The Effects of Lavandula Angustifolia Mill Infusion on Depression in Patients Using Citalopram: A comparison Study

Background: Many herbs have been used to treat psychiatric disorders including anxiety and depression in traditional medicine. Objectives: This study was carried out to determine the effect of using Lavandula angustifilia infusion on depression in patients taking Citalopram. Patients and Methods: Among all patients referred to the Hajar Hospital psychiatric clinic, Shahrekord, Iran, 80 patients who met the criteria of major depression according to the structured interviews and the Hamilton questionnaire for Depression were included in the study. They were randomly assigned into two groups of experimental treatment group and standard treatment group at this study. In standard treatment group, the patients were given Citalopram 20 mg. In experimental treatment group, the patients took 2 cups of the infusion of 5 g dried Lavandula angustifilia in addition to tablet Citalopram 20 mg twice a day. The patients were followed up for four and eight weeks of the study onset using Hamilton Scale questionnaire and treatment side effects form. Data were analyzed using student t-test, pair t-test and chi square. Results: After four weeks of the trial onset, the mean depression score according to the Hamilton Scale for Depression was 17.5 +/- 3.5 in the standard treatment group and 15.2 +/- 3.6 in the experimental treatment group (P < 0.05). After eight weeks, it was 16.8 +/- 4.6 and 14.8 +/- 4 respectively (P < 0.01). In addition, the most commonly observed adverse effects were nausea (12.8 %) and confusion (10%). In terms of side effects, there were no significant differences between two groups. Conclusions: Considering the results of this study, Lavandula angustifilia infusion has some positive therapeutic effects on depressed patients most importantly decreases mean depression score and might be used alone or as an adjunct to other anti-depressant drugs

Barriers to Opioid Deprescription in Rural Newfoundland and Labrador: Findings from Pilot Interviews with Rural Family Physicians

Background: Medical doctors in Canada have a lack of education and understanding on how to safely prescribe opioids. Rural areas and Aboriginal populations have been identified as being at greater risk for opioid misuse. The purpose of this pilot project is to investigate barriers to rural physicians deprescribing opioids for noncancer pain in rural NL to better understand this under-researched topic. Methods: Semi-structured interviews were conducted over the phone and audio recorded. The audio recordings were transcribed using Microsoft Word then thematically analysed. The themes were discussed with another team member to reach a consensus. Results: Three broad themes were identified including system related, provider related and patient related barriers with sub-themes under each. Interpretation: These preliminary results identified many barriers including lack of resources in rural areas, lack of provider education and lack of patient understanding of the mechanisms of opioid prescriptions that fit into three broad categories. Barriers not previously identified in the literature were acknowledged including lack of pain management resources in rural communities as well as patient misunderstanding opioid medication pharmacology. These results are preliminary and further research is required

Low density lipoprotein cholesterol control status among Canadians at risk for cardiovascular disease: findings from the Canadian Primary Care Sentinel Surveillance Network Database

Background To determine the prevalence of uncontrolled LDL-C in patients with high cardiovascular disease (CVD) risks across Canada and to examine its related factors. Methods Non-pregnant adults >20 years-old, who had a lipid test completed between January 1, 2009 and December 31, 2011 and were included in the Canadian Primary Care Surveillance Network (CPCSSN) database were studied. The Framingham-Risk-Score was calculated to determine the risk levels. A serum LDL-C level of >2.0 mmol/L was considered as being poorly controlled. Patients with a previous record of a cerebrovascular accident, peripheral artery disease, or an ischemic heart disease were regarded as those under secondary prevention. Logistic regression modeling was performed to examine the factors associated with the LDL-C control. Results A total of 6,405 high-risk patients were included in the study and, of this population, 68 % had a suboptimal LDL-C, which was significantly associated with the female gender (OR: 3.26; 95 % CI: 2.63–4.05, p < 0.0001) and no medication therapy (OR: 6.31, 95 % CI: 5.21–7.65, p < 0.0001). Those with comorbidities of diabetes, hypertension, obesity, and smokers had a better LDL-C control. Rural residents (OR: 0.64, 95 % CI: 0.52–0.78, p < 0.0001), and those under secondary prevention (OR: 0.42; 95 % CI: 0.35–0.51, p < 0.0001), were also more likely to have a better LDL-C control. Conclusion A high proportion of high-cardiac risk patients in Canadian primary care settings have suboptimal LDL-C control. A lack of medication therapy appears to be the major contributing factor to this situation

