Changes in Children and Youth's Mental Health Presentations during COVID-19: A Study of Primary Care Practices in Northern Ontario, Canada.

Recent research suggests that children and youth are at increased risk of anxiety and depression due to the indirect effects of the COVID-19 pandemic. In Canada, children and youths may face additional hurdles in accessing mental health services in rural areas due to socioeconomic disadvantages and healthcare provider shortages worsened by the pandemic. Our study aimed to assess changes in primary healthcare utilization related to depression and anxiety among children and youth aged 10-25 years in Northern Ontario, Canada. We analyzed de-identified electronic medical record data to assess primary healthcare visits and prescriptions for depression and anxiety among children and youth aged 10-25 years. We used provider billing data and reasons for visits and antidepressant/antianxiety prescriptions compared with 21 months pre-pandemic (1 June 2018 to 28 February 2020) and 21 months during the pandemic (1 April 2020 to 31 December 2021). Our interrupted time series analysis showed an average increase in visits by 2.52 per 10,000 person-months and in prescriptions by 6.69 per 10,000 person-months across all ages and sexes. Females aged 10 to 14 years were found to have the greatest relative change in visits across all age-sex groups. The greatest relative increases in antianxiety and antidepression prescriptions occurred among females and males aged 10 to 14 years, respectively. These findings indicate that there were increased anxiety and depression presentations in primary healthcare among children and youths living in northern and rural settings during the COVID-19 pandemic. The increased primary healthcare presentations of anxiety and depression by children and youths suggest that additional mental health resources should be allocated to northern rural primary healthcare to support the increased demand. Adequate mental health professionals, accessible services, and clinical recommendations tailored to northern rural populations and care settings are crucial.

A model for faculty engagement in distributed medical education: Crafting a paddle.

Distributed medical education initiatives are now a key component of all Canadian medical schools. The success of these initiatives requires engaged community-based faculty who are able to successfully balance both their clinical and educational responsibilities. Present understanding of faculty engagement within distributed medical education is limited. Faculty engagement is a complex and multifaceted construct that includes a reciprocal relationship between a Faculty of Medicine and their faculty. Clarification of both the extrinsic and intrinsic motivators of distributed faculty provide opportunities for Faculties of Medicine to more fully engage their faculty and sustain distributed medical education programs.

Evaluation of a novel model for rural obstetric care.

INTRODUCTION: The group practice physicians in Marathon, a small rural community in northwestern Ontario, discovered general lifestyle dissatisfaction with the traditional model for obstetric practice. The old model of doing the follow-up and delivery for one's own patients created perceived onerous on-call responsibilities. The providers created a new model of obstetric care. This involved the local providers of obstetric care each taking 1 month of the year in rotation and following up any woman due in that month for prenatal and intrapartum services. This study is an investigation of patient and provider satisfaction with this model. METHODS: Patient survey: We surveyed all 73 women who received obstetric care under the new model during its first 14 months of implementation. We collected data on patient demographics and patients' satisfaction with their obstetric experience using Likert scale, yes/no and short-answer questions. Physician survey: We surveyed the 9 physicians of Marathon Family Practice using Likert scale, yes/no and short-answer questions. We collected information on demographics, history of involvement with obstetric service, and comparison of old and new models with regard to patient care, and professional and personal issues. RESULTS: Patient survey: The response rate was 56%. Of the respondents, 97% reported their expectations for their obstetric care were met, if not surpassed, and 100% were satisfied with their obstetric care. Physician survey: All the physicians responded and found the new model to cause less disruption of their family practice (Wilcoxon signed rank test, p = 0.041), to improve scheduling of personal activities (p = 0.017) and to improve their satisfaction with on-call hours (p = 0.027). Overall, the physicians were satisfied with the new model and preferred it to the old model. CONCLUSION: This obstetric care model meets patients' expectations and provides patient satisfaction. It provides practitioners with an increased quality of life and greater satisfaction. It is a viable paradigm for the provision of obstetric care in the appropriate setting.

Home or away? Factors affecting where women choose to give birth.

OBJECTIVE: To investigate the factors that influence women to deliver their babies in small rural communities rather than in larger centres that have more comprehensive obstetric services, including cesarean section capability and epidural anesthesia. DESIGN: Self-administered survey. SETTING: Marathon, Ont, a rural community of 4500 in north western Ontario that offers low-risk obstetric services and has no local cesarean section capability. The closest referral centre, Thunder Bay, is 300 km away. PARTICIPANTS: Sixty-four women between 16 and 40 years old living in Marathon. MAIN OUTCOME MEASURES: The relative importance of personal and systemic factors and of beliefs that influence women to choose to give birth in Marathon rather than a larger centre. How well informed women are about local obstetric services. How likely women would be to choose to deliver in Marathon if they had low-risk pregnancies. RESULTS: Beliefs were more important than personal and systemic factors in influencing women's decisions. Respondents were moderately well informed about local obstetric services (mean proportion of correct responses was 66%). Most women with low-risk pregnancies would choose to deliver in Marathon (77.8%). CONCLUSION: For women in Marathon, beliefs are much more important than personal and systemic factors in influencing the decision to give birth in this small rural community.

Gender and power: Nurses and doctors in Canada.

BACKGROUND: The nurse-doctor relationship is historically one of female nurse deference to male physician authority. We investigated the effects of physicians' sex on female nurses' behaviour. METHODS: Nurses at an urban, university based hospital completed one of two forms of a vignette-based survey in January, 2000. Each survey included four clinical scenarios. In form 1 of the questionnaire the physicians described were female, male, female, and male. In form 2, vignettes were identical but the physician sex was changed to male, female, male, and female. Differences in responses to questions based on the sex of the physician in each vignette were studied RESULTS: 199 self-selected nurses completed the survey. The responses of 177 female respondents and 11 respondents who did not specifiy their sex, and were assumed to be female based on the overall sex ratio of respondents, were analysed. Persistent sex-role stereotypes influenced the relationship between female nurses and physicians. Nurses were more willing to serve and defer to male physicians. They approached female physicians on a more egalitarian basis, were more comfortable communicating with them, yet more hostile toward them. CONCLUSION: When nurses and doctors are female, traditional power imbalances in their relationship diminish, suggesting that these imbalances are based as much on gender as on professional hierarchy. The effects of this change on the authority of the medical profession, the role of nurses, and on patient care merit further exploration.