Katz) and Community Health Sciences (Katz), Winnipeg, Man.; Nova Scotia Health Authority (MacKenzie, Marshall), Halifax, NS; Department of Family Medicine (Marshall), Primary Care Research Unit, Dalhousie University, Halifax, NS; Department of Family Practice (McCracken, Scott), and Centre for Health Education Scholarship (Scott), and School of Nursing (Wong), The University of British Columbia, Vancouver, BC; National Institute of Nursing Research (Wong), Bethesda, Md.; Tier II Primary Care (Lavergne), Canada Research Chairs Program, Ottawa, Ont
| | - Rita McCracken
- Faculty of Health Sciences (Rudoler), Ontario Tech University, Oshawa, Ont.; Ontario Shores Centre for Mental Health Sciences (Rudoler), Whitby, Ont.; Centre for Health Services and Policy Research (Peterson, McGrail, Wong), The University of British Columbia, Vancouver, BC; Department of Community Health and Epidemiology (Stock, MacKenzie), Dalhousie University, Halifax, NS; Manitoba Centre for Health Policy (Taylor), University of Manitoba, Winnipeg, Man.; Institute for Clinical Evaluative Sciences (Wilton, Glazier), Toronto, Ont.; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; Department of Family Medicine (Burge, Lavergne), Dalhousie University, Halifax, NS; St. Michael's Hospital (Glazier), Toronto, Ont.; Faculty of Health Sciences (Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Institute of Health Policy Management and Evaluation (Jamieson), University of Toronto, Toronto, Ont.; Departments of Family Medicine (Katz) and Community Health Sciences (Katz), Winnipeg, Man.; Nova Scotia Health Authority (MacKenzie, Marshall), Halifax, NS; Department of Family Medicine (Marshall), Primary Care Research Unit, Dalhousie University, Halifax, NS; Department of Family Practice (McCracken, Scott), and Centre for Health Education Scholarship (Scott), and School of Nursing (Wong), The University of British Columbia, Vancouver, BC; National Institute of Nursing Research (Wong), Bethesda, Md.; Tier II Primary Care (Lavergne), Canada Research Chairs Program, Ottawa, Ont
| | - Kim McGrail
- Faculty of Health Sciences (Rudoler), Ontario Tech University, Oshawa, Ont.; Ontario Shores Centre for Mental Health Sciences (Rudoler), Whitby, Ont.; Centre for Health Services and Policy Research (Peterson, McGrail, Wong), The University of British Columbia, Vancouver, BC; Department of Community Health and Epidemiology (Stock, MacKenzie), Dalhousie University, Halifax, NS; Manitoba Centre for Health Policy (Taylor), University of Manitoba, Winnipeg, Man.; Institute for Clinical Evaluative Sciences (Wilton, Glazier), Toronto, Ont.; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; Department of Family Medicine (Burge, Lavergne), Dalhousie University, Halifax, NS; St. Michael's Hospital (Glazier), Toronto, Ont.; Faculty of Health Sciences (Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Institute of Health Policy Management and Evaluation (Jamieson), University of Toronto, Toronto, Ont.; Departments of Family Medicine (Katz) and Community Health Sciences (Katz), Winnipeg, Man.; Nova Scotia Health Authority (MacKenzie, Marshall), Halifax, NS; Department of Family Medicine (Marshall), Primary Care Research Unit, Dalhousie University, Halifax, NS; Department of Family Practice (McCracken, Scott), and Centre for Health Education Scholarship (Scott), and School of Nursing (Wong), The University of British Columbia, Vancouver, BC; National Institute of Nursing Research (Wong), Bethesda, Md.; Tier II Primary Care (Lavergne), Canada Research Chairs Program, Ottawa, Ont
| | - Ian Scott
- Faculty of Health Sciences (Rudoler), Ontario Tech University, Oshawa, Ont.; Ontario Shores Centre for Mental Health Sciences (Rudoler), Whitby, Ont.; Centre for Health Services and Policy Research (Peterson, McGrail, Wong), The University of British Columbia, Vancouver, BC; Department of Community Health and Epidemiology (Stock, MacKenzie), Dalhousie University, Halifax, NS; Manitoba Centre for Health Policy (Taylor), University of Manitoba, Winnipeg, Man.; Institute for Clinical Evaluative Sciences (Wilton, Glazier), Toronto, Ont.; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; Department of Family Medicine (Burge, Lavergne), Dalhousie University, Halifax, NS; St. Michael's Hospital (Glazier), Toronto, Ont.; Faculty of Health Sciences (Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Institute of Health Policy Management and Evaluation (Jamieson), University of Toronto, Toronto, Ont.; Departments of Family Medicine (Katz) and Community Health Sciences (Katz), Winnipeg, Man.; Nova Scotia Health Authority (MacKenzie, Marshall), Halifax, NS; Department of Family Medicine (Marshall), Primary Care Research Unit, Dalhousie University, Halifax, NS; Department of Family Practice (McCracken, Scott), and Centre for Health Education Scholarship (Scott), and School of Nursing (Wong), The University of British Columbia, Vancouver, BC; National Institute of Nursing Research (Wong), Bethesda, Md.; Tier II Primary Care (Lavergne), Canada Research Chairs Program, Ottawa, Ont
| | - Sabrina T Wong
- Faculty of Health Sciences (Rudoler), Ontario Tech University, Oshawa, Ont.; Ontario Shores Centre for Mental Health Sciences (Rudoler), Whitby, Ont.; Centre for Health Services and Policy Research (Peterson, McGrail, Wong), The University of British Columbia, Vancouver, BC; Department of Community Health and Epidemiology (Stock, MacKenzie), Dalhousie University, Halifax, NS; Manitoba Centre for Health Policy (Taylor), University of Manitoba, Winnipeg, Man.; Institute for Clinical Evaluative Sciences (Wilton, Glazier), Toronto, Ont.; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; Department of Family Medicine (Burge, Lavergne), Dalhousie University, Halifax, NS; St. Michael's Hospital (Glazier), Toronto, Ont.; Faculty of Health Sciences (Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Institute of Health Policy Management and Evaluation (Jamieson), University of Toronto, Toronto, Ont.; Departments of Family Medicine (Katz) and Community Health Sciences (Katz), Winnipeg, Man.; Nova Scotia Health Authority (MacKenzie, Marshall), Halifax, NS; Department of Family Medicine (Marshall), Primary Care Research Unit, Dalhousie University, Halifax, NS; Department of Family Practice (McCracken, Scott), and Centre for Health Education Scholarship (Scott), and School of Nursing (Wong), The University of British Columbia, Vancouver, BC; National Institute of Nursing Research (Wong), Bethesda, Md.; Tier II Primary Care (Lavergne), Canada Research Chairs Program, Ottawa, Ont
| | - M Ruth Lavergne
- Faculty of Health Sciences (Rudoler), Ontario Tech University, Oshawa, Ont.; Ontario Shores Centre for Mental Health Sciences (Rudoler), Whitby, Ont.; Centre for Health Services and Policy Research (Peterson, McGrail, Wong), The University of British Columbia, Vancouver, BC; Department of Community Health and Epidemiology (Stock, MacKenzie), Dalhousie University, Halifax, NS; Manitoba Centre for Health Policy (Taylor), University of Manitoba, Winnipeg, Man.; Institute for Clinical Evaluative Sciences (Wilton, Glazier), Toronto, Ont.; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; Department of Family Medicine (Burge, Lavergne), Dalhousie University, Halifax, NS; St. Michael's Hospital (Glazier), Toronto, Ont.; Faculty of Health Sciences (Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Institute of Health Policy Management and Evaluation (Jamieson), University of Toronto, Toronto, Ont.; Departments of Family Medicine (Katz) and Community Health Sciences (Katz), Winnipeg, Man.; Nova Scotia Health Authority (MacKenzie, Marshall), Halifax, NS; Department of Family Medicine (Marshall), Primary Care Research Unit, Dalhousie University, Halifax, NS; Department of Family Practice (McCracken, Scott), and Centre for Health Education Scholarship (Scott), and School of Nursing (Wong), The University of British Columbia, Vancouver, BC; National Institute of Nursing Research (Wong), Bethesda, Md.; Tier II Primary Care (Lavergne), Canada Research Chairs Program, Ottawa, Ont
