Patient- and Community-Oriented Primary Care Approaches for Health in Rural, Remote and Resource-Dependent Places: Insights for Eco-Social Praxis.

Accelerating ecological and societal changes require re-imagining the role of primary care and public health to address eco-social concerns in rural and remote places. In this narrative review, we searched literatures on: community-oriented primary care, patient-oriented research engagement, public health and primary care synergies, and primary care addressing social determinants of health. Our analysis was guided by questions oriented to utility for addressing concerns of social-ecological systems in rural, remote contexts characterized by a high degree of reliance on resource extraction and development (e.g., forestry, mining, oil and gas, fisheries, agriculture, ranching and/or renewables). We describe a range of useful frameworks, processes and tools that are oriented toward bolstering the resilience and engagement of both primary care and public health, though few explicitly incorporated considerations of eco-social approaches to health or broader eco-social context(s). In synthesizing the existing evidence base for integration between primary care and public health, the results signal that for community-oriented primary care and related frameworks to be useful in rural and remote community settings, practitioners are required to grapple with complexity, durable relationships, sustainable resources, holistic approaches to clinician training, Indigenous perspectives, and governance.

Large pertussis outbreak in rural Canada: Lessons learned from Haida Gwaii.

OBJECTIVE: To present characteristics of and response to a large outbreak of pertussis on Haida Gwaii, BC, in 2014. DESIGN: Quantitative descriptive review. SETTING: Haida Gwaii, a remote island archipelago located 100 km off of British Columbia's west coast. PARTICIPANTS: All patients presenting with symptoms evaluated for pertussis on Haida Gwaii between February and August 2014. MAIN OUTCOME MEASURES: The primary outcome measures included the demographic characteristics, time course, and morbidity of the outbreak. The secondary outcome measures included the laboratory result reports, the effects on clinician workload, and the treatment and prophylaxis practices. Statistical analysis for significance of pertussis severity and immunization status was performed with a maximum-likelihood framework. RESULTS: Between February and August 2014, out of 873 clinical encounters, 579 patients were seen for pertussis-related care. Of these, 260 patients were reported to public health for case identification, contact tracing, and follow-up. There were 123 cases of probable and confirmed pertussis, a case rate of 2795 cases per 100 000 population. Of these 123 cases, 91 had a cough of more than 2 weeks' duration. A subset of patients presented with mild symptoms, atypical of pertussis. Nasopharyngeal swabs were collected on 221 occasions, 378 antibiotic prescriptions were written, and 248 prophylactic immunizations were given. The odds ratio that previous immunization protected against the development of classic pertussis was 0.23; however, statistical significance was not reached (P = .112). CONCLUSION: Pertussis is resurging. Physicians need to remain vigilant for its characteristic symptoms. Clear and standardized criteria for the declaration of an outbreak should be developed. To contain an outbreak, it is crucial to deploy resources commensurate with disease activity while coordinating public health and primary care. More research into why large outbreaks continue to occur, why endemic rates continue to rise, and how these can be most effectively prevented is essential.

Refractory cutaneous Rosai-Dorfman disease responsive to cryotherapy.

Rosai-Dorfman disease (RDD), also known as sinus histiocytosis with massive lymphadenopathy, is a rare, acquired, idiopathic, nonneoplastic histiocytosis. In many cases the skin is involved and treatment is indicated. Various treatment options have been attempted with variable success. We report a case of cutaneous Rosai-Dorfman disease (CRDD) refractory to both topical and intralesional corticosteroid therapy that showed a rapid and remarkable response to cryotherapy. These observations suggest that cryotherapy should be considered as a therapeutic option for CRDD.