Medical recruitment in rural Canada: Marathon breaks the cycle

Two years ago, the 5500 residents of marathon, ont., had 1 overworked physician to look after their medical needs. Today, they have 7 physicians to share the load. In this article Michael OReilly looks at the steps the town took to attract new doctors. It offered a financial incentive and also worked to revitalize its hospital. As Marathon worked to attract new doctors, it also found that a new generation of physicians has much different career aspirations than past generations.     

Infertility treatment: lack of consensus plagues an unregulated field

Each year, in an attempt to stimulate journalism students'' interest in medical writing, CMAJ sponsors the Amy Chouinard Memorial Essay Prize. The $750 award is in memory of Amy Chouinard, a longtime and valued contributor to CMAJ and the Canadian Journal of Surgery. Students from any recognized journalism program at a Canadian college or university are eligible to enter, and the deadline for 1998 entries is June 1. The 1997 winner, Megan Easton, presents a well-written and thorough account of the issues surrounding infertility treatment. Interest in the topic came naturally enough--her father, Dr. William Easton, is a urogynecologist in private practice in Scarborough, Ont.     

深圳市龙华地区城镇用地动态模型建设及模拟研究

在１９８８～１９９６年时段景面遥感制的基础上,利用细胞自组织模型对深圳市龙华地区城镇成区的动态变化过程进行了模拟研究。模型其选择了高程,城率、限最近干线公路的生趣距离,斑块相邻度指数和形状指数等５个变量参与非域镇用地单元的综合转移概率计算,利用１９８８～１９９０年的城镇扩张结果确定不同变量的权重参数,利用１９９２、１９９４和１９６年的数据进行模型验证。结果表明,细胞自组织模型可以很好地反映模拟起始     

Consensus finally achieved on resuscitative interventions.

A joint policy statement on the resuscitation of patients is published in this issue of CMAJ. Dr. John Williams, the CMA''s director of ethics and legal affairs, discusses how it differs from the joint statement published last year.     

A second look at the effects of supportive follow-up on smoking cessation.

In 1982 a report in CMAJ (1982; 126: 127-129) indicated that the addition of supportive follow-up appointments in a family practice increased the 6-month cigarette abstinence rate from 12% to 23%. We reanalysed the data by means of recognized standards for treatment success and found little evidence that the treatment had any reliable effect on attempts to quit that lasted at least 3 months: 8.5% and 4.8% of the groups with and without supportive follow-up respectively abstained for more than 3 months. We discuss a problem of the experimental design (longer evaluative follow-up for the control group than for the treatment group) and cost-benefit issues.     

The effect of long-distance running on plasma immunoreactive glucagon levels

Twelve highly conditioned long-distance runners were studied to determine the effects of marathon (42 km) and 10,000 m running on plasma immunoreactive glucagon (IRG), serum immunoreactive insulin (IRI), and serum glucose (G) levels. Blood samples were drawn just prior to and immediately upon completion of the run. Marathon running resulted in no significant change in G, IRI, or IRG levels. After running 10,000 m, plasma IRG levels did not change significantly, while IRI and G increased significantly. In evaluating the pooled data from both runs, a significant inverse correlation was observed between delta G and delta IRG. This relationship between delta G and delta IRG suggests that glucagon plays a role in maintaining normal blood glucose levels during strenuous exercise.     

US editorial writers put Canadian health care under microscope

Editorial writers from the US descended on Ottawa recently for their annual meeting, and CMAJ contributing editor Charlotte Gray was one of the speakers. She said the visitors received widely differing views on the Canadian health care system and may have emerged from the meeting more confused than informed.     

JIPB's Editorial Board Meeting 2009: A New Face in 2010

The annual editorial board meeting of JIPB, which this year coincided with the 2009 Integrative Plant Biology Symposium in the seaside town of Yantai, China, was recently concluded. Twenty-four editors attended the very constructive meeting (Figure 1). The symposium, partially sponsored by JIPB, at-tracted more than 300 participants from Chinese universities and research organizations.     

Results of large scale media antismoking campaign in Australia: North Coast "Quit for Life" programme.

A three community study was carried out in northern New South Wales, Australia, to determine the effectiveness of interventions via media and media plus community programmes in altering behaviours of life style, including smoking, dietary fat intake, and exercise. Results were analysed of one aspect of the "North Coast Healthy Lifestyle Programme" entitled "Quit for Life," which aimed at reducing cigarette smoking over a two year period. There was a significant decline in the prevalence of smoking in both test towns, ranging from 16% in younger men to 6% in older women. These were significantly greater than the declines in the control town. The declines were more sustained over the two year period in the town subjected to media plus community programmes.     

To Know One's Place: Belonging and Differentiation in Alice Springs Town

Based on research in the town of Alice Springs in Central Australia the article explores how social and material aspects of the town generate meaningful understandings of oneself and differentiated others. Drawing on anthropology of place and space and analytical notions of belonging, I explore shared and divergent ways in which a range of people in town come to ‘know their place’ both in a socio-cultural sense and in the sense of relating to the built environment. Paying just as detailed attention to non-indigenous experience as scholars have long paid to indigenous lives, the article suggests that a focus on how people form material and social attachments to place can facilitate more open-ended understandings of changing forms of indigenous-settler relations than the more common focus on difference and division between categories of indigenous and non-indigenous people and domains of life.     