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Haldane V, Morales-Vazquez M, Jamieson M, Veillard J, Marchildon GP, Allin S. Learning from the first wave of the COVID-19 pandemic: Comparing policy responses in Uruguay with 10 other Latin American and Caribbean countries. Health Policy Open 2022; 3:100081. [PMID: 36405237 PMCID: PMC9661545 DOI: 10.1016/j.hpopen.2022.100081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 10/12/2022] [Accepted: 10/30/2022] [Indexed: 11/16/2022] Open
Abstract
A range of public health and social measures have been employed in response to the disproportionate impact of COVID-19 in Latin America and the Caribbean (LAC). Yet, pandemic responses have varied across the region, particularly during the first 6 months of the pandemic, with Uruguay effectively limiting transmission during this crucial phase. This review describes features of pandemic responses which may have contributed to Uruguay's early success relative to 10 other LAC countries - Argentina, Chile, Ecuador, El Salvador, Guatemala, Haiti, Honduras, Panama, Paraguay, and Trinidad and Tobago. Uruguay differentiated its early response efforts from reviewed countries by foregoing strict border closures and restrictions on movement, and rapidly implementing a suite of economic and social measures. Our findings describe the importance of supporting adherence to public health interventions by ensuring that effective social and economic safety net measures are in place to permit compliance with public health measures.
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Affiliation(s)
- Victoria Haldane
- Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College St., Toronto, ON M5T 3M6, Canada
| | - Mariana Morales-Vazquez
- Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College St., Toronto, ON M5T 3M6, Canada
| | - Margaret Jamieson
- Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College St., Toronto, ON M5T 3M6, Canada
| | - Jeremy Veillard
- Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College St., Toronto, ON M5T 3M6, Canada,World Bank, Health, Nutrition and Population, Washington, DC, USA
| | - Gregory P. Marchildon
- Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College St., Toronto, ON M5T 3M6, Canada
| | - Sara Allin
- Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College St., Toronto, ON M5T 3M6, Canada,Corresponding author at: Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College St., Toronto, ON M5T 3M6, Canada
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8
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Saunders H, Pham B, Loong D, Mishra S, Ashoor HM, Antony J, Darvesh N, Bains SK, Jamieson M, Plett D, Trivedi S, Yu CH, Straus SE, Tricco AC, Isaranuwatchai W. The Cost-Effectiveness of Intermediate-Acting, Long-Acting, Ultralong-Acting, and Biosimilar Insulins for Type 1 Diabetes Mellitus: A Systematic Review. Value Health 2022; 25:1235-1252. [PMID: 35341688 DOI: 10.1016/j.jval.2021.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 11/15/2021] [Accepted: 12/14/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES The incidence of type 1 diabetes mellitus is increasing every year requiring substantial expenditure on treatment and complications. A systematic review was conducted on the cost-effectiveness of insulin formulations, including ultralong-, long-, or intermediate-acting insulin, and their biosimilar insulin equivalents. METHODS MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, HTA, and NHS EED were searched from inception to June 11, 2021. Cost-effectiveness and cost-utility analyses were included if insulin formulations in adults (≥ 16 years) with type 1 diabetes mellitus were evaluated. Two reviewers independently screened titles, abstracts, and full-text articles, extracted study data, and appraised their quality using the Drummond 10-item checklist. Costs were converted to 2020 US dollars adjusting for inflation and purchasing power parity across currencies. RESULTS A total of 27 studies were included. Incremental cost-effectiveness ratios ranged widely across the studies. All pairwise comparisons (11 of 11, 100%) found that ultralong-acting insulin was cost-effective compared with other long-acting insulins, including a long-acting biosimilar. Most pairwise comparisons (24 of 27, 89%) concluded that long-acting insulin was cost-effective compared with intermediate-acting insulin. Few studies compared long-acting insulins with one another. CONCLUSIONS Long-acting insulin may be cost-effective compared with intermediate-acting insulin. Future studies should directly compare biosimilar options and long-acting insulin options and evaluate the long-term consequences of ultralong-acting insulins.
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Affiliation(s)
- Hailey Saunders
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Ba' Pham
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Desmond Loong
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Sujata Mishra
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Huda M Ashoor
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Jesmin Antony
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Nazia Darvesh
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Silkan K Bains
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Margaret Jamieson
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Donna Plett
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Srushhti Trivedi
- Joint Centre for Bioethics, University of Toronto, Toronto, Ontario, Canada
| | - Catherine H Yu
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada; Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sharon E Straus
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Andrea C Tricco
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada; Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Wanrudee Isaranuwatchai
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada.
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9
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Singh S, McNab C, Olson RM, Bristol N, Nolan C, Bergstrøm E, Bartos M, Mabuchi S, Panjabi R, Karan A, Abdalla SM, Bonk M, Jamieson M, Werner GK, Nordström A, Legido-Quigley H, Phelan A. How an outbreak became a pandemic: a chronological analysis of crucial junctures and international obligations in the early months of the COVID-19 pandemic. Lancet 2021; 398:2109-2124. [PMID: 34762857 PMCID: PMC8575464 DOI: 10.1016/s0140-6736(21)01897-3] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 08/01/2021] [Accepted: 08/17/2021] [Indexed: 12/11/2022]
Abstract
Understanding the spread of SARS-CoV-2, how and when evidence emerged, and the timing of local, national, regional, and global responses is essential to establish how an outbreak became a pandemic and to prepare for future health threats. With that aim, the Independent Panel for Pandemic Preparedness and Response has developed a chronology of events, actions, and recommendations, from December, 2019, when the first cases of COVID-19 were identified in China, to the end of March, 2020, by which time the outbreak had spread extensively worldwide and had been characterised as a pandemic. Datapoints are based on two literature reviews, WHO documents and correspondence, submissions to the Panel, and an expert verification process. The retrospective analysis of the chronology shows a dedicated initial response by WHO and some national governments, but also aspects of the response that could have been quicker, including outbreak notifications under the International Health Regulations (IHR), presumption and confirmation of human-to-human transmission of SARS-CoV-2, declaration of a Public Health Emergency of International Concern, and, most importantly, the public health response of many national governments. The chronology also shows that some countries, largely those with previous experience with similar outbreaks, reacted quickly, even ahead of WHO alerts, and were more successful in initially containing the virus. Mapping actions against IHR obligations, the chronology shows where efficiency and accountability could be improved at local, national, and international levels to more quickly alert and contain health threats in the future. In particular, these improvements include necessary reforms to international law and governance for pandemic preparedness and response, including the IHR and a potential framework convention on pandemic preparedness and response.
