Northern Ontario's Rural Physician Teams: Who, why and for how long.

Introduction: This study examines the state of Rural and Northern Physician Group Agreement (RNPGA) physician teams in rural Northern Ontario in terms of demographics, intent to stay, length of stay, number of physicians relative to the RNPGA-designated complement and perceptions of various workplace and community factors. Materials and Methods: Data were based on a survey mailed, in 2018, to Ontario physicians in RNPGA communities having a designated complement of 2 or more physicians. Physicians reported on aspects of the work environment, community and intentions to stay. Results: Sixty-five percent of all practices and 91.7% of those with a designated complement of 2 physicians were at or above their government-designated complement. Intent to stay was higher in groups below complement. The mean length of stay was 11.3 years. More physicians were male (58.7%). Older physicians were more represented in smaller practice groups. Physicians reported positive ratings on several aspects of their work environment, community and intentions to stay. Length of stay in the community was related to strong family ties and was a predictor of intent to stay. Many physicians had neither strong family ties (65.3%) nor a rural upbringing (57.3%). Conclusion: The results show positive outcomes in terms of: high intentions to stay, satisfaction with workplace and community factors, and full recruitment into RNPGA groups designated for a complement of two physicians. Further research is needed to understand the role of family ties to length of stay, and the role of level of physician complement and group size in retention and recruitment.

Résumé Introduction: Cette étude examine l'état des équipes de médecins de l'Entente relative au groupe de médecins en milieu rural et dans le Nord (EGMMRN) dans les régions rurales du Nord de l'Ontario en termes de données démographiques, d'intention de rester, de durée, de nombre de médecins par rapport à l'effectif désigné par l'EGMMRN, ainsi que de perceptions de divers facteurs liés au milieu de travail et à la communauté. Méthodes: Les données sont fondées sur un sondage envoyé par courrier en 2018 aux médecins de l'Ontario dans les communautés associées à l'EGMMRN ayant un effectif désigné de 2 médecins ou plus. Les médecins ont fait état des aspects du milieu de travail, de la communauté et de leurs intentions de rester. Résultats: Soixante-cinq pour cent de tous les cabinets et 91,7% de ceux dont l'effectif désigné est de 2 médecins se situaient au niveau ou au-dessus de leur effectif désigné par le gouvernement. L'intention de rester était plus élevée dans les groupes en dessous de l'effectif. La durée moyenne de présence était de 11,3 ans. Plus de médecins étaient des hommes (58,7%). Les médecins plus âgés étaient plus représentés dans les petits groupes de pratique. Les médecins ont attribué des notes positives à plusieurs aspects de leur environnement de travail, de leur communauté et de leur intention de rester. La durée de présence dans la communauté était liée à des liens familiaux forts et constituait un facteur prédictif de l'intention de rester. De nombreux médecins n'avaient ni des liens familiaux forts (65,3%) ni une éducation en milieu rural (57,3%). Conclusion: Les conclusions montrent des résultats positifs en termes d'intentions élevées de rester, de satisfaction à l'égard du lieu de travail et des facteurs communautaires, ainsi qu'un recrutement complet dans les groupes désignés de l'EGMMRN pour un effectif de 2 médecins. D'autres recherches sont nécessaires pour mieux comprendre le rôle des liens familiaux sur la durée de présence, ainsi que le rôle du niveau d'effectif de médecins et de la taille du groupe en matière de rétention et de recrutement. Mots-clés: Recrutement, rétention, rural.

Childbirth-Associated Fistula and Perineal Tears Repaired on Outreach Campaigns in Remote Democratic Republic of Congo.

PURPOSE: To describe the demographics and evaluate the repair of childbirth-associated injuries leading to incontinence in patients in remote Democratic Republic of Congo (DRC). PATIENTS AND METHODS: Four surgical outreach campaigns were organised between March 2018 and October 2019. These campaigns specifically targeted women with incontinence secondary to childbirth-associated injuries. Patients were recruited on a voluntary basis, and locations included Katako-kombe (Sankuru province), Wamba (Haut Uelé province), Karawa (North Ubangi province) and Kipaka (Maniema province). Necessary care was provided along with informal teaching with local healthcare professionals. RESULTS: A total of 481 patients,14-71 years old with a mean of 32 years of age, were included in this study. The average duration of incontinence associated with a childbirth injury was 6.8 years. Vesicovaginal fistulas (277/481; 57.6%) and perineal tears (148/481; 30.8%) were predominant, while the combination of vesicovaginal and rectovaginal fistulas were seen in only 5 (1.0%) patients. Vaginal delivery (259/481; 53.9%), caesarean section (120/481; 25.0%) and laparotomy (hysterectomy) (102/481; 21.2%) were identified as the causes of the fistulas treated during the surgical campaign. Vesicovaginal fistulas were more likely to require complex repairs, as compared to rectovaginal fistulas and perineal tears (P-value <0.0001). As well, vesicovaginal fistulas were less likely to result in successful resolution of the incontinence when compared to rectovaginal fistulas and perineal tears (P-value < 0.0001). CONCLUSION: Vesicovaginal fistulas are predominant among childbirth injuries encountered in remote DRC with poorly managed vaginal deliveries being the leading cause. Cure rate of fistulas and perineal tears is high during outreach campaigns; however, long-term follow-up is limited. There remains a need to train and mentor rural medical professionals in the DRC on adequate management of obstetric emergencies.

Transcriptional profiling of equine endometrium before, during and after capsule disintegration during normal pregnancy and after oxytocin-induced luteostasis in non-pregnant mares.

The current study used RNA sequencing to determine transcriptional profiles of equine endometrium collected 14, 22, and 28 days after ovulation from pregnant mares. In addition, the transcriptomes of endometrial samples obtained 20 days after ovulation from pregnant mares, and from non-pregnant mares which displayed and failed to display extended luteal function following the administration of oxytocin, were determined and compared in order to delineate genes whose expressions depend on the presence of the conceptus as opposed to elevated progesterone alone. A mere fifty-five transcripts were differentially expressed between samples collected from mares at Day 22 and Day 28 of pregnancy. This likely reflects the longer-term exposure to a relatively constant, progesterone-dominated environment with little change in factors secreted by the conceptus that would affect endometrial gene expression. The complement system was amongst the canonical pathways significantly enriched in transcripts differentially expressed between Day 14 and Day 22/28 of pregnancy. The expression of complement components 7 and 8 was confirmed using in situ hybridization. The expression of SERPING1, an inhibitor of the complement system, was confirmed by immunohistochemistry. In line with the resumed capacity of the endometrium to produce prostaglandin, prostaglandin G/H synthase 1 was expressed at higher levels at Days 22 and 28 than at Day 14 of pregnancy. Our data suggest that this up-regulation is enhanced by the presence of the conceptus; samples obtained from mares at Day 20 of pregnancy had significantly higher levels of prostaglandin G/H synthase 1 transcript than mares with extended luteal function.