Socioeconomic and demographic correlates of medical care and health practices

using a 2-stage stratified sampling procedure, a random sample of 1021 rural families in North Arcot District of Tamil Nadu State in South India was studied to determine the interrelationships of utilization of medical care and health behavior with social, demographic and economic factors. Distance from a town, education, and accessibility of medical facilities seem to play a prominent role in the various decision making processes. 81.5% of respondents preferred only home treatment for common ailments at the initial stages of the disease. Of the remainder 1/2 preferred to go to a hospital and the other 1/2 chose a qualified physician. If the ailment persisted, 53% preferred to go to a hospital and 43% to a physician. The 1st choice for outside medical care for 44.8% of the respondents was a private medical practitioner, for 42.9% it was the government hospital and for the remaining 11.4% it was a nearly clinic or private hospital. In 88% of the cases, the head of the household met all the expenses. In only 4% of the cases were the expenses met by the employer or through another arrangement. Nearly 2/3 of the respondents agreed and 2i% disagreed that treatment would be better if provided free of cost and most thought it would be improved if health facilities were situated within the village itself. At the initial stages of common ailments some 90% of those residing within 5 km from a town said that they would treat themselves at home. If the ailment persisted, 52.4% preferred to go to the hospital and 43.7% to approach a physician. Only 63.7% of those living beyond 10 km from town preferred home treatment during early stages, and when the ailment persisted, 45% preferred the hospital while 55% preferred to approach a physician. 90% of respondents with lower incomes preferred home treatment for common ailments in the initial stages, compared to 56% of those with higher incomes. The proportion choosing a private medical practitioner as the 1st choice is much lower in the lowest income groups than in the highest income group. Those in the upper income groups preferred the source of medical care where they could get quick relief; lower income groups preferred the source of free services. The proportion who said they would approach a physician even during the initial stages of ailments increased significantly with education. The proportion whose 1st choice was a government hospital declined as education increased.     

Coronary sinus cannulation predicts atrioventricular nodal reentry as mechanism of supraventricular tachycardia

IntroductionCommon clinical teaching, for invasive electrophysiology, is that if the first year fellow cannulates the coronary sinus (CS) in his first attempt, the arrhythmia is more likely to be atrioventricular nodal reentry tachycardia (AVNRT). This general perception has not yet been clinically tested. We evaluated this theory in prospective patients undergoing an electrophysiological study (EPS) for paroxysmal supraventricular tachycardia (PSVT).MethodsCohort study. CS ease of cannulation (CSCS) was graded as: 1) 1st year fellow cannulates in first attempt; 2) 1st year fellow needs more than one attempt or maneuver to cannulate the CS; 3) staff physician cannulates in first attempt after the fellow was unsuccessful; 4) staff physician requires more than one maneuver to cannulate the CS; 5) staff physician judges that the cannulation process was extremely difficult.ResultsOf the 1361 patients undergoing EPS in our institution, 165 were selected. Age was 49 ± 15 years. AVNRT occurred in 77.6%, atrioventricular reentry tachycardia (AVRT) in 15.1% and atrial tachycardia (AT) in 7.3% of cases. The CSCS = 1 was more prevalent in AVNRT, 89% versus 68% AVRT and 58.3% of AT (P = 0.0005). Patients with CSCS = 1 have a higher chance of the PSVT being AVNRT (odds ratio: 4.41; 95CI: 1.84–10.56; P = 0.0009).ConclusionThe CSCS predicts the likelihood of the induced PSVT being AVNRT as compared to AVRT and AT. More studies are required to try to associate this finding to clinical patient characteristics to create a score for PSVT mechanism prediction.     

乡镇尺度金塔绿洲时空格局变化

基于遥感、GIS技术和1990、1999、2006和2009年4期Landsat TM/ETM+遥感影像等,利用绿洲变化幅度、动态度模型、绿洲变化趋势指数模型及绿洲化荒漠化转移矩阵,开展乡镇尺度上金塔绿洲时空变化及分异研究.结果表明:1990-2009年间,金塔绿洲不断扩张,荒漠面积呈现减少趋势,绿洲净增长面积达199.49 km2.金塔绿洲整体处于非平衡状态,不同乡镇绿洲变化程度不同,乡镇绿洲规模变化强弱顺序为羊井子湾乡＞场站机关辖区＞东坝镇＞三合乡＞古城乡＞金塔镇＞中东镇＞大庄子乡＞西坝乡.金塔绿洲聚集度增加,景观破碎化程度减少,荒漠基质优势度降低.绿洲扩张区主要有羊井子湾乡、场站机关管辖区、东坝镇、金塔镇、古城乡和三合乡等.近20年来,金塔绿洲变化主要受人文与社会因素的影响,水资源的开发利用是绿洲扩张的前提条件,人口(含移民迁入)、经济发展、政策和科技进步是主要的驱动因素.     