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Affiliation(s)
- Sudhvir Singh
- The Independent Panel for Pandemic Preparedness and Response, Geneva, Switzerland; Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
| | - Christine McNab
- The Independent Panel for Pandemic Preparedness and Response, Geneva, Switzerland
| | - Rose McKeon Olson
- Brigham and Women's Hospital, Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Nellie Bristol
- The Independent Panel for Pandemic Preparedness and Response, Geneva, Switzerland
| | - Cody Nolan
- Brigham and Women's Hospital, Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Elin Bergstrøm
- The Independent Panel for Pandemic Preparedness and Response, Geneva, Switzerland
| | - Michael Bartos
- The Independent Panel for Pandemic Preparedness and Response, Geneva, Switzerland; School of Sociology, Australian National University, Canberra, ACT, Australia
| | - Shunsuke Mabuchi
- The Independent Panel for Pandemic Preparedness and Response, Geneva, Switzerland
| | - Raj Panjabi
- The Independent Panel for Pandemic Preparedness and Response, Geneva, Switzerland
| | - Abraar Karan
- Brigham and Women's Hospital, Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Salma M Abdalla
- The Independent Panel for Pandemic Preparedness and Response, Geneva, Switzerland; Boston University School of Public Health, Boston, MA, USA
| | - Mathias Bonk
- The Independent Panel for Pandemic Preparedness and Response, Geneva, Switzerland
| | - Margaret Jamieson
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - George K Werner
- The Independent Panel for Pandemic Preparedness and Response, Geneva, Switzerland
| | - Anders Nordström
- The Independent Panel for Pandemic Preparedness and Response, Geneva, Switzerland
| | - Helena Legido-Quigley
- The Independent Panel for Pandemic Preparedness and Response, Geneva, Switzerland; London School of Hygiene & Tropical Medicine, London, UK; Saw Swee Hock School of Public Health, Singapore
| | - Alexandra Phelan
- The Independent Panel for Pandemic Preparedness and Response, Geneva, Switzerland; Center for Global Health Science & Security, Georgetown University, Washington, DC, USA
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10
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Haldane V, Jung AS, Neill R, Singh S, Wu S, Jamieson M, Verma M, Tan M, De Foo C, Abdalla SM, Shrestha P, Chua AQ, Nordström A, Legido-Quigley H. From response to transformation: how countries can strengthen national pandemic preparedness and response systems. BMJ 2021; 375:e067507. [PMID: 34840139 PMCID: PMC8624064 DOI: 10.1136/bmj-2021-067507] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Victoria Haldane
- Department of Global Health & Development, London School of Hygiene and Tropical Medicine, UK
| | - Anne-Sophie Jung
- Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
| | - Rachel Neill
- Johns Hopkins Bloomberg School of Public Health, USA
| | - Sudhvir Singh
- The Independent Panel for Pandemic Preparedness and Response Secretariat
| | - Shishi Wu
- Dalla Lana School of Public Health, University of Toronto, Canada
| | - Margaret Jamieson
- Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
| | - Monica Verma
- Saw Swee Hock School of Public Health, National University of Singapore and NUHS, Singapore
| | - Melisa Tan
- Saw Swee Hock School of Public Health, National University of Singapore and NUHS, Singapore
| | - Chuan De Foo
- Saw Swee Hock School of Public Health, National University of Singapore and NUHS, Singapore
| | - Salma M Abdalla
- The Independent Panel for Pandemic Preparedness and Response Secretariat
- School of Public Health, Boston University, USA
| | - Pami Shrestha
- Saw Swee Hock School of Public Health, National University of Singapore and NUHS, Singapore
| | - Alvin Qijia Chua
- Saw Swee Hock School of Public Health, National University of Singapore and NUHS, Singapore
| | - Anders Nordström
- The Independent Panel for Pandemic Preparedness and Response Secretariat
| | - Helena Legido-Quigley
- Department of Global Health & Development, London School of Hygiene and Tropical Medicine, UK
- The Independent Panel for Pandemic Preparedness and Response Secretariat
- Saw Swee Hock School of Public Health, National University of Singapore and NUHS, Singapore
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11
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Abdalla SM, Koya SF, Jamieson M, Verma M, Haldane V, Jung AS, Singh S, Nordström A, Obaid T, Legido-Quigley H, McNab C. Investing in trust and community resilience: lessons from the early months of the first digital pandemic. BMJ 2021; 375:e067487. [PMID: 34840130 PMCID: PMC8624756 DOI: 10.1136/bmj-2021-067487] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Salma M Abdalla and colleagues examine how an atmosphere of misinformation, disinformation, and erosion of trust shaped the early response to covid-19 on both global and national levels
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Affiliation(s)
- Salma M Abdalla
- Independent Panel for Pandemic Preparedness and Response Secretariat, Global Health Campus, Geneva, Switzerland
- School of Public Health, Boston University, USA
| | | | - Margaret Jamieson
- Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
| | - Monica Verma
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Victoria Haldane
- Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
| | - Anne-Sophie Jung
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, UK
| | - Sudhvir Singh
- Independent Panel for Pandemic Preparedness and Response Secretariat, Global Health Campus, Geneva, Switzerland
- Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Anders Nordström
- Independent Panel for Pandemic Preparedness and Response Secretariat, Global Health Campus, Geneva, Switzerland
| | - Thoraya Obaid
- Independent Panel for Pandemic Preparedness and Response
| | - Helena Legido-Quigley
- Independent Panel for Pandemic Preparedness and Response Secretariat, Global Health Campus, Geneva, Switzerland
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, UK
| | - Christine McNab
- Independent Panel for Pandemic Preparedness and Response Secretariat, Global Health Campus, Geneva, Switzerland
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12
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Jung AS, Haldane V, Neill R, Wu S, Jamieson M, Verma M, Tan M, De Foo C, Abdalla SM, Shrestha P, Chua AQ, Bristol N, Singh S, Bartos M, Mabuchi S, Bonk M, McNab C, Werner GK, Panjabi R, Nordström A, Legido-Quigley H. National responses to covid-19: drivers, complexities, and uncertainties in the first year of the pandemic. BMJ 2021; 375:e068954. [PMID: 34840138 PMCID: PMC8624066 DOI: 10.1136/bmj-2021-068954] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Affiliation(s)
- Anne-Sophie Jung
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, UK
| | - Victoria Haldane
- Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
| | - Rachel Neill
- Johns Hopkins Bloomberg School of Public Health, USA
| | - Shishi Wu
- Dalla Lana School of Public Health, University of Toronto, Canada
| | - Margaret Jamieson
- Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
| | - Monica Verma
- Saw Swee Hock School of Public Health, Singapore
| | - Melisa Tan
- Saw Swee Hock School of Public Health, Singapore
| | - Chuan De Foo
- Saw Swee Hock School of Public Health, Singapore
| | - Salma M Abdalla
- The Independent Panel for Pandemic Preparedness and Response Secretariat
- School of Public Health, Boston University, USA
| | | | | | - Nellie Bristol
- The Independent Panel for Pandemic Preparedness and Response Secretariat
| | - Sudhvir Singh
- The Independent Panel for Pandemic Preparedness and Response Secretariat
- Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Michael Bartos
- The Independent Panel for Pandemic Preparedness and Response Secretariat
| | - Shunsuke Mabuchi
- The Independent Panel for Pandemic Preparedness and Response Secretariat
| | - Mathias Bonk
- The Independent Panel for Pandemic Preparedness and Response Secretariat
| | - Christine McNab
- The Independent Panel for Pandemic Preparedness and Response Secretariat
| | - George K Werner
- The Independent Panel for Pandemic Preparedness and Response Secretariat
| | - Raj Panjabi
- The Independent Panel for Pandemic Preparedness and Response Secretariat
| | - Anders Nordström
- The Independent Panel for Pandemic Preparedness and Response Secretariat
| | - Helena Legido-Quigley
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, UK
- Saw Swee Hock School of Public Health, Singapore
- The Independent Panel for Pandemic Preparedness and Response Secretariat
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13
