An evaluation of gender equity in different models of primary care practices in Ontario

Background: The World Health Organization calls for more work evaluating the effect of health care reforms on gender equity in developed countries. We performed this evaluation in Ontario, Canada where primary care models resulting from reforms co-exist. // Methods: This cross sectional study of primary care practices uses data collected in 2005-2006. Healthcare service models included in the study consist of fee for service (FFS) based, salaried, and capitation based. We compared the quality of care delivered to women and men in practices of each model. We performed multi-level, multivariate regressions adjusting for patient socio-demographic and economic factors to evaluate vertical equity, and adjusting for these and health factors in evaluating horizontal equity. We measured seven dimensions of health service delivery (e.g. accessibility and continuity) and three dimensions of quality of care using patient surveys (n = 5,361) and chart abstractions (n = 4,108). // Results: Health service delivery measures were comparable in women and men, with differences ≤ 2.2% in all seven dimensions and in all models. Significant gender differences in the health promotion subjects addressed were observed. Female specific preventive manoeuvres were more likely to be performed than other preventive care. Men attending FFS practices were more likely to receive influenza immunization than women (Adjusted odds ratio: 1.75, 95% confidence intervals (CI) 1.05, 2.92). There was no difference in the other three prevention indicators. FFS practices were also more likely to provide recommended care for chronic diseases to men than women (Adjusted difference of -11.2%, CI -21.7, -0.8). A similar trend was observed in Community Health Centers (CHC). // Conclusions: The observed differences in the type of health promotion subjects discussed are likely an appropriate response to the differential healthcare needs between genders. Chronic disease care is non equitable in FFS but not in capitation based models. We recommend that efforts to monitor and address gender based differences in the delivery of chronic disease management in primary care be pursued.Funding for the original study on which this research is based was provided by the Ontario Ministry of Health and Long Term Care Primary Health Care Transition Fund. The views expressed in this report are the views of the authors and do not necessarily reflect those of the Ontario Ministry of Health and Long Term Care

An evaluation of gender equity in different models of primary care practices in Ontario

Abstract Background The World Health Organization calls for more work evaluating the effect of health care reforms on gender equity in developed countries. We performed this evaluation in Ontario, Canada where primary care models resulting from reforms co-exist. Methods This cross sectional study of primary care practices uses data collected in 2005-2006. Healthcare service models included in the study consist of fee for service (FFS) based, salaried, and capitation based. We compared the quality of care delivered to women and men in practices of each model. We performed multi-level, multivariate regressions adjusting for patient socio-demographic and economic factors to evaluate vertical equity, and adjusting for these and health factors in evaluating horizontal equity. We measured seven dimensions of health service delivery (e.g. accessibility and continuity) and three dimensions of quality of care using patient surveys (n = 5,361) and chart abstractions (n = 4,108). Results Health service delivery measures were comparable in women and men, with differences ≤ 2.2% in all seven dimensions and in all models. Significant gender differences in the health promotion subjects addressed were observed. Female specific preventive manoeuvres were more likely to be performed than other preventive care. Men attending FFS practices were more likely to receive influenza immunization than women (Adjusted odds ratio: 1.75, 95% confidence intervals (CI) 1.05, 2.92). There was no difference in the other three prevention indicators. FFS practices were also more likely to provide recommended care for chronic diseases to men than women (Adjusted difference of -11.2%, CI -21.7, -0.8). A similar trend was observed in Community Health Centers (CHC). Conclusions The observed differences in the type of health promotion subjects discussed are likely an appropriate response to the differential healthcare needs between genders. Chronic disease care is non equitable in FFS but not in capitation based models. We recommend that efforts to monitor and address gender based differences in the delivery of chronic disease management in primary care be pursued.</p

Interactions between the atmosphere, cryosphere, and ecosystems at northern high latitudes

