Opioid-related deaths in Kingston, Frontenac, Lennox and Addington in Ontario, Canada: the shadow epidemic. / Décès liés aux opioïdes dans la région de Kingston, Frontenac, Lennox et Addington en Ontario, Canada : l'épidémie invisible.

INTRODUCTION: In the Kingston, Frontenac, Lennox and Addington (KFL&A) health unit, opioid overdoses are an important preventable cause of death. The KFL&A region differs from larger urban centres in its size and culture; the current overdose literature that is focussed on these larger areas is less well suited to aid in understanding the context within which overdoses take place in smaller regions. This study characterized opioidrelated mortality in KFL&A, to enhance understanding of opioid overdoses in these smaller communities. METHODS: We analyzed opioid-related deaths that occurred in the KFL&A region between May 2017 and June 2021. Descriptive analyses (number and percentage) were performed on factors conceptually relevant in understanding the issue, including clinical and demographic variables, as well as substances involved, locations of deaths and whether substances were used while alone. RESULTS: A total of 135 people died of opioid overdose. The mean age was 42 years, and most participants were White (94.8%) and male (71.1%). Decedents often had the following characteristics: being currently or previously incarcerated; using substances alone; not using opioid substitution therapy; and having a prior diagnosis of anxiety and depression. CONCLUSION: Specific characteristics such as incarceration, using alone and not using opioid substitution therapy were represented in our sample of people who died of an opioid overdose in the KFL&A region. A robust approach to decreasing opioid-related harm integrating telehealth, technology and progressive policies including providing a safe supply would assist in supporting people who use opioids and in preventing deaths.

United to Reduce Childhood Obesity in North America

Today in North America, 1 in every 3 children under the age of 18 is overweight or obese. These children are at risk of developing chronic illnesses that will affect their lifelong health and well-being. And this, in turn, affects prosperity and economic growth. In fact, across the globe, obesity siphons off approximately $2 trillion from the world economy every year. We recognize that the influences on child obesity in our countries are environmental, socio-economic and behavioral. And we know that the conditions necessary for healthy lives are not equally available to all. Some families, neighborhoods and communities cannot access affordable and nutritious foods and have fewer opportunities for regular physical activity. This is especially true in communities underserved by public transportation, fresh food outlets, recreation facilities and green spaces...

Prehospital Identification of Underlying Coronary Artery Disease by Community Paramedics.

There is a lack of definitive evidence that preventative, in-home medical care provided by highly trained community paramedics reduces acute health care utilization and improves the overall well-being of patients suffering from chronic diseases. The Expanding Paramedicine in the Community (EPIC) trial is a randomized controlled trial designed to investigate the use of community paramedics in chronic disease management (ClinicalTrials.gov ID: NCT02034045). This case of a patient randomized to the intervention arm of the EPIC study demonstrates how the added layer of frequent patient contact by community paramedics and real-time electronic medical record (EMR) correspondence between the paramedics, physicians and other involved practitioners prevented possible life-threatening complications. The visiting community paramedic deduced the need for an electrocardiogram, which prompted the primary care physician to order a stress test revealing abnormalities and thus a coronary artery bypass graft was performed without emergency procedures, unnecessary financial expenditure or further health degradation such as a myocardial infarction.

Expanding Paramedicine in the Community (EPIC): study protocol for a randomized controlled trial.

BACKGROUND: The incidence of chronic diseases, including diabetes mellitus (DM), heart failure (HF) and chronic obstructive pulmonary disease (COPD) is on the rise. The existing health care system must evolve to meet the growing needs of patients with these chronic diseases and reduce the strain on both acute care and hospital-based health care resources. Paramedics are an allied health care resource consisting of highly-trained practitioners who are comfortable working independently and in collaboration with other resources in the out-of-hospital setting. Expanding the paramedic's scope of practice to include community-based care may decrease the utilization of acute care and hospital-based health care resources by patients with chronic disease. METHODS/DESIGN: This will be a pragmatic, randomized controlled trial comparing a community paramedic intervention to standard of care for patients with one of three chronic diseases. The objective of the trial is to determine whether community paramedics conducting regular home visits, including health assessments and evidence-based treatments, in partnership with primary care physicians and other community based resources, will decrease the rate of hospitalization and emergency department use for patients with DM, HF and COPD. The primary outcome measure will be the rate of hospitalization at one year. Secondary outcomes will include measures of health system utilization, overall health status, and cost-effectiveness of the intervention over the same time period. Outcome measures will be assessed using both Poisson regression and negative binomial regression analyses to assess the primary outcome. DISCUSSION: The results of this study will be used to inform decisions around the implementation of community paramedic programs. If successful in preventing hospitalizations, it has the ability to be scaled up to other regions, both nationally and internationally. The methods described in this paper will serve as a basis for future work related to this study. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02034045. Date: 9 January 2014.

The dawn of family medicine in Ethiopia.

BACKGROUND AND OBJECTIVES: This article describes the development of the first training program in family medicine in Ethiopia that was launched on February 4, 2013, at Addis Ababa University (AAU). The postgraduate program will prepare highly trained doctors for all parts of the country who choose generalism for their lifelong career. The paper describes a series of strategies that were used from 2008 to 2013 to take the Ethiopian family medicine program from vision to reality. There is no single model for the development of family medicine in a country where it does not yet exist. In this case the strategies included Continuing Medical Education events, discussions with stakeholders, international collaboration, needs assessment, curriculum design, and faculty development. The article also reviews both the potential for a new program in family medicine to contribute to the country's health system plus the challenges that are expected in the early stages of establishing a new specialty. The challenges include the ambiguous roles of the family physician in the Ethiopian health care system, uncertainty about career opportunities, adaptation of the curriculum to address local needs, expansion of the training programs to produce larger numbers of family physicians, development of Ethiopian faculty who will be teachers of family medicine, and internal and external brain drain. Family physicians will need to maintain a respectful relationship with other specialist physicians as well as nonphysician primary care providers. The development of this AAU family medicine residency is an example of a successful inter- institutional relationship between local and international partners to create a sustainable, Ethiopian-led training program. Insights from this article may guide development of similar training programs.

A case study of global health at the university: implications for research and action.

BACKGROUND: Global health is increasingly a major focus of institutions in high-income countries. However, little work has been done to date to study the inner workings of global health at the university level. Academics may have competing objectives, with few mechanisms to coordinate efforts and pool resources. OBJECTIVE: To conduct a case study of global health at Canada's largest health sciences university and to examine how its internal organization influences research and action. DESIGN: We drew on existing inventories, annual reports, and websites to create an institutional map, identifying centers and departments using the terms 'global health' or 'international health' to describe their activities. We compiled a list of academics who self-identified as working in global or international health. We purposively sampled persons in leadership positions as key informants. One investigator carried out confidential, semi-structured interviews with 20 key informants. Interview notes were returned to participants for verification and then analyzed thematically by pairs of coders. Synthesis was conducted jointly. RESULTS: More than 100 academics were identified as working in global health, situated in numerous institutions, centers, and departments. Global health academics interviewed shared a common sense of what global health means and the values that underpin such work. Most academics interviewed expressed frustration at the existing fragmentation and the lack of strategic direction, financial support, and recognition from the university. This hampered collaborative work and projects to tackle global health problems. CONCLUSIONS: The University of Toronto is not exceptional in facing such challenges, and our findings align with existing literature that describes factors that inhibit collaboration in global health work at universities. Global health academics based at universities may work in institutional siloes and this limits both internal and external collaboration. A number of solutions to address these challenges are proposed.