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Haldane V, Jung AS, De Foo C, Bonk M, Jamieson M, Wu S, Verma M, Abdalla SM, Singh S, Nordström A, Legido-Quigley H. Strengthening the basics: public health responses to prevent the next pandemic. BMJ 2021; 375:e067510. [PMID: 34840134 PMCID: PMC8624065 DOI: 10.1136/bmj-2021-067510] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Victoria Haldane
- Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
| | | | - Chuan De Foo
- Saw Swee Hock School of Public Health, Singapore
| | - Mathias Bonk
- Independent Panel for Pandemic Preparedness and Response Secretariat
| | - Margaret Jamieson
- Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
| | - Shishi Wu
- Dalla Lana School of Public Health, University of Toronto, Canada
| | - Monica Verma
- Saw Swee Hock School of Public Health, Singapore
| | - Salma M Abdalla
- Independent Panel for Pandemic Preparedness and Response Secretariat
- School of Public Health, Boston University, USA
| | - Sudhvir Singh
- Independent Panel for Pandemic Preparedness and Response Secretariat
- Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Anders Nordström
- Independent Panel for Pandemic Preparedness and Response Secretariat
| | - Helena Legido-Quigley
- London School of Hygiene and Tropical Medicine, UK
- Saw Swee Hock School of Public Health, Singapore
- Independent Panel for Pandemic Preparedness and Response Secretariat
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14
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English S, Fergusson D, Lalu M, Thebaud B, Watpool I, Champagne J, Sobh M, Courtman D, Khan S, Jamieson M, Hodgins S, Stewart D. Results of the cellular immuno-therapy for covid-19 related acute respiratory distress syndrome (circa-phase i trial. Cytotherapy 2021. [PMCID: PMC8111924 DOI: 10.1016/s1465324921002796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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15
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Jamieson M, Cooper Reed A, Amaral E, Cameron JI. Exploring the Emergence of Self-Directed Home Care in Ontario: A Qualitative Case Study on Gotcare Services. Home Health Care Management & Practice 2021. [DOI: 10.1177/1084822320953840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In Ontario, the number of older adults (≥65) is expected to increase from 2.4 million in 2017, to 4.6 million by 2046. This substantial increase necessitates a spectrum of care delivery options for older adults who wish to age in their homes. Self-directed care refers to a growing trend in healthcare that provides care recipients with more autonomy to determine what care they need, and how that care should be delivered. This research explores self-directed care in Ontario, Canada, examining an Ontario-based home care agency, Gotcare, as a case study. Semi-structured interviews were completed with eight of Gotcare’s care workers, three of their management team, and 11 home care experts from the healthcare sector. Analysis of these interviews generated four key themes: the circumstances under which self-directed care is an appropriate model for a care recipient; the experiences of home care workers offering self-directed care; the risks of self-directed care; and the opportunities of self-directed care. Findings suggest Gotcare’s model of self-directed home care is responding to a lack of home care options in Ontario, especially in rural and remote regions. The model should be seen as a viable option within the home care sector, but further research should be conducted to ensure that the highest standard of care is delivered to care recipients, and to inform evidence-based policy decisions.
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16
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Cernat A, Jamieson M, Kavelaars R, Khalili S, Bhambhwani V, Mireskandari K, Moretti ME. Immediate versus delayed sequential bilateral cataract surgery in children: a cost-effectiveness analysis. Br J Ophthalmol 2020; 106:211-217. [PMID: 33218991 DOI: 10.1136/bjophthalmol-2020-316507] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 08/02/2020] [Accepted: 10/30/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS Children with bilateral cataracts may undergo immediate sequential bilateral cataract surgery (ISBCS), which involves surgery on both eyes during the same general anaesthesia, or delayed sequential bilateral cataract surgery (DSBCS), which involves operating on each eye on separate days and requires a second anaesthesia. ISBCS is viewed with caution because of the risk of bilateral endophthalmitis. Proponents of ISBCS emphasise that the incidence of serious complications is low and is outweighed by benefits such as avoidance of multiple anaesthesia, faster visual rehabilitation and potential for decreased costs. However, there is a paucity of literature regarding the cost-effectiveness of ISBCS in children. We conducted a cost-effectiveness analysis to determine whether ISBCS is more cost-effective than DSBCS from the societal and health system perspectives in Ontario, Canada, which has a universal, single-payer system. METHODS A retrospective analysis of children who underwent ISBCS or DSBCS at a tertiary referral paediatric hospital was conducted. A decision tree was constructed using TreeAge Pro 2018 software. Clear visual axis was the measure of effectiveness. A time horizon of 8 weeks postoperatively was adopted. Both direct and indirect costs were included. RESULTS Fifty-three children were included, 37 in the ISBCS group and 16 in the DSBCS group. ISBCS and DSBCS were equally effective. ISBCS resulted in cost-savings of $3,776 (95% CI:-$4,641 to $12,578) CAD, per patient, from the societal perspective and $2,200 (95% CI:-$5,615 to $10,373) CAD per patient from the health system perspective. CONCLUSION ISBCS was less costly than DSBCS from both societal and health system perspectives while being equally effective.
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Affiliation(s)
- Alexandra Cernat
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Margaret Jamieson
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - RuthAnne Kavelaars
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Sina Khalili
- Ophthalmology and Vision Sciences, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Vishaal Bhambhwani
- Ophthalmology and Vision Sciences, Hospital for Sick Children, Toronto, Ontario, Canada.,Ophthalmology Services, Department of Surgery, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada.,Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Kamiar Mireskandari
- Ophthalmology and Vision Sciences, Hospital for Sick Children, Toronto, Ontario, Canada.,Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Myla E Moretti
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada .,Ontario Child Health Support Unit, Clinical Trials Unit, Hospital for Sick Children, Toronto, Ontario, Canada
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17
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de Oliveira C, Cho E, Kavelaars R, Jamieson M, Bao B, Rehm J. Economic analyses of mental health and substance use interventions in the workplace: a systematic literature review and narrative synthesis. Lancet Psychiatry 2020; 7:893-910. [PMID: 32949521 DOI: 10.1016/s2215-0366(20)30145-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/27/2020] [Accepted: 03/27/2020] [Indexed: 11/25/2022]
Abstract
Mental illness and substance use disorders in the workplace have been increasingly recognised as a problem in most countries; however, evidence is scarce on which solutions provide the highest return on investment. We searched academic and grey literature databases and additional sources for studies that included a workplace intervention for mental health or substance abuse, or both, and that did an economic analysis. We analysed the papers we found to identify the highest yielding and most cost-effective interventions by disorder. On the basis of 56 studies, we found moderate strength of evidence that cognitive behavioural therapy is cost-saving (and in some cases cost-effective) to address depression. We observed strong evidence that regular and active involvement of occupational health professionals is cost-saving and cost-effective in reducing sick leave related to mental health and in encouraging return to work. We identified moderate evidence that coverage for pharmacotherapy and brief counselling for smoking cessation are both cost-saving and cost-effective. Addressing mental health and substance misuse in the workplace improves workers' wellbeing and productivity, and benefits employers' bottom line (ie, profit). Future economic analyses would benefit from the consideration of subgroup analyses, examination of longer follow-ups, inclusion of statistical and sensitivity analyses and discussion around uncertainty, and consideration of potential for bias.
