TransKidsNL 2023: A Seven-Year Follow-Up of Healthcare and Support Needs of Trans Youth in Newfoundland & Labrador

This investigation examined needs and concerns of transgender youth and their families throughout the island of Newfoundland. Twenty-four youth and 21 parents completed qualitative questionnaires. Both parent and youth participants expressed concern about general practitioners’ lack of knowledge of transgender healthcare. Trans youths’ main concerns included lack of parental support, feelings of dysphoria, the desire to be fully accepted, and safety. Parents’ main concerns included wait times for care, their child’s mental health, lack of information or guidance, safety, and depathologizing their children’s identities. The findings point to six key recommendations for healthcare providers and policymakers.

Perceived Need for Mental Health Care and Service Use Among Adults in Western Europe: Results of the ESEMeD Project

BackgroundThe negative impact of vertebral and hip low-energy fractures on health-related quality-of-life (HRQOL) has been demonstrated previously, but few prospective long-term follow-up studies have been conducted. This study aims to (i) investigate the changes and long-term impact of vertebral or hip fracture and between fracture groups on HRQOL in postmenopausal women prospectively between two and seven years after the inclusion fracture, (ii) compare HRQOL results between fracture and reference groups and (iii) study the relationship between HRQOL and physical performance, spinal deformity index and bone mineral density at seven-year follow-up.MethodsNinety-one women examined two years after a low-energy vertebral or hip fracture were invited to a new examination seven years after the diagnosis. HRQOL was examined using the SF-36 questionnaire and was compared with an age and sex-matched reference group. Physical function was assessed using tests and questionnaires. Bone mineral density was measured. Radiographs of the spine were evaluated using the visual semiquantitative technique. A longitudinal and cross-sectional design was used in this study. Statistical analyses included descriptive statistics, Student's t-tests, ANCOVA, and partial correlation.ResultsSixty-seven women participated. In the 42 women (mean age 75.8, SD 4.7) with vertebral fracture as inclusion fracture, bodily pain had deteriorated between two and seven years and might be explained by new fracture. Remaining pronounced reduction of HRQOL was seen in all domains except general health and mental health at seven-year follow-up in women with vertebral fractures compared to the reference group (p < 0.05). All 25 women (mean age 75.0, SD 4.7) with hip fracture as inclusion fracture had no significant changes in HRQOL between two and seven years and did not differ from the reference group regarding HRQOL after seven years. The vertebral group had significantly lower values for bodily pain, vitality, role-emotional function and mental health compared to the hip group. HRQOL showed a positive relationship between physical activity, static balance and handgrip strength.ConclusionThe long-term reduction of HRQOL in women with vertebral fracture emerged clearly in this study. The relationships between HRQOL and physical performance in women with vertebral and hip fracture raise questions for more research.

Treatment Seeking for Depression in Canada and the United States

Dear Editor: We believe that integration of mental health services within primary care is essential for the well-being of patients. We want to discuss our successful approach. As such, we, the members of the Edmonton Southside Primary Care Network (PCN), read the position paper entitled, Evolution of Collaborative Mental Health Care in Canada: A Shared Vision for the Future,1 with interest. As of May 2005, the Edmonton Southside PCN has been developing a model of collaboration, effective communication, consultation, coordination of care, co-location, and integration within primary care. These are all mentioned in the position paper. Below is an outline of some of the successes and continuing challenges within the PCN in the area of providing collaborative mental health care. Collaboration The mental health team consists of mental health coordinators (MHCs), family physicians, and psychiatrists. In addition, all primary care team members can be involved, including nurses, nurse practitioners, dietitians, and auxiliary staff. Effective Communication The MHCs ensure the family physician is aware of all referrals and services recommended to patients. This has improved care for patients as less is missed and it prevents the duplication of services on an already overworked mental health system. Continuity of care is maintained within this model. Consultation In 2007, the PCN added a psychiatric consultation service to the multidisciplinary team. While most mental health concerns are managed well by the family physician, the need for specialized services for some patients was recognized as beneficial in maintaining patient care within the primary care setting. An ongoing challenge is that patients who require ongoing psychiatric care continue to be referred in the normal way and wait times are still long. This is mitigated somewhat by the MHCs who can support the patient and the family physician while waiting for services, and by the psychiatrist who can advise the family physician regarding management in the interim. Coordination of Care and Co-location Coordination of care has been the main focus of the mental health team. It was recognized early on that improving coordination would benefit the patients, the family physicians, and the other mental health team members. The Edmonton Southside PCN is a decentralized model. Nurses, nurse practitioners, dietitians, and respiratory therapists are all placed in the family physicians' offices to provide care. When possible, the psychiatrists come to the family physicians' clinics as do the MHCs. …