Dowsing for Knowledge: Probing the Depth of Arsenic Awareness in Rural Newfoundland to Effect Change in Policy and Health Outcomes

Background: Arsenic is an odourless, colourless and tasteless carcinogen that can contaminate well-water. Research in Nova Scotia suggests that well-owners misunderstand the issues and risks related to arsenic and do not take necessary precautions. Rationale: Given that no similar study has occurred in Newfoundland, we examined knowledge gaps about arsenic and related water safety issues among well owners in three rural Newfoundland jurisdictions affected by arsenic (Cormack, New World Island, Gander Bay) and one control area unaffected by arsenic (Codroy Valley). Research Methodology & Approach: We mailed 1380 semi-structured surveys to the four regions, aiming to collect 100 surveys. Results: We received 247 responses (17.8% response rate). A very low response rate from Cormack (n=2) meant the community could not be included in most analyses. We conducted descriptive analyses and Chi Squares in SPSS. Discussion: While the majority of respondents in New World Island had previously tested their water for arsenic, most in Gander Bay and the Codroy Valley had not. Some respondents listed ServiceNL as their go-to tester for arsenic despite the fact that the organization can only test for coliforms, and some respondents also mentioned using sensory cues and ineffective purification strategies (e.g. boiling, using a Brita filter). Conclusion & Recommendations: This study revealed encouraging and concerning results that are informative for both the public and policymakers. We recommend the provincial government develop a new online well-water safety resource, devise strategies to clarify the limitations of ServiceNL water testing, and facilitate citizens’ access to affordable water tests for arsenic

Primary health care services for patients with chronic disease in Newfoundland and Labrador: a descriptive analysis

Background: Newfoundland and Labrador has a rapidly aging population, much of which is rural, with poor health behaviours and high rates of chronic disease. These factors contribute to a unique challenge in health care delivery. Our aim was to describe the availability of publicly funded primary health care programs and services delivered by regional health authorities across the province. Methods: We performed a descriptive analysis using data from a cross-sectional provincial primary health care survey deployed across Newfoundland and Labrador. Survey data included location, disease-specific chronic disease prevention programming, types of routine primary care, allied health prevention and promotion, chronic disease prevention and management services, and team-based care. The mode of service delivery was identified for most programs and services. Results: Surveys were returned by 153 sites (99.4% response rate). Family physician services were available at 66% of sites (95/145) and nurse practitioner services were available at 51% (74/144) of sites. Many sites offered screening for cervical (60%, 86/144), colon (42%, 59/142) and prostate cancers (43%, 60/141), in addition to various self-management and education services. Allied health services, such as clinical nutrition counselling (47%, 68/46) and occupational therapy (46%, 68/147), were available at many sites. Available health care services were most often offered by on-site staff, and few sites provided primary health care services through telehealth. Overall, rural sites offered a greater variety of services than urban sites. Interpretation: Considerable variability exists in the range of primary health care services available across Newfoundland and Labrador, with limited delivery of some programs and services. Future research should examine how availability of programs and services affects health outcomes and costs

Management of Malignant Pleural Effusion with ASEPT® Pleural Catheter: Quality of Life, Feasibility, and Patient Satisfaction