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Affiliation(s)
- Claire de Oliveira
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada; Centre for Health Economics and Hull York Medical School, University of York, York, UK; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
| | - Edward Cho
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - RuthAnne Kavelaars
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Margaret Jamieson
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Buddy Bao
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Epidemiological Research Unit, Technische Universität Dresden, Dresden, Germany; Department of International Health Projects, Institute for Leadership and Health Management, IM Sechenov First Moscow State Medical University, Moscow, Russia
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18
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Craven MP, Goodwin R, Rawsthorne M, Butler D, Waddingham P, Brown S, Jamieson M. Try to see it my way: exploring the co-design of visual presentations of wellbeing through a workshop process. Perspect Public Health 2019; 139:153-161. [PMID: 30955447 PMCID: PMC6595544 DOI: 10.1177/1757913919835231] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
AIMS A 10-month project funded by the NewMind network sought to develop the specification of a visualisation toolbox that could be applied on digital platforms (web- or app-based) to support adults with lived experience of mental health difficulties to present and track their personal wellbeing in a multi-media format. METHODS A participant co-design methodology, Double Diamond from the Design Council (Great Britain), was used consisting of four phases: Discover - a set of literature and app searches of wellbeing and health visualisation material; Define - an initial workshop with participants with lived experience of mental health problems to discuss wellbeing and visualisation techniques and to share personal visualisations; Develop - a second workshop to add detail to personal visualisations, for example, forms of media to be employed, degree of control over sharing; and Deliver - to disseminate the learning from the exercise. RESULTS Two design workshops were held in December 2017 and April 2018 with 13 and 12 experts-by-experience involved, respectively, including two peer researchers (co-authors) and two individual-carer dyads in each workshop, with over 50% of those being present in both workshops. A total of 20 detailed visualisations were produced, the majority focusing on highly personal and detailed presentations of wellbeing. DISCUSSION While participants concurred on a range of typical dimensions of wellbeing, the individual visualisations generated were in contrast to the techniques currently employed by existing digital wellbeing apps and there was a great diversity in preference for different visualisation types. Participants considered personal visualisations to be useful as self-administered interventions or as a step towards seeking help, as well as being tools for self-appraisal. CONCLUSION The results suggest that an authoring approach using existing apps may provide the high degree of flexibility required. Training on such tools, delivered via a module on a recovery college course, could be offered.
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Affiliation(s)
- M P Craven
- NIHR MindTech MedTech Co-operative, Institute of Mental Health, University of Nottingham Innovation Park, Jubilee Campus, Triumph Road, Nottingham NG7 2TU, UK.,Bioengineering Research Group, Faculty of Engineering, University of Nottingham, Nottingham, UK
| | - R Goodwin
- The Oliver Zangwill Centre, Cambridgeshire Community Services NHS Trust, Ely, UK
| | - M Rawsthorne
- NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East Midlands, Institute of Mental Health, Nottingham, UK
| | - D Butler
- NIHR MindTech MedTech Co-operative, Institute of Mental Health, University of Nottingham Innovation Park, Jubilee Campus, Nottingham, UK
| | - P Waddingham
- The Oliver Zangwill Centre, Cambridgeshire Community Services NHS Trust, Ely, UK
| | - S Brown
- NIHR MindTech MedTech Co-operative, Institute of Mental Health, University of Nottingham Innovation Park, Jubilee Campus, Nottingham, UK.,Division of Psychiatry and Applied Psychology, University of Nottingham, Jubilee Campus, Nottingham, UK
| | - M Jamieson
- Institute of Health and Wellbeing, Administration Building, Gartnavel Royal Hospital, Glasgow, UK
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19
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Lawlis T, Jamieson M. Experiencing food insecurity – perspectives from those relying on food charities. Journal of Nutrition & Intermediary Metabolism 2017. [DOI: 10.1016/j.jnim.2017.04.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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20
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Jamieson M, Chen SP, Murphy S, Maracle L, Mofina A, Hill J. Pilot Testing an Intervention on Cultural Safety and Indigenous Health in a Canadian Occupational Therapy Curriculum. J Allied Health 2017; 46:e1-e7. [PMID: 28255598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 12/08/2016] [Indexed: 06/06/2023]
Abstract
First-year Canadian occupational therapy students (n=27) rated their knowledge of and cultural/emotional responses to cultural safety and Indigenous health prior to and following an educational intervention led by a trained Indigenous educator. At post-intervention, students were also asked to comment on their learning experience. Pilot data of 40% of the class were analyzed using nonparametric approaches proposed by Koller and colleagues; qualitative data were explored using conventional methods. The majority of participant ratings reflected a perceived increase in knowledge and cultural/emotional responses, indicative of positive change following intervention. Student comments about their learning were in keeping with the positive findings. Although our sample size was small and our study examined perceived knowledge acquisition, preliminary results were consistent with related literature.
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Affiliation(s)
- Margaret Jamieson
- School of Rehabilitation Therapy, Queen's University, 933 Mayfair Crescent, Kingston, ON K7M 5S5, Canada. Tel 613-634-8042.