THE PSYCHOTHERAPEUTIC APPROACH TO EMOTIONAL PROBLEMS

Physicians are confronted with more and more psychological problems in their daily practice. Not only must a physician be able to recognize the problems, he must also be prepared to treat a certain number of them. Some of the patients will improve just because of a good relationship with the physician. Others will require more definitive, yet comparatively simple, psychotherapy. On the other hand, some patients with clear-cut emotional problems are best treated by the physician''s traditional medical approach rather than by some type of “formal” psychotherapy. In some circumstances psychotherapeutic efforts may be damaging.     

The Primary Care Network: A New Type of HMO for Private Practice Physicians

A new type of health maintenance organization has been developed to encourage primary care physicians in private practice to become coordinators and financial managers for all medical care. Each patient chooses one internist, family or general physician, or pediatrician and must be referred by that physician for all hospital admissions and care by specialists. The primary care physician authorizes all payments from his own account for care provided to his patients. He shares any deficit or surplus remaining at the end of the year.Hospital admission rates and length of stay are lower than those of Blue Cross, with only one of three dollars paid to hospitals. The plan is providing care to 38,000 persons with 750 participating physicians in Northern California, Washington and Utah.This plan represents an attempt by physicians to control costs without government regulation.     

A competitive marathon race decreases neutrophil functions in athletes

A full marathon is the longest running race in official track events and is a form of acute exercise. However, no studies have examined the acute neutrophil function response to a competitive marathon race. Thirty‐six male athletes who had just completed the 42.195 km course of the 50th Beppu‐Oita Mainichi Marathon were enrolled in this study. Neutrophil oxidative burst activity, phagocytic activity and expression of CD11b and CD16 per cell were measured by flow cytometry immediately before and after the marathon. Total leukocyte/neutrophil counts increased significantly (p < 0.001), whereas total oxidative burst activity per neutrophil cell decreased significantly after the race (p < 0.001). Furthermore, total phagocytic activity per neutrophil cell also decreased after the race, although it was not significant (p = 0.08). Although CD11b expression per cell did not change, the expression of CD16 per cell significantly decreased (p < 0.001) after the race. In conclusion, a competitive marathon race decreased neutrophil functions (oxidative burst activity and phagocytic activity), which may be partly due to a decrease in CD16 expression. The increase in total neutrophil counts might reflect a compensatory response to counteract the decrease in neutrophil functions. Copyright © 2003 John Wiley & Sons, Ltd.     

Straight talk with...Joe Selby

The US Supreme Court's ruling in late June to uphold most of the Patient Protection and Affordable Care Act of 2010 decided more than just the fate of the law's individual mandate for health care. It also allowed many of the other provisions of the legislation to safely go ahead. Chief among those was the establishment of a comparative-effectiveness research hub called the Patient-Centered Outcomes Research Institute (PCORI), located in Washington, DC. With a budget of $3.3 billion over the next seven years and an independent status, PCORI is now tasked with creating the evidence base to help patients and doctors make more informed decisions about their medical choices. Leading the fledgling institute is executive director Joe Selby. A family physician and clinical epidemiologist, Selby joined PCORI in July 2011 after 13 years as head of research at Kaiser Permanente, the California-based health provider. Even amid all the uncertainty that surrounded the future of US healthcare reform, Selby, together with PCORI's board of directors, managed to help craft the institute's first research agenda and to fund 50 pilot projects totaling $30 million, all in the spring of this year. Elie Dolgin spoke with Selby to discuss how PCORI will influence the debate about which treatments work best.     

黑龙江省植物花期对气温变化的响应

为了解黑龙江省植物花期对气温变化的响应趋势。利用1951~2007年采集于黑龙江省的188种植物标本信息,分析黑龙江省植物花期变化与年均温、上年均温和春季、夏季、秋季均温变化的关系。结果表明:黑龙江省42.0%以上植物的花期与气温间存在显著的相关性(P<0.05)。这些植物中,25%以上物种的相对采集时间指数与年均温、上年均温及各季节均温存在显著正相关(P<0.05)关系,且多为草本植物。其余草本植物及木本植物的相对采集时间指数与年均温、上年均温及各季节均温多呈显著负相关(P<0.05),如春季均温每升高1℃,木本植物花期平均提前12.65%。年均温、上年均温和春季、夏季、秋季均温每升高1℃,黑龙江省植物花期分别整体提前4.47%、7.08%、3.87%、5.84%和6.73%。花期对气温变化的响应,在短花期植物中相对明显。相较于春季、秋季及年均温,黑龙江省植物花期对夏季均温变化的响应更为敏感。     

A system worth saving.

The country will mark Canada Health Day on May 12, so CMAJ asked Dr. Michael Gordon to reflect on Canada''s health care system and the changes it has seen and will see. The special day, cosponsored by the Canadian Public Health Association, is designed to highlight "the need for better communication between health professionals and the communities they serve." In this article, Gordon reflects on the dangers facing Canada''s medicare system and the need to protect it from the inroads threatened by privatization.