The Nordic Centre of Excellence CRAICC (CRyosphere-Atmosphere Interactions in a Changing Arctic Climate), funded by NordForsk in the years 2011–2016, was the largest joint Nordic research and innovation initiative to date, aiming to strengthen research and innovation regarding climate change issues in the Nordic Region. CRAICC gathered more than 100 scientists from all Nordic countries in a virtual Centre with the objectives to identify and quantify the major processes controlling Arctic warming and related feedback mechanisms, to outline strategies to mitigate Arctic warming and to develop Nordic Earth System modelling with a focus on the short-lived climate forcers (SLCF), including natural and anthropogenic aerosols. The outcome of CRAICC is reflected in more than 150 peer-reviewed scientific publications, most of which are in the CRAICC special-issue of the journal Atmospheric Chemistry and Physics. This manuscript presents an overview on the main scientific topics investigated in the Centre and provides the reader a state-of-the-art comprehensive summary of what has been achieved in CRAICC with links to the particular publications for further detail. Facing the vast amount of outcomes we are not claiming to cover all results from CRAICC in this manuscript but concentrate here on the main results which are related to the feedback loops in the climate change-cryosphere interaction scheme affecting the Arctic amplification.The Nordic Centre of Excellence CRAICC (CRyosphere-Atmosphere Interactions in a Changing Arctic Climate), funded by NordForsk in the years 2011–2016, was the largest joint Nordic research and innovation initiative to date, aiming to strengthen research and innovation regarding climate change issues in the Nordic Region. CRAICC gathered more than 100 scientists from all Nordic countries in a virtual Centre with the objectives to identify and quantify the major processes controlling Arctic warming and related feedback mechanisms, to outline strategies to mitigate Arctic warming and to develop Nordic Earth System modelling with a focus on the short-lived climate forcers (SLCF), including natural and anthropogenic aerosols. The outcome of CRAICC is reflected in more than 150 peer-reviewed scientific publications, most of which are in the CRAICC special-issue of the journal Atmospheric Chemistry and Physics. This manuscript presents an overview on the main scientific topics investigated in the Centre and provides the reader a state-of-the-art comprehensive summary of what has been achieved in CRAICC with links to the particular publications for further detail. Facing the vast amount of outcomes we are not claiming to cover all results from CRAICC in this manuscript but concentrate here on the main results which are related to the feedback loops in the climate change-cryosphere interaction scheme affecting the Arctic amplification.The Nordic Centre of Excellence CRAICC (CRyosphere-Atmosphere Interactions in a Changing Arctic Climate), funded by NordForsk in the years 2011–2016, was the largest joint Nordic research and innovation initiative to date, aiming to strengthen research and innovation regarding climate change issues in the Nordic Region. CRAICC gathered more than 100 scientists from all Nordic countries in a virtual Centre with the objectives to identify and quantify the major processes controlling Arctic warming and related feedback mechanisms, to outline strategies to mitigate Arctic warming and to develop Nordic Earth System modelling with a focus on the short-lived climate forcers (SLCF), including natural and anthropogenic aerosols. The outcome of CRAICC is reflected in more than 150 peer-reviewed scientific publications, most of which are in the CRAICC special-issue of the journal Atmospheric Chemistry and Physics. This manuscript presents an overview on the main scientific topics investigated in the Centre and provides the reader a state-of-the-art comprehensive summary of what has been achieved in CRAICC with links to the particular publications for further detail. Facing the vast amount of outcomes we are not claiming to cover all results from CRAICC in this manuscript but concentrate here on the main results which are related to the feedback loops in the climate change-cryosphere interaction scheme affecting the Arctic amplification.Peer reviewe

Interactions between the atmosphere, cryosphere, and ecosystems at northern high latitudes

The Nordic Centre of Excellence CRAICC (Cryosphere–Atmosphere Interactions in a Changing Arctic Climate), funded by NordForsk in the years 2011–2016, is the largest joint Nordic research and innovation initiative to date, aiming to strengthen research and innovation regarding climate change issues in the Nordic region. CRAICC gathered more than 100 scientists from all Nordic countries in a virtual centre with the objectives of identifying and quantifying the major processes controlling Arctic warming and related feedback mechanisms, outlining strategies to mitigate Arctic warming, and developing Nordic Earth system modelling with a focus on short-lived climate forcers (SLCFs), including natural and anthropogenic aerosols. The outcome of CRAICC is reflected in more than 150 peer-reviewed scientific publications, most of which are in the CRAICC special issue of the journal Atmospheric Chemistry and Physics. This paper presents an overview of the main scientific topics investigated in the centre and provides the reader with a state-of-the-art comprehensive summary of what has been achieved in CRAICC with links to the particular publications for further detail. Faced with a vast amount of scientific discovery, we do not claim to completely summarize the results from CRAICC within this paper, but rather concentrate here on the main results which are related to feedback loops in climate change–cryosphere interactions that affect Arctic amplification