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Belton S, Jamieson M, Lawlis T. Food security, access and quality among charitable food programs serving the homeless in the Australian capital territory region. Journal of Nutrition & Intermediary Metabolism 2016. [DOI: 10.1016/j.jnim.2015.12.268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Lawlis T, Knox M, Jamieson M. School canteens: Parents perceptions on transitioning to healthy canteens. Journal of Nutrition & Intermediary Metabolism 2016. [DOI: 10.1016/j.jnim.2015.12.216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Lawlis T, Knox M, Jamieson M. School canteens: A systematic review of stakeholder's perception and use. Journal of Nutrition & Intermediary Metabolism 2016. [DOI: 10.1016/j.jnim.2015.12.313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Abstract
Occupational therapists have agreed that culture can affect therapy by influencing such factors as acceptance of a physical disability, attitude to the sick role, and perceived pain. Occupational therapists however, seem to have ignored the fact that culture also affects factors that influence learning. Learning can be a critical component of paediatric occupational therapy; therefore, it would seem desirable if not necessary for therapists who work with children from different cultural groups to be aware of the cultural variations in those characteristics that influence learning. With this knowledge, therapists would be able to develop strategies that would complement the unique characteristics of each child and ensure effective therapy This paper supports this argument. It introduces therapists to the research literature on the cultural variations in motivational style, cognitive style, human relational style and social interaction and discusses how the literature could be used to develop more effective therapy
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Affiliation(s)
- Margaret Jamieson
- Margaret Jamieson, B.S.R., M.Ed, Ph.D., Assistant Professor, McGill University, Montreal
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Gladding P, Erogbogbo F, Swihart M, Smart K, El-Jack S, Korcyk D, Webster M, Stewart R, Zeng I, Jullig M, Bakeev K, Jamieson M, Kasabov N, Liang L, Hu R, Schliebs S, Gopalan B, Villas-Boas S. Bioengineering silicon quantum dot theranostics using a network analysis of metabolomic and proteomic data in cardiac ischaemia. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.04.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Wang YA, Kovacs G, Sullivan EA, Sullivan EA, Wang YA, Scotland G, Mclernon D, Kurinczuk JJ, Jamieson M, Lyall H, Rajkhowa M, Harrold A, Bhattacharya S, Romundstad LB, Vatten LJ, Sunde A, During VV, Skjaerven R, Romundstad PR, Norgaard L, Bergholt T, Pinborg A. Session 20: Single Embryo Transfer & Art Pregnancy. Hum Reprod 2010. [DOI: 10.1093/humrep/de.25.s1.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Jamieson M, Hutchinson NL, Taylor J, Westlake KP, Berg D, Boyce W. Friendships of Adolescents with Physical Disabilities Attending Inclusive High Schools. Can J Occup Ther 2009. [DOI: 10.1177/000841740907600508] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Adolescents with physical disabilities (PD) report difficulties making friends. Education in inclusive high schools may help to minimize these challenges. Purpose This paper begins to answer the question: What is the nature of the friendships of adolescents with PD attending inclusive high schools? Methods Standard qualitative methods were used to analyze the data of three multi-perspective case studies that included interviews of three adolescents with PD and their nominated friends, parents, and teachers. Based on these analyses, we describe the activities and the quality of the adolescents’ interactions and relationships. Findings Three unique patterns of friendship were identified: an extensive network of friendships, a core group of friends with an avid interest, and few friendships in or out of school. Implications Successful development of friendships among adolescents with and without PD is complex and influenced by personal, environmental, interactional, and relationship factors.
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Affiliation(s)
- Margaret Jamieson
- School of Rehabilitation Therapy, Louise D. Acton Building, Queen's University, Kingston, ON, K7L 3N6
| | | | - Jennifer Taylor
- Faculty of Education, McArthur Hall, Queen's University, Kingston, ON, K7L 3N6
| | - Kelly P. Westlake
- Department of Radiology, 513 Parnassus Avenue S362, University of California San Francisco, San Francisco, CA, 94143-0628
| | - Derek Berg
- McArthur Hall, Queen's University, Kingston, ON, K7L 3N6
| | - Will Boyce
- Centre for Health Services and Policy Research, Abramsky Hall, Queen's University, Kingston, ON, K7L 3N6
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Jamieson M, Baraniuk J. Sitagliptin - Induced Cough, Rhinorrhea and Fatigue: Case Series. J Allergy Clin Immunol 2009. [DOI: 10.1016/j.jaci.2008.12.920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Nelson SM, Yates RW, Lyall H, Jamieson M, Traynor I, Gaudoin M, Mitchell P, Ambrose P, Fleming R. Anti-Mullerian hormone-based approach to controlled ovarian stimulation for assisted conception. Hum Reprod 2008; 24:867-75. [DOI: 10.1093/humrep/den480] [Citation(s) in RCA: 259] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Fisher K, Hussain R, Jamieson M, Minichiello V. Syphilis and disadvantage in rural communities. Int J STD AIDS 2008; 19:215. [DOI: 10.1258/ijsa.2007.007310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- K Fisher
- University New England, School of Health, Armidale, University of Newcastle, Newcastle, NSW, Australia
- Greater Southern Area Health Service, University of Newcastle, Newcastle, NSW, Australia
| | - R Hussain
- Greater Southern Area Health Service, University of Newcastle, Newcastle, NSW, Australia
| | - M Jamieson
- Greater Southern Area Health Service, University of Newcastle, Newcastle, NSW, Australia
- University Department of Rural Health, University of Newcastle, Newcastle, NSW, Australia
| | - V Minichiello
- University New England, School of Health, Armidale, University of Newcastle, Newcastle, NSW, Australia
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Jamieson M, Krupa T, O'Riordan A, O'Connor D, Paterson M, Ball C, Wilcox S. Developing empathy as a foundation of client-centred practice: evaluation of a university curriculum initiative. Can J Occup Ther 2006; 73:76-85. [PMID: 16680911 DOI: 10.2182/cjot.05.0008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND The foundation of client-centred practice is the therapist's capacity to view the world through the client's eyes and to develop an understanding of the lived experience of disability. PURPOSE This paper describes the evaluation of an educational initiative promoting student empathy to the lived experience of disability. METHODS Pairs of first-year occupational therapy students visited adults with disabilities who shared their knowledge and experience of living with a disability. Students reflected on their visits in journals, which were later analyzed using pattern matching. FINDINGS Students appeared to appreciate the co-existence of health and disorder and demonstrated a holistic understanding of living with a disability. Little attention was focused on cultural and institutional environments. Students struggled to define the nature of their relationship with their tutors. Practice Implications. The evaluation confirmed our belief that this educational initiative could facilitate student empathy, consistent with critical features of client-centred practice.
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Abstract
OBJECTIVES To assess injury patterns and incidence in the Australian Wallabies rugby union players from 1994 to 2000. To compare these patterns and rates with those seen at other levels of play, and to see how they have changed since the beginning of the professional era. METHODS Prospective data were recorded from 1994 to 2000. All injuries to Australian Wallabies rugby union players were recorded by the team doctor. An injury was defined as one that forced a player to either leave the field or miss a subsequent game. RESULTS A total of 143 injuries were recorded from 91 matches. The overall injury rate was 69/1000 player hours of game play. The injury rates in the periods before (1994-1995) and after (1996-2000) the start of the professional era were 47/1000 player hours and 74/1000 player hours respectively. The lock was the most injured forward, and the number 10 the most injured back. Most injuries were soft tissue, closed injuries (55%), with the head being the most commonly injured region (25.1%). The phase of play responsible for most injuries was the tackle (58.7%). Injuries were more likely to occur in the second half of the game, specifically the third quarter (40%). The vast majority of injuries were acute (90%), with the remainder being either chronic or recurrent. CONCLUSIONS Injury rate increases at higher levels of play in rugby union. Injury rates have increased in the professional era. Most injuries are now seen in the third quarter of the game, a finding that may reflect new substitution laws. There is a need for standardised collection of injury data in rugby union.
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Affiliation(s)
- A Bathgate
- Eastern Suburbs Sports Medicine Centre, Sydney 2002, Australia.
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Minichiello V, Mariño R, Browne J, Jamieson M, Peterson K, Reuter B, Robinson K. Male sex workers in three Australian cities: socio-demographic and sex work characteristics. J Homosex 2001; 42:29-51. [PMID: 11991565 DOI: 10.1300/j082v42n01_02] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
This article describes the socio-demographic and sex work characteristics of sex workers in Sydney, Melbourne, and Brisbane. A total of 185 male sex workers completed the questionnaire component of the study. The results of this study serve to debunk many of the myths surrounding the popular view of the male sex worker (MSW). The respondents in this study were on average 27 years old, and the majority had completed secondary education, with 30% having gained some form of tertiary qualification. Interestingly, those MSWs who had not completed secondary education were mostly street workers and were generally aged under 25 years. The majority of sex workers lived in rented accommodation, with only 6% reporting to be homeless. Half of all respondents identified as being "gay," 31% as "bisexual" and 5.5% as "straight." More than half of the respondents were in a permanent relationship. Only 7.3% of this group reported using heroin daily, although the majority consumed alcohol, tobacco, marijuana, and ecstasy. The majority of sex workers had been in the profession for less than six months, although some had been working in the industry for more than ten years. Most of the sex workers reported having taken an HIV test and a preference to offer safer sex. The article highlights ways in which the work context of MSW can be better understood and supported by education and public policy programs.