Objective. The PleurX® IPC system has been used extensively in the past. Over time, management of MPE with the PleurX system can be costly. The new ASEPT pleural catheter, through advantages in design, may ultimately show cost savings. The primary outcome of this study was to evaluate safety and efficacy of the ASEPT system. Method. This single centre, prospective study enrolled 50 patients with MPE, who were followed for as long as they were alive with a catheter. Quality of Life (QoL) was assessed before, at 2 weeks, and 6 weeks after ASEPT catheter insertion using the EORTC QLQ-C30 and LC13 questionnaires. Ease of catheter use and complications were reported by physician and community nurses. Results. 50 patients with MPE with a mean age of 64.5±1.9, BDI of 2.8±0.9, and ECOG score of 3.0±0.7 were recruited. No immediate or long-term complications were reported during the study period. Compared to precatheter insertion, global health status (−18, p<0.001), QLQ-C30 dyspnea (−39, p<0.00001), and LC13 dyspnea (−11, p<0.0005) significantly improved at 2 and 6 weeks after intervention. Provider surveys indicated favourable ease of use. Conclusion. The new ASEPT catheter offers a safe and effective option for the management of MPE

Family physicians’ roles in long-term care homes and other congregate residential care settings during the COVID-19 pandemic: a qualitative study

Context: The COVID-19 pandemic disproportionally affected long-term care (LTC) homes and other community-based congregate residential care settings. Although family physicians (FPs) play important roles in the care of residents in LTC homes, provincial pandemic plans make few references to their specific roles in LTC. Objective: To examine the experiences of FPs providing care in LTC homes and other congregate care settings in Canada during the first year of the COVID-19 pandemic (2020–2021). Methods: As part of a multiple case study, we conducted semi-structured qualitative interviews with FPs across four Canadian regions. Interviews were transcribed, and a thematic analysis approach was employed. Findings: Twenty-one of the 68 FPs interviewed discussed providing care in congregate residential settings, including LTC. We identified three major themes: 1) the roles of FPs in community-based congregate residential care settings during a pandemic, 2) modification of the delivery of routine care, and 3) special workforce considerations in pandemic response for community-based congregate residential care settings. Limitations: We interviewed FPs in four Canadian jurisdictions between October 2020 and June 2021; findings may not be generalisable to later pandemic stages or to other provinces. Our recruitment strategy did not specifically target FPs who worked in different types of congregate residential care facilities; further research is needed to examine these settings in greater depth. Implications: FPs have a unique understanding of the populations they serve and are well suited to plan and implement community-adaptive procedures. Future pandemic plans should implement LTC-related FP roles during the pre-pandemic stage of a pandemic response

Six-year time-trend analysis of dyslipidemia among adults in Newfoundland and Labrador: findings from the laboratory information system between 2009 and 2014

Background: Dyslipidemia, an increased level of total cholesterol (TC), triglycerides (TG), low-density-lipoprotein cholesterol (LDL-C) and decreased level of high-density-lipoprotein cholesterol (HDL-C), is one of the most important risk factors for cardiovascular disease. We examined the six-year trend of dyslipidemia in Newfoundland and Labrador (NL), a Canadian province with a historically high prevalence of dyslipidemia. Methods: A serial cross-sectional study on all of the laboratory lipid tests available from 2009 to 2014 was performed. Dyslipidemia for every lipid component was defined using the Canadian Guidelines for the Diagnosis and Treatment of Dyslipidemia. The annual dyslipidemia rates for each component of serum lipid was examined. A fixed and random effect model was applied to adjust for confounding variables (sex and age) and random effects (residual variation in dyslipidemia over the years and redundancies caused by individuals being tested multiple times during the study period). Results: Between 2009 and 2014, a total of 875,208 records (mean age: 56.9 ± 14.1, 47.6% males) containing a lipid profile were identified. The prevalence of HDL-C and LDL-C dyslipidemia significantly decreased during this period (HDL-C: 35.8% in 2009 [95% CI 35.5-36.1], to 29.0% in 2014 [95% CI: 28.8-29.2], P = 0.03, and LDL-C: 35.2% in 2009 [95% CI: 34.9-35.4] to 32.1% in 2014 [95% CI: 31.9-32.3], P = 0.02). A stratification by sex, revealed no significant trend for any lipid element in females; however, in men, the previously observed trends were intensified and a new decreasing trend in dyslipidemia of TC was appeared (TC: 34.1% [95% CI 33.7-34.5] to 32.3% [95%CI: 32.0-32.6], p < 0.02, HDL-C: 33.8% (95%CI: 33.3-34.2) to 24.0% (95% CI: 23.7-24.3)], P < 0.01, LDL-C: 32.9% (95%CI:32.5-33.3) to 28.6 (95%CI: 28.3-28.9), P < 0.001). Adjustment for confounding factors and removing the residual noise by modeling the random effects did not change the significance. Conclusion: This study demonstrates a significant downward trend in the prevalence of LDL-C, HDL-C, and TC dyslipidemia, exclusively in men. These trends could be the result of males being the primary target for cardiovascular risk management