Interactions between the atmosphere, cryosphere, and ecosystems at northern high latitudes

The Nordic Centre of Excellence CRAICC (Cryosphere–Atmosphere Interactions in a Changing Arctic Climate), funded by NordForsk in the years 2011–2016, is the largest joint Nordic research and innovation initiative to date, aiming to strengthen research and innovation regarding climate change issues in the Nordic region. CRAICC gathered more than 100 scientists from all Nordic countries in a virtual centre with the objectives of identifying and quantifying the major processes controlling Arctic warming and related feedback mechanisms, outlining strategies to mitigate Arctic warming, and developing Nordic Earth system modelling with a focus on short-lived climate forcers (SLCFs), including natural and anthropogenic aerosols. The outcome of CRAICC is reflected in more than 150 peer-reviewed scientific publications, most of which are in the CRAICC special issue of the journal Atmospheric Chemistry and Physics. This paper presents an overview of the main scientific topics investigated in the centre and provides the reader with a state-of-the-art comprehensive summary of what has been achieved in CRAICC with links to the particular publications for further detail. Faced with a vast amount of scientific discovery, we do not claim to completely summarize the results from CRAICC within this paper, but rather concentrate here on the main results which are related to feedback loops in climate change–cryosphere interactions that affect Arctic amplification.The CRAICC team acknowledges the following institutions for financial support: the Finnish Cultural Foundation grant, Markku Kulmala “International Working Groups”; Russian mega-grant no. 11.G34.31.0048 (University of Nizhny Novgorod); Academy of Finland contracts 259537, 257411, and 254195; Beautiful Beijing (Finland–China collaboration project) funded by TEKES; Nordforsk CRAICC-PEEX (amendment to contract 26060); CRAICC-CRUCIAL (project no. 81257); Icelandic Research Fund (Rannis) grant no. 152248- 051; Danish Environmental Protection Agency with means from the Dancea fund for environmental support to the Arctic region (M 112 002700); the Villum Foundation; the Carlsberg Foundation (project 009_1_0515); COST1303 (TOPROF); COST ES1404 (HarmoSnow); and the Pan-Eurasian Experiment (PEEX). The development and use of NorESM1 was supported by the Norwegian Research Council through the projects Earth-Clim (207711/E10), EVA (grant no. 229771), NOTUR (nn2345k), and NorStore (ns2345k) and through the Nordic Centre of Excellence eSTICC (57001) and the EU H2020 project CRESCENDO (grant no. 641816). The CRAICC team also thanks Rogier Floors for providing Fig. 8 and Christoph Münkel for Fig. 9. The authors and entire CRAICC community would like to thank and acknowledge the work and inspiration of Jon Egill Kristjansson, whose life was cut short during these collaborations. Jon Egill Kristjansson is deeply missed, but his scientific legacy continues.Peer Reviewe

Interactions between the atmosphere, cryosphere, and ecosystems at northern high latitudes

Abstract The Nordic Centre of Excellence CRAICC (Cryosphere–Atmosphere Interactions in a Changing Arctic Climate), funded by NordForsk in the years 2011–2016, is the largest joint Nordic research and innovation initiative to date, aiming to strengthen research and innovation regarding climate change issues in the Nordic region. CRAICC gathered more than 100 scientists from all Nordic countries in a virtual centre with the objectives of identifying and quantifying the major processes controlling Arctic warming and related feedback mechanisms, outlining strategies to mitigate Arctic warming, and developing Nordic Earth system modelling with a focus on short-lived climate forcers (SLCFs), including natural and anthropogenic aerosols. The outcome of CRAICC is reflected in more than 150 peer-reviewed scientific publications, most of which are in the CRAICC special issue of the journal Atmospheric Chemistry and Physics. This paper presents an overview of the main scientific topics investigated in the centre and provides the reader with a state-of-the-art comprehensive summary of what has been achieved in CRAICC with links to the particular publications for further detail. Faced with a vast amount of scientific discovery, we do not claim to completely summarize the results from CRAICC within this paper, but rather concentrate here on the main results which are related to feedback loops in climate change–cryosphere interactions that affect Arctic amplification