IntroductionReliable information about the time spent waiting for health care services is a critical metric for measuring health system performance. Wait times are a useful measure of access to various health care sectors. Alongside the increased adoption of electronic medical records (EMR) by Canadian family physicians (FP), is the secondary use of FP EMR data for research. However, using FP EMR data can be challenging in its unstructured, free-text format.&#x0D; Objectives and ApproachOur objective was to identify the target specialist physician type from the EMR FP referral note and then calculate wait times from a FP referral to a specialist physician visit. We used FP EMR data and linked to Ontario, Canada health administrative data (called EMRPC). EMRPC collects the entire clinical record from patients including the content of FP referral notes. We used machine learning (ML) methods to identify the type of specialist physician in which the referral was intended. Labels to test the ML methods were created from physicians’ claims data. Wait times were calculated from the FP EMR referral note date to the specialist physician claim date in administrative data.&#x0D; ResultsOur ML models’ ability to classify 2016 FP EMR referral notes to selected medical and surgical specialists achieved sensitivity and positive predictive values ranging from the high 70s to low 80s.Compared to earlier analyses from 2008, we observed a similar relative ordering to see specific specialist physicians. Overall, the median wait times have increased by 14 days on average, with a maximum increase of 28 days to see a gastroenterologist.&#x0D; Conclusion / ImplicationsThe accuracy of ML on unstructured FP EMR data is high, thereby providing a mechanism to “codifying” information in a timely manner. This information can help inform decision makers and providers about which patients or FP practices are experiencing long wait times in seeing specialist physicians.

The aims of this study were: (1) to identify the determinants of unmet need for access to primary care in middle-aged and older adults; and (2) to examine the reasons for unmet need. We used data from the Canadian Longitudinal Study on Aging (CLSA), a nationally representative survey of adults aged 45 to 85 years. Respondents were asked if they ‘needed health care during the last 12 months but did not receive it’. For those who replied ‘Yes’, the survey asked for the reason(s) for not receiving the needed care. Out of 41,135 respondents, 3,468 had unmet need for healthcare in the last 12 months. Among respondents with 0, 1, 2 and ≥3 morbidities, the proportion reporting unmet need was 2.5%, 5.3%, 5.1% and 9.1% respectively. After adjusting for covariates, the odds ratios (ORs) for unmet need for 1, 2 and ≥3 morbidities (compared to no morbidity) were 1.25 (95% CI: 0.87 to 1.78; p = 0.23), 1.57 (95% CI: 1.13 to 2.17; p < 0.05) and 2.03 (95% CI: 1.51 to 2.73; p < 0.05), respectively. For income groups, the ORs for unmet need (compared to >$150,000/year) were 0.94 (95% CI: 0.79 to 1.12) for $100,000-$150,000, 1.02 (95% CI: 0.87 to 1.20;) for $50,000-$100,000, 1.30 (95% CI: 1.09 to 1.55) for $20,000-$50,000, and 1.39 (95% CI: 1.08 to 1.78) for < $20,000. Other statistically significant determinants of unmet need included age (older adults were less likely to have unmet need), sex (females were more likely), having a family physician (less likely) and perceived physical and mental health (poor health more likely to be associated with unmet need). The most common reasons for unmet need were: ‘long wait time’ (52.1%) and ‘doctor did not think it was necessary’ (16.7%). Multimorbidity and low-income are associated with higher odds of unmet need among older adults. This disparity is partly due to not having a regular family physician and long wait time to see a doctor. Reducing these barriers are critical to reducing inequalities in health outcomes.

Disparities in Adequate Mental Health Care for Past-Year Major Depressive Episodes Among Caucasian and Hispanic Youths

Following efforts made in recent years to provide effective mental health treatments based on evidence-based guidelines, a working definition was developed in the literature detailing a minimum level of "adequate mental health care" for serious mental illness. However, little is known about racial or ethnic disparities in receipt of adequate mental health care for individuals affected with serious mental illness. The objective of this study was to examine disparities among Caucasian and Hispanic youths in receipt of adequate mental health care for past-year major depressive episodes. Data for this study were drawn from the 2005 National Survey on Drug Use and Health. The study sample was composed of 1,169 Caucasian youths and 316 Hispanic youths aged 12 to 17 with past-year major depressive episodes. The percentages of youths in the sample who received adequate mental health care for past-year major depressive episodes were estimated, and the correlates of receipt of adequate mental health care were examined. Thirty-four percent of the full sample received adequate mental health care for past-year major depressive episodes, but separate analyses indicated that adequate mental health care was received by a significantly higher proportion of Caucasian youths (36%) than Hispanic youths (27%). The odds of receiving adequate mental health care for past-year major depressive episodes for Caucasians were 1.55 times that of Hispanics (p=.01). Having Medicaid or coverage via the State Children's Health Insurance Program significantly increased the odds of receiving adequate mental care for past-year major depressive episodes for both Hispanics and Caucasians. As mental health problems of adolescents from diverse racial or ethnic backgrounds become more easily identified and a larger proportion of these groups is referred to mental health treatment services, it is important to examine the degree to which treatment should be tailored to engage and retain specific racial or ethnic groups so that they will receive the minimum of adequate mental health care.