A systematic review of reviews: Recruitment and retention of rural family physicians

The recruitment and retention of family physicians in rural and remote communities has been the topic of many reviews; however, a lack of consensus among them with regard to which factors are most influential makes it difficult for setting priorities. We performed a systematic review of reviews which helped to establish an overall conclusion and provided a set of fundamental influential factors, regardless of the consistency or generalisability of the findings across reviews. This review also identified the knowledge gaps and areas of priority for future research. Methods: A literature search was conducted to find the review articles discussing the factors of recruitment or retention of rural family physicians. Results were screened by two independent reviewers. The number of times that each factor was mentioned in the literature was counted and ordered in terms of frequency. Results: The literature search identified 84 systematic reviews. Fourteen met the inclusion criteria, from which 158 specific factors were identified and summarised into 11 categories: personal, health, family, training, practice, work, professional, pay, community, regional and system/legislation. The three categories referenced most often were training, personal and practice. The specific individual factors mentioned most often in the literature were 'medical school characteristics', 'longitudinal rural training' and 'raised in a small town'. Conclusion: The three most often cited categories resemble three distinct phases of a family physician's life: pre-medical school, medical school and post-medical school. To increase the number of physicians who choose to work in rural practice, strategies must encompass and promote continuity across all three of these phases. The results of this systematic review will allow for the identification of areas of priority that require further attention to develop appropriate strategies to improve the number of family physicians working in rural and remote locations

Family physicians\u27 responses to personal protective equipment shortages in four regions in Canada: a qualitative study.

BACKGROUND: Despite well-documented increased demands and shortages of personal protective equipment (PPE) during previous disease outbreaks, health systems in Canada were poorly prepared to meet the need for PPE during the COVID-19 pandemic. In the primary care sector, PPE shortages impacted the delivery of health services and contributed to increased workload, fear, and anxiety among primary care providers. This study examines family physicians\u27 (FPs) response to PPE shortages during the first year of the COVID-19 pandemic to inform future pandemic planning. METHODS: As part of a multiple case study, we conducted semi-structured qualitative interviews with FPs across four regions in Canada. During the interviews, FPs were asked to describe the pandemic-related roles they performed over different stages of the pandemic, facilitators and barriers they experienced in performing these roles, and potential roles they could have filled. Interviews were transcribed and a thematic analysis approach was employed to identify recurring themes. For the current study, we examined themes related to PPE. RESULTS: A total of 68 FPs were interviewed across the four regions. Four overarching themes were identified: 1) factors associated with good PPE access, 2) managing PPE shortages, 3) impact of PPE shortages on practice and providers, and 4) symbolism of PPE in primary care. There was a wide discrepancy in access to PPE both within and across regions, and integration with hospital or regional health authorities often resulted in better access than community-based practices. When PPE was limited, FPs described rationing and reusing these resources in an effort to conserve, which often resulted in anxiety and personal safety concerns. Many FPs expressed that PPE shortages had come to symbolize neglect and a lack of concern for the primary care sector in the pandemic response. CONCLUSIONS: During the COVID-19 pandemic response, hospital-centric plans and a lack of prioritization for primary care led to shortages of PPE for family physicians. This study highlights the need to consider primary care in PPE conservation and allocation strategies and to examine the influence of the underlying organization of primary care on PPE distribution during the pandemic