Canadian family physician Medecin de famille canadien

Online ISSN: 0008-350X
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Article
Until we know numbers of patients at risk, their ages and sexes, we can do very little epidemiological research in family practice.This pilot study sought to establish whether family physicians could define their populations at risk, whether volunteer recording would work, and whether medicare-generated data could be used.
 
Attack Rates of Stool-Positive Cases/100,000 Population in Greater Vancouver Regional District, June-July 1986 
Article
The enteric pathogen Escherichia coli serotype 0157:H7 has been shown to cause hemorrhagic colitis. In British Columbia, the number of cases of E. coli 0157:H7 reported during the summer months of June, July and August increased substantially from 1985 to 1986. That increase formed the basis of a number of studies. This article describes two such studies, both conducted in B.C. The first study attempted to find a common source of infection. The second study further examined, as possible sources of infection, specific dietary elements identified in the first.
 
Article
Unsolicited data can be accumulated through the utilization of laboratory reports. This article gives the results of a study performed on serum calcium and inorganic phosphate determinations carried out as part of an investigative routine. Since Ca and P vary together in a set of specific diseases, we should perhaps evaluate these tests together, since they might be a more sensitive and more specific index of disease than any other single abnormal component in interrelated findings.
 
Article
One thousand new patients attending a Special Treatment Clinic for venereal disease were surveyed over a two year period to identify those at risk for the development of the disease. Data presented included age and sex incidence, occupation, marital status, referral sources, prevalence of homosexuality in diagnosed cases and religious affiliation.
 
Article
A representative sample of 1000 Ontario adults was surveyed by mail about: 1. their opinion on the desirability of legal and social changes to permit physicians to comply with requests by adult, hopelessly ill patients for measures to hasten their death, and 2. what they would prefer to do if ever faced with hopeless illness.A MAJORITY: a. favors changes to permit a doctor to carry out requests for withdrawing life-supporting equipment; b. favors rewording the law to clarify that it is legal for a doctor to carry out requests not to use forced feeding when patients refuse food; c. is against changes to permit a doctor to carry out requests for lethal drugs; d. feels that if faced with hopeless illness, they would choose to bring about their death, rather than carrying on as best as they could.
 
Article
A study was undertaken to see if a group of patients could estimate their blood pressure (BP). One hundred and thirteen hypertensive patients were asked whether they could tell when their BP was high, and if so, how. Patients were also asked to give a categorical and a numerical estimate of their current BP. We found that patients did not appear to be able to predict their BP any more accurately than they could be expected to by chance. Patients who predicted correctly, and those who were incorrect, used the same symptoms to predict elevated BP. These were headache, a feeling of warmth, nervousness, dizziness, and pounding heart.
 
Article
We examined 104 torture victims, 99 of whom were from Chile. Most of our patients were young men who had been arrested for political reasons. All the patients had been beaten; other common methods of torture included the application of electricity, cigaret burns, forced physical activity resulting in exhaustion, threats of death, sham execution and isolation. The only signs specific to torture were picana (electrical burn scars) and scars from cigaret burns. The most common psychological sequelae were anxiety, insomnia and recurrent nightmares. Psychological symptoms were similar to those documented in other populations who have suffered severe trauma.
 
Article
Objective: To describe the relationships between rural practice and the personal and medical education characteristics of medical students and residents. Design: Cross-sectional, mailed survey. Setting: Manitoba. Participants: Of 2578 physician graduates of the University of Manitoba from 1965 to 2000 who were surveyed, 1269 (49%) responded. Main outcome measures: Whether physicians had ever practised in rural settings, and their demographic characteristics and adolescent, medical school, and residency training experiences. Multivariate logistic regression models were used to determine variables jointly and independently associated with rural practice. Results: Of 1269 respondents, 39% had practised in rural settings, including 58% of the 362 respondents who identified family practice as their primary career activity, and 32% of the 907 respondents whose primary activities were other than family practice. For all graduates, being male (P = .0289), having lived in a rural community (P < .0001), having attended a rural high school (P < .0001), and having rural educational experiences during medical school (P = .0068) or during postgraduate training (P < .0001) were significantly related to a greater likelihood of rural practice. In the final multivariate model, graduates of rural high schools, compared with those from urban public schools, were 1.57 times (95% CI 1.09 to 2.26) more likely to have practised in rural settings. Graduates who undertook part of their undergraduate training in rural settings were 1.34 times (95% CI 1.09 to 1.75) more likely to practise in rural locations. For both undergraduates and residents, the distance of their rural education experiences from Winnipeg and the likelihood of rural practice were directly related. For both FPs and non-FPs, being male and undertaking rural education during residency training were associated with a greater likelihood of rural practice, as was the distance of the training experience from the urban setting. For non-FPs a similar association was observed with undergraduate rural experiences. Conclusion: This large survey of graduates from a Canadian medical school demonstrated that attending a rural high school (P < .0001) and having rural educational exposure during medical school and residency training (P = .0068) were significantly associated with a physician practising in a rural location. That is, rural educational experiences on the continuum from high school through residency training appeared to be associated with rural practice.
 