Background: Non-alcoholic fatty liver disease (NAFLD) is a condition with a global prevalence of 24%. A broad spectrum of liver complications has been attributed to this condition. Objectives: This study was conducted to determine the incidence of NAFLD and its potential risk factors in a seven-year follow-up study in Iran. Methods: This is a prospective cohort population-based study conducted in the northern region of Iran. In phase I of the cohort study, 2,461 participants were selected, between 2009 and 2010, using the stratified randomization method based on the sex and age of individuals. Ultrasonographic examination was performed again after a seven-year follow-up between 2016 and 2017. The multiple binary regression analysis was applied to evaluate the association between the development of NAFLD and potential risk factors. Results: The incidence of NAFLD was 27.88% (95% CI: 25.41% - 30.35%) in men and 30.17% (95% CI: 27.40% - 32.94%) in women (P = 0.226) in a seven-year follow-up period. Based on the multiple binary logistic regression analysis, body mass index (BMI) [OR = 1.219 (95% CI: 1.162 - 1.278) P < 0.001], triglyceride (TG) [OR = 1.003 (95% CI: 1.001 - 1.005); P = 0.005] and high-density lipoprotein (HDL) [OR = 0.986 (95% CI: 0.972 - 0.999); P = 0.046] showed a significant association with the incidence of NAFLD in men. In contrast, the marital status [OR = 2.141 (95% CI: 1.286 - 3.565); P = 0.003], BMI [OR = 1.165 (95% CI: 1.121 - 1.211); P < 0.001] and homeostatic model assessment for insulin resistance (HOMA-IR) [OR = 1.164 (95% CI: 1.041 - 1.301); P = 0.007] had a significant relationship with the incidence of NAFLD in women. Conclusions: It seems that NAFLD is markedly rising in the northern part of Iran. Higher levels of BMI, TG, and HDL are considered independent risk factors for the development of NAFLD in men, while the marital status, BMI, and HOMA-IR exhibited independent risk factors with the incidence of NAFLD in women.

BackgroundThere is an unmet need for mental health care in Canada. Primary care providers such as general practitioners and family physicians are the essential part of mental health care services; however, mental health is often underestimated and underprioritized by family physicians. It is currently not known what is required to increase care providers’ willingness, comfort, and skills to adequately provide care to patients who present with mental health issues.ObjectiveThe aim of this study was to understand the need of caregivers (family members overseeing care of an individual with a mental health diagnosis) and family physicians regarding the care and medical management of individuals with mental health conditions.MethodsA needs assessment was designed to understand the educational needs of caregivers and family physicians regarding the provision of mental health care, specifically to seek advice on the format and delivery mode for an educational curriculum to be accessed by both stakeholder groups. Exploratory qualitative interviews were conducted, and data were collected and analyzed iteratively until thematic saturation was achieved.ResultsCaregivers of individuals with mental health conditions (n=24) and family physicians (n=10) were interviewed. Both the caregivers and the family physicians expressed dissatisfaction with the status quo regarding the provision of mental health care at the family physician’s office. They stated that there was a need for more educational materials as well as additional support. The caregivers expressed a general lack of confidence in family physicians to manage their son’s or daughter’s mental health condition, while family physicians sought more networking opportunities to improve and facilitate the provision of mental health care.ConclusionsRobust qualitative studies are necessary to identify the educational and medical management needs of caregivers and family physicians. Understanding each other’s perspectives is an essential first step to collaboratively designing, implementing, and subsequently evaluating community-based mental health care. Fortunately, there are initiatives underway to address these need areas (eg, websites such as the eMentalHealth, as well as the mentorship and collaborative care network), and information from this study can help inform the gaps in those existing initiatives.

Imaging Changes and Outcomes of Patients Undergoing Active Monitoring for Ductal Carcinoma In Situ: Seven-Year Follow-up Study

Waiting for a Consultation: Sorry, But the Doctor Cannot See You

Assessing the Health, Functional Characteristics, and Health Needs of Youth Attending a Noncategorical Transition Support Program

BackgroundWait times are an important measure of access to various health care sectors and from a patient’s perspective include several stages in their care. While mechanisms to improve wait times from specialty care have been developed across Canada, little is known about wait times from primary to specialty care. Our objectives were to calculate the wait times from when a referral is made by a family physician (FP) to when a patient sees a specialist physician and examine patient and provider factors related to these wait times.MethodsOur study used the Electronic Medical Record Administrative data Linked Database (EMRALD) which is a linkage of FP electronic medical record (EMR) data to the Ontario, Canada administrative data. The EMR referral date was linked to the administrative physician claims date to calculate the wait times. Patient age, sex, socioeconomic status, comorbidity and FP continuity of care and physician age, sex, practice location, practice size and participation in a primary care delivery model were examined with respect to wait times.ResultsThe median waits from medical specialists ranged from 39 to 76 days and for surgical specialists from 33 days to 66 days. With a few exceptions, patient factors were not associated with wait times from primary care to specialty care. Similarly physician factors were not consistently associated with wait times, except for FP practice location and size.ConclusionsActual wait times for a referral from a FP to seeing a specialist physician are longer than those reported by physician surveys. Wait times from primary to specialty care need to be included in the calculation of surgical and diagnostic wait time benchmarks in Canada.