12 research outputs found
Modern work patterns of “classic” versus millennial family doctors and their effect on workforce planning for community-based primary care: a cross-sectional survey
Background:
There are ongoing accessibility challenges in primary care in British Columbia, Canada, with 17% of the population not having a regular source of care. Anecdotal evidence suggests that physicians are moving away from a community-based comprehensive practice model, which could contribute to shortages. Thus, we aimed to identify and describe how family physicians are currently organizing their primary care practices in a large health region in British Columbia and to examine differences between newer graduates and more established physicians.
Methods:
Data for this cross-sectional study were drawn from an annual physician privileging survey. N = 1017 physicians were invited to participate. We categorized practice style into five distinct groupings and compared features across respondent groups, including personal and practice location characteristics, hospital and teaching work, payment and appointment characteristics, and scope of practice. We discuss the implications of styles of practice and associated characteristics on health workforce policy and planning.
Results:
We received responses from 525 (51.6%) physicians. Of these, 355 (67.6%) reported doing at least some community-based primary care. However, only 112 (21.3%) provided this care full time. Most respondents supplemented community-based work with part-time hours in focused practice, hospitals, or inpatient facilities. We found diversity in the scope and style of practice across practice models. Compared to established physicians, new graduates (in practice less than 10 years) work more weekly hours (more patient care, and paperwork in particular). However, we found no difference between new and established physicians in the odds of providing any or full-time community-based primary care.
Conclusions:
Despite a lack of formalized structural reform in British Columbia’s primary care system, most physicians are finding alternative ways to model their practice and shifting away from work at single-location, community-based clinics. This shift challenges assumptions that are relied on for workplace planning that is intended to ensure adequate access to longitudinal, community-based family medicine.Medicine, Faculty ofNon UBCFamily Practice, Department ofReviewedFacult
Relationship between self-reported exposure to passive smoking and maternal urinary cotinine level in pregnant women
Background and Objective: Passive smoking during pregnancy increases the risk of pregnancy complications. The purpose of this study was to determine the relationship between self-reported exposure to passive smoking and urinary cotinine level of the pregnant women. Materials and Methods: This cross-sectional study was done on 108 non-smoker pregnant women referred to Arash hospital in Tehran, Iran for delivery during 2010. A questionnaire including smoke exposure during pregnancy was completed for all the participants. Urine samples were collected from the mothers in the delivery room. The urinary cotinine levels was measured by ELISA method. Data were analyzed using SPSS-16, Student t-test, Chi-Square and one-way ANOVA tests. The Kappa test was used to evaluate the variability of mothers which report exposure to passive smoking with maternal urinary cotinine level. Results: The geometric mean cotinine of the maternal urine in the exposed group (27.4±29.96 ng/ml) was significantly higher than the non-exposed group (0.75±2.29 ng/ml) (P<0.05). There was a significant association between maternal reports of cigarette smoke exposure and urinary cotinine (Kappa=96%) (P<0.05). Conclusion: This study indicated that there is a relationship between maternal self-reporting and urinary cotinine level during pregnancy
Genome-wide Linkage Analysis of a Parkinsonian-Pyramidal Syndrome Pedigree by 500 K SNP Arrays
Robust SNP genotyping technologies and data analysis programs have encouraged researchers in recent years to use SNPs for linkage studies. Platforms used to date have been 10 K chip arrays, but the possible value of interrogating SNPs at higher densities has been considered. Here, we present a genome-wide linkage analysis by means of a 500 K SNP platform. The analysis was done on a large pedigree affected with Parkinsonian-pyramidal syndrome (PPS), and the results showed linkage to chromosome 22. Sequencing of candidate genes revealed a disease-associated homozygous variation (R378G) in FBXO7. FBXO7 codes for a member of the F-box family of proteins, all of which may have a role in the ubiquitin-proteosome protein-degradation pathway. This pathway has been implicated in various neurodegenerative diseases, and identification of FBXO7 as the causative gene of PPS is expected to shed new light on its role. The performance of the array was assessed and systematic analysis of effects of SNP density reduction was performed with the real experimental data. Our results suggest that linkage in our pedigree may have been missed had we used chips containing less than 100,000 SNPs across the genome
Identification of four novel potentially Parkinson\u27s disease associated LRRK2 variations among Iranian patients.
The results of mutation screening of 24 exons of LRRK2 in 60 Iranian Parkinson\u27s Disease patients are presented. The Iranian cohort represents a novel population and was notably young (average age at onset of disease: 36.0 years). Fifty sequence variations were found, seventeen of which are novel. Variations considered possibly associated with disease were screened in available family members, 145 additional patients and 220 control individuals. It was surmised that four novel sequence variations (IVS49+178A\u3eG, p.R1725Q, p.Q1823K, and p.D2175H) may be associated with PD status, albeit they may be very rare non-disease associated variations. The four variations were all observed in the heterozygous state in early onset cases. If one or more of the variations do indeed contribute to disease status, their penetrance is expected to be low
PRKN, DJ-1, and PINK1 screening identifies novel splice site mutation in PRKN and two novel DJ-1 mutations
We present results of mutation screening of PRKN gene in 93 Iranian Parkinson's disease (PD) patients with average age at onset (AAO) of 42.2 years. The gene was screened by direct sequencing and by a semi-quantitative PCR protocol for detection of sequence rearrangements. Heterozygous rearrangements were tested by reverse transcription-polymerase chain reaction (RT-PCR). Nine different PRKN mutations were found. One of these, IVS9+1G>A, affects splicing and is novel. Two mutated PRKN alleles were observed in each of 6 patients whose average AAO was 25.7 years. Only 1 patient carried a single mutated allele and his AAO was 41 years. Among patients with AAO of 30 years carried a PRKN mutation. Analysis of PRKN by RT-PCR led to identification of a novel exon expressed in leukocytes of control and PD individuals. The alternatively spliced transcript if translated would code a protein without a RING Finger 2 domain. Its functional relevance remains to be shown. DJ-I and PINK1 were also screened. Two novel DJ-1 mutations, c.91-2A>G affecting splicing and c.319G>C causing Ala107Pro, were observed among patients with AAO of 12) of this group of Iranian patients may be due to mutations in DJ-1. Mutations in PINK1 were not observed. Our results complement previous findings on LRRK2 mutations among Iranian PD patients. © 2010 Movement Disorder Society