Article
This article identifies 13 key factors of which family physicians should be aware in the ongoing care of men with prostate cancer. PubMed was searched with the relevant search terms for each of the 13 topics discussed. Most of the studies described in this article provide level II or level III evidence. Family physicians are increasingly involved in the care of men with prostate cancer. The 13 clinical pearls presented in this article will enhance family physicians' ability to care for these patients along the disease trajectory. Men with prostate cancer face unique challenges as they deal with their disease and its treatment. Family physicians can make a substantial contribution to improving the quality of life of their prostate cancer patients by applying the information in this paper.
 
Article
Question: A 29-year-old woman had a carbon 14 urea breath test for diagnosis of Helicobacter pylori infection. At time of consultation, it had been 6 weeks since her last menstrual period. Four weeks after her last menstrual period, the results of a urine pregnancy test were negative. On that day, she received an ionizing radiation dose of 74 KBq (2 microCi) carbon 14 urea, followed by the breath test 30 minutes thereafter. Four days later, when the urine pregnancy test results turned positive, she was concerned about the possible effect of her exposure to ionizing radiation on the developing fetus. Answer: The amount of radiation used in these tests is extremely low-much lower than the amount a pregnant woman is absorbing through natural sources.
 
Article
To document the management of and outcomes for patients receiving narcotic replacement and tapering with long-acting morphine preparations during pregnancy. A prospective cohort study over 18 months. Northwestern Ontario. All 600 births at Meno Ya Win Health Centre in Sioux Lookout, Ont, from January 1, 2012, to June 30, 2013, including 166 narcotic-exposed pregnancies. Narcotic replacement and tapering of narcotic use with long-acting morphine preparations. Prenatal management of maternal narcotic use, incidence of neonatal abstinence syndrome, and other neonatal outcomes. The incidence of neonatal abstinence syndrome fell significantly to 18.1% of pregnancies exposed to narcotics (from 29.5% in a previous 2010 study, P = .003) among patients using narcotic replacement and tapering with long-acting morphine preparations. Neonatal outcomes were otherwise equivalent to those of the nonexposed pregnancies. In many patients, long-acting morphine preparations can be safely used and tapered in pregnancy, with a subsequent decrease in observed neonatal withdrawal symptoms.
 
Article
To determine whether high weight for length at the 18-month well-baby visit is predictive of overweight or obese body mass index (BMI) at the 4- to 6-year well-child visit. Retrospective cohort study using objective electronic medical record measurements. Eighteen family practices forming a community family health organization in Peterborough, Ont. All children from the family health organization practices with at least 1 set of weight and length or height measurements at age 17 to 19 months and age 4 to 6 years (N = 126). Relative risk (RR) of overweight BMI and RR of obese BMI at 4 to 6 years of age for normal versus overweight or obese 18-month-olds. Children who were either overweight or obese at their 18-month visits (n = 37) were more than twice as likely to be obese at age 4 to 6 years than children who had healthy weights at 18 months were (n = 89; RR = 2.71, 95% CI 1.13 to 6.47). The subgroup of obese 18-month-olds (n = 13) were at more than 3 times the risk of being obese at age 4 to 6 years than their healthy-weight-for-length counterparts (RR = 3.42, 95% CI 1.20 to 9.78). Thirty-one percent of obese 18-month-olds were obese at 4 to 6 years and a further 31% were overweight. High weight for length at 18 months substantially increased a child's risk of being overweight or obese at 4 to 6 years of age. Most overweight and obese 18-month-olds in this study did not achieve healthy BMIs by 4 to 6 years of age. A brief glance at the 18-month weight-for-length chart can easily help identify these high-risk toddlers.
 
Article
1 He was taken to Chipman in Queens County, where the overseers of the poor made arrangements for his care. He was described as an insane and indigent foreigner who was frozen for 5 days. There are 2 theories as to how Ellorimo happened to be in central New Brunswick in late December. Dr Alexander Leighton—a distinguished Harvard and Dalhousie psychiatrist who spent his summers in Digby County, NS, not far from where Ellorimo eventually lived—suggested that Ellorimo probably came from the Adriatic and was mentally defective from birth. When his family could no longer care for him, arrangements were made to send him away (ie, abandon him). He eventually arrived in Saint John, NB, where he made his way up the river and was looked after by or employed in a lumber camp. When the loggers went home for the holidays in December, Ellorimo wandered away from camp, became lost, and nearly froze to death.
 
Top-cited authors
Gideon Koren
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James Rourke
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Walter W Rosser
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Brian Hutchison
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Kevin C Pottie
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