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Affiliation(s)
- V Minichiello
- School of Health, University of New England, Armidale, New South Wales, Australia
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Jamieson M. Nursing's feminine perspective. Creat Nurs 2000; 5:3. [PMID: 10732583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
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Minichiello V, Mariño R, Browne J, Jamieson M, Peterson K, Reuter B, Robinson K. A profile of the clients of male sex workers in three Australian cities. Aust N Z J Public Health 1999; 23:511-8. [PMID: 10575774 DOI: 10.1111/j.1467-842x.1999.tb01308.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE This paper describes the profile of clients as reported by 186 male sex workers in three Australian cities. METHOD The data were collected using a diary which was completed after each commercial sexual encounter with a male client over a two-week period. The data reported in this study are based on reports from 2,088 sex encounters and a profile of 1,776 clients. RESULTS The findings reveal, for example, that the most common source used for recruiting clients was advertisements, followed by escort agencies, although there were differences between the three cities; the majority of the clients were in their 40s but clients of street workers were younger; clients were most often classified as 'middle class', with differences by source of client recruitment; less than half the clients were identified as being gay and a significant number were identified as bisexual or straight; alcohol and drug use took place in a small percentage of the encounters; most workers had some information about their clients, such as occupation and home number; violence was infrequent; and unsafe sex was requested in a minority of the encounters. CONCLUSION Overall, the results reveal that clients of male sex workers are a highly heterogeneous group. IMPLICATIONS The paper highlights a number of issues which can further promote safety and public accountability in male sex work.
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Affiliation(s)
- V Minichiello
- School of Health, University of New England, Armidale, New South Wales.
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Abstract
This study explored the attitudes of south Indian Community Based Rehabilitation (CBR) workers towards people with disabilities. The research presents a demographic profile of the CBR worker, provides a measure of their attitudes towards people with disabilities, and investigates the factors that influence the formation of these attitudes, in particular the role of CBR education programmes. A questionnaire and an attitude measurement instrument, specifically developed for the Indian context, provided descriptive data. Interviews provided background information on south Indian culture and CBR educational programmes. Analysis of the data revealed that CBR workers in south India tend to be young, female and lacking in work experience. They have positive attitudes towards people with disabilities, which are influenced by their amount of education. CBR educational programmes appeared to have little effect on workers' attitudes, perhaps reflecting a lack of educational strategies directed specifically at attitude development.
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Affiliation(s)
- J Paterson
- School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
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Thomas N, Goodacre R, Timmins É, Mitchell P, Jamieson M, Yates R, Fleming R. P-066. Fourier transform infra-red (FT-IR) spectroscopy of follicular fluids from antral follicles. Hum Reprod 1999. [DOI: 10.1093/humrep/14.suppl_3.173-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
OBJECTIVE To investigate the efficacy of aromatherapy in the treatment of patients with alopecia areata. DESIGN A randomized, double-blind, controlled trial of 7 months' duration, with follow-up at 3 and 7 months. SETTING Dermatology outpatient department. PARTICIPANTS Eighty-six patients diagnosed as having alopecia areata. INTERVENTION Eighty-six patients were randomized into 2 groups. The active group massaged essential oils (thyme, rosemary, lavender, and cedarwood) in a mixture of carrier oils (jojoba and grapeseed) into their scalp daily. The control group used only carrier oils for their massage, also daily. MAIN OUTCOME MEASURES Treatment success was evaluated on sequential photographs by 2 dermatologists (I.C.H. and A.D.O.) independently. Similarly, the degree of improvement was measured by 2 methods: a 6-point scale and computerized analysis of traced areas of alopecia. RESULTS Nineteen (44%) of 43 patients in the active group showed improvement compared with 6 (15%) of 41 patients in the control group (P = .008). An alopecia scale was applied by blinded observers on sequential photographs and was shown to be reproducible with good interobserver agreement (kappa = 0.84). The degree of improvement on photographic assessment was significant (P = .05). Demographic analysis showed that the 2 groups were well matched for prognostic factors. CONCLUSIONS The results show aromatherapy to be a safe and effective treatment for alopecia areata. Treatment with these essential oils was significantly more effective than treatment with the carrier oil alone (P = .008 for the primary outcome measure). We also successfully applied an evidence-based method to an alternative therapy.
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Affiliation(s)
- I C Hay
- Department of Dermatology, Aberdeen Royal Infirmary, Foresterhill, Scotland.
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Jamieson M. Politics as relationships. Creat Nurs 1998; 4:3-4. [PMID: 9775781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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Jamieson M. Grass roots efforts. Nurses involved in the political process. Creat Nurs 1998; 4:7-9, 14, 16. [PMID: 9775783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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Jamieson M, Griffiths R, Jayasuriya R. Developing outcomes for community nursing: the Nominal Group Technique. AUST J ADV NURS 1998; 16:14-9. [PMID: 9807278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The focus of healthcare has shifted from examining the process (what is done) to measuring what is achieved (outcomes). While various tools have been developed to measure inpatient outcomes, there is no specific measure of outcomes for community-based care. A collaborative research project involving the University of Wollongong and the Illawarra Area Health Service has been established to address the gap in patient reporting and evaluation. This paper describes the initial phase of a research project using the Nominal Group Technique (NGT) to develop outcome measures appropriate to community health. The NGT is a technique that uses groups of stake holders to obtain information. Nominal groups are unlike focus groups in that NGT seek responses to predetermined and structured questions. Other aspects of outcome measurement, such as casenote audits and addressing the client's perspective are being considered later in the project. This paper focuses largely upon the process of using the NGT to develop outcomes and to encourage the participation in the research project by community nurses. It was vital from the outset to generate a sense of ownership of both the process and the findings and the NGT was seen as a process that would enable both the development of outcome statements and active participation.
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Affiliation(s)
- M Jamieson
- Department of Health Studies, University of New England, Armidale, Australia
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Birnie D, Tometzki A, Curzio J, Houston A, Hood S, Swan L, Doig W, Wilson N, Jamieson M, Pollock J, Hillis WS. Outcomes of transposition of the great arteries in the ear of atrial inflow correction. Heart 1998; 80:170-3. [PMID: 9813565 PMCID: PMC1728792 DOI: 10.1136/hrt.80.2.170] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To examine long term morbidity and mortality following atrial inflow corrective procedures for transposition of the great arteries (TGA) and to investigate factors that influence morbidity and mortality. DESIGN Retrospective cohort study from a single centre. SETTING Cardiology and cardiothoracic surgical unit in a large tertiary referral centre. PATIENTS All 130 patients who had TGA diagnosed between August 1972 and May 1988 and were considered suitable for atrial inflow correction; 109 of these underwent surgery (operative cohort: 84 Mustard operations and 25 Senning operations); 95 survived to hospital discharge (hospital surviving cohort). MAIN OUTCOME MEASURES Death and cardiac events. RESULTS There were relatively good long term results from atrial inflow correction for TGA with 5, 10, and 15 year survivals of 77.3%, 75.9%, and 71.3%. However, there was an appreciable incidence of late cardiac death and events, with 5, 10, and 15 year cardiac event-free survivals of 74.5%, 67.1%, and 39.6%. Supraventricular tachycardia was the only significant risk factor for late cardiac death (relative risk 8.72, 95% confidence interval, 2.86 to 26.64). Senning patients had better event-free survival (p = 0.04). CONCLUSIONS Atrial inflow correction for TGA has a reasonably good 15 year survival (71.3%), but there is an appreciable incidence of late cardiac deaths and events (15 year event-free survival 39.6%). The Senning procedure is preferable to the Mustard procedure for cases unsuitable for arterial switching.
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Affiliation(s)
- D Birnie
- Department of Medicine and Therapeutics, Glasgow University, Western Infirmary, UK
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Jamieson M, Paterson J, Krupa T, Topping A. Determining the effectiveness of thresholds, an intervention to enhance the career development of young people with physical disabilities. Work 1998; 11:43-55. [PMID: 24441482 DOI: 10.3233/wor-1998-11106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
People with disabilities have lower work force participation rates than the general public. One factor that has been attributed to this is a lack of vocational programs for adolescents with disabilities. Thresholds is a vocational program designed to enhance the career development strategies of adolescents with physical disabilities. In a three-part series, participants reflect on who they are, clarify their career future and explore the world of work, and test out strategies for investigating career opportunities and addressing obstacles to career success. Following pilot testing, Thresholds was field tested with two groups of adolescents in two urban centres in Canada. Findings suggested that this program could enhance the vocational decision-making abilities and self-appraisal skills of participants. Entry level characteristics of participants were critical in determining the extent of change. Feedback encouraged modifications to make the program more useful and effective.
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Affiliation(s)
- M Jamieson
- School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, ON, K7L 3N6 Canada
| | - J Paterson
- School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, ON, K7L 3N6 Canada
| | - T Krupa
- School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, ON, K7L 3N6 Canada
| | - A Topping
- School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, ON, K7L 3N6 Canada
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Weinreb M, Jamieson M, Fulton N, Chen Y, Johnson JX, Bremer J, Smith C, Baucom J. Operational calibration of Geostationary Operational Environmental Satellite-8 and-9 imagers and sounders. Appl Opt 1997; 36:6895-6904. [PMID: 18259561 DOI: 10.1364/ao.36.006895] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
We describe the operational in-orbit calibration of the Geostationary Operational Environmental Satellite (GOES)-8 and-9 imagers and sounders. In the infrared channels the calibration is based on observations of space and an onboard blackbody. The calibration equation expresses radiance as a quadratic in instrument output. To suppress noise in the blackbody sequences, we filter the calibration slopes. The calibration equation also accounts for an unwanted variation of the reflectances of the instruments' scan mirrors with east-west scan position, which was not discovered until the instruments were in orbit. The visible channels are not calibrated, but the observations are provided relative to the level of space and are normalized to minimize east-west striping in the images. Users receive scaled radiances in a GOES variable format (GVAR) data stream. We describe the procedure users can apply to transform GVAR counts into radiances, temperatures, and mode-A counts.
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Affiliation(s)
- M Weinreb
- National Oceanic and Atmospheric Administration-National Environmental Satellite, Data, and Information Service, Washington, DC 20233, USA
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Jamieson M. Oral contraceptive pill method failures. N Z Med J 1996; 109:171. [PMID: 8657373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Jamieson M. Nurse-managed community healthcare for seniors. Interview by Marie Manthey. Creat Nurs 1996; 2:6-9. [PMID: 9025386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Abstract
The risk of administering thrombolysis to patients with suspected myocardial infarction who subsequently do not sustain an infarct, but develop complications associated with thrombolysis is of concern to all physicians. The objective of this study was to ascertain the effect of altering the criteria for the administration of thrombolysis on the number of patients who received thrombolysis in the absence of infarction. During 1990 and 1992 details of all admissions with chest pain were recorded. During 1991 the policy for the administration of thrombolysis was altered so that only patients with ST elevation were eligible. A total of 1473 patients were admitted with chest pain in 1990 and 1967 in 1992. Of the patients admitted in 1990, 663 (45%) had confirmed infarction of whom 378 (57.0%) received thrombolysis. In 1992, 855 (43%) were admitted with infarction and of these 450 (52.6%) had thrombolytic therapy. 118 patients had no evidence of myocardial infarction, but received thrombolysis. 91 (77.1%) were admitted in 1990 and 27 (22.9%) in 1992 (P < 0.01). Of these only 24 (20%) subjects had ST elevation or bundle branch block on the admission electrocardiograph and 41 (35%) had normal tracings. Four (3%) subjects had serious complications of whom one (0.8%) died. The implementation of ECG criteria resulted in a significant reduction in the number of patients without infarction who received thrombolysis, but did not significantly alter the rate of thrombolysis in those with definite myocardial infarction.
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Affiliation(s)
- J N Adams
- Cardiac Department, Aberdeen Royal Infirmary, Foresterhill, UK
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Jamieson M. Diabetes. Catering for youth. Nurs N Z 1995; 1:20. [PMID: 7656172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Abstract
OBJECTIVE To determine whether women with myocardial infarction are treated differently from men of the same age and to assess the effect of changes in the coronary care unit admission policy. DESIGN Clinical audit. SETTING The coronary care unit and general medical wards of a teaching hospital. In 1990 the age limit for admission to coronary care was 65 years. This age limit was removed in 1991. PATIENTS 539 female and 977 male patients admitted with myocardial infarction between 1990 and 1992. MAIN OUTCOMES Admission to the coronary care unit, administration of thrombolysis, and in-hospital mortality. RESULTS 409 men and 254 women were admitted with myocardial infarction in 1990 and 568 men and 285 women in 1992. Removal of the age limit for admission to the coronary care unit resulted in an increase in the numbers of both sexes admitted with myocardial infarction. In both years, however, proportionately more men with infarction were admitted to coronary care: 226 men (55%) and 96 women (38%) (P < 0.01) (95% CI 7 to 28) in 1990 and 459 men (81%) and 200 women (70%) (P < 0.01) (%CI 2 to 19) in 1992. Some 246 men (60%) and 133 women (52%) with infarction (P < 0.01) received thrombolytic treatment in 1990 compared with 319 men (56%) and 130 women (46%) (P < 0.01) in 1992. The mean age of women sustaining a myocardial infarction was significantly greater in both years studied. In 1992 a total of 78 men (7%) and 34 women (4%) (P < 0.05) admitted with chest pain underwent cardiac catheterisation before discharge from hospital. CONCLUSIONS Differences in admission rates to the coronary care unit and the rate of thrombolysis between the sexes can be explained by the older age of women sustaining infarction. The application of age limits for admission to coronary care or administration of thrombolysis places elderly patients at a disadvantage. As women sustain myocardial infarctions at an older age they are placed at a greater disadvantage.
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Affiliation(s)
- J N Adams
- Cardiac Department, Aberdeen Royal Infirmary, Foresterhill
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