Challenges and opportunities for using administrative data to explore changes in health status: a study of the closure of the Newfoundland cod fishery.

The closure of the cod fishery in Newfoundland and Labrador has had dramatic social and economic impacts on fishing communities in the province. Following a limited closure in 1992, a more extensive closure followed in 1994, which is still in force today, although income support provided to displaced fishery workers ended in 1999. A population-based study was conducted in 2004/2005 using 7 different sources of administrative and survey data to investigate a range of social, demographic, and health changes in fishing communities affected by the closure of the cod fishery from the period 1991 to 2001. Findings of this study extend our understanding of the impact of the fishing moratorium in Newfoundland. This article also presents both the challenges to and opportunities for using administrative and survey data to explore the impact of the fishery closure on the health and well-being of Newfoundland fishing communities. One of the most significant challenges to using administrative and survey databases was the inconsistencies in how communities were identified across the various databases. Although not without limitations, administrative data is a cost-effective means to explore the impact of socioeconomic change on a population's health status.

Retention of provisionally licensed international medical graduates: a historical cohort study of general and family physicians in Newfoundland and Labrador.

BACKGROUND: To alleviate the shortage of primary care physicians in rural communities, the Canadian province of Newfoundland and Labrador (NL) introduced provisional licensure for international medical graduates (IMGs), allowing them to practise in under-served communities while completing licensing requirements. Although provisional licensing has been seen as a needed recruitment strategy, little is known about its impact on physician retention. To assess the relationship between provincial retention time and type of initial practice licence, we compared the retention of: (1) IMGs who began practice with a provisional licence; (2) fully licensed Memorial University medical graduates (MMGs); and (3) fully licensed medical graduates from other Canadian medical schools (CMGs). METHODS: Using administrative data from the NL College of Physicians and Surgeons, the 2004 Scott's Medical Database, and the Memorial University postgraduate database, we identified family physicians/general practitioners (FPs/GPs) who began their practice in NL in the period 1997-2000 and determined where they were in 2004. We used Cox regression to examine differences in retention among these 3 groups of physicians. RESULTS: There were 42 MMGs, 38 CMGs and 77 IMGs in our sample. The median time for IMGs to qualify for full licensure was 15 months. Twenty-one physicians (13.4%) stayed in NL after beginning their practice (35.7% MMGs, 5.3% CMGs, 5.2% IMGs; p < 0.000). The median retention time was 25 months (MMGs, 39 months; CMGs, 22 months; IMGs, 22 months; p < 0.000). After controlling for Certificant of the College of Family Physicians status, CMGs (hazard ratio [HR] = 2.15; 95% confidence interval [CI] 1.29-3.60) and IMGs (HR = 2.03; 95% CI 1.26-3.27) were more likely to leave NL than MMGs. CONCLUSIONS: Provisional licensing accounts for the largest proportion of new primary care physicians in NL but does not lead to long-term retention of IMGs. However, IMG retention is no worse than the retention of CMGs.

Physicians as mothers: breastfeeding practices of physician-mothers in Newfoundland and Labrador.

OBJECTIVE: To determine the initiation rate and duration of breastfeeding among female physicians in Newfoundland and Labrador, and to identify demographic factors that might influence duration of breastfeeding in this population. DESIGN: Mailed survey. SETTING: Newfoundland and Labrador. PARTICIPANTS: One hundred eighty licensed female physicians. MAIN OUTCOME MEASURES: Self-reported initiation of breastfeeding for each baby born, duration of breastfeeding in number of months, and reasons for ending breastfeeding. RESULTS: The response rate was 68%. The breastfeeding initiation rate among respondents was 96.6%. More physicians who graduated in 1980 or later breastfed for longer periods (63.9% vs 33.3%, P = .008). More family doctors than specialists breastfed their babies for longer periods (65.5% vs 33.3%, P = .004). More physicians whose partners were working part-time breastfed for longer periods than physicians whose partners were working full-time (83.3% vs 50.8%, P = .037). Other factors, such as age, income, maternity leave and benefits, part-time or full-time work, and urban or rural practice, did not affect duration of breastfeeding. Personal issues accounted for 51% of respondents' ending breastfeeding; baby issues accounted for 38%, practice issues for 33%, medical school issues for 4%, and societal issues for 1%. CONCLUSION: The breastfeeding initiation rate among female physician respondents in Newfoundland and Labrador was 96.6%; more than 50% of these physicians breastfed for longer than 7 months. Physicians graduating in 1980 or later breastfed their babies for longer.

Having a regular doctor: rural, semi-urban and urban differences in Newfoundland.

INTRODUCTION: Recent studies suggest that 23% of adult Newfoundlanders do not have a regular doctor. Using data from the 1995 Newfoundland Panel on Health and Medical Care study, we examined the urban, semi-urban and rural differences in the characteristics of adult (age 20 and over) Newfoundlanders who did and did not have a regular doctor. METHODS: We used chi2 tests and logistic regression to analyze data from 11,789 respondents from randomly selected households in Newfoundland. The dependent variable was "Have a regular doctor" (Yes / No). The independent variable was "Place of residence" (Urban / Semi-urban / Rural) and covariates included socio-demographic and health-related variables. RESULTS: Fifteen percent (1771) of Newfoundlanders did not have a regular doctor. Of these, the largest proportion of respondents without a regular doctor lived in rural communities (74.4%); were male (62.6%); were 20-29 years old (28.7%); married (68.8%); of high socio-economic status (44.7%); working full-time (35.3%); had excellent or good health (83.0%); had no chronic illness (40.3%), disability (93.3%) or impairments to activities of daily living (98.0%); and were in excellent or good emotional health (90.7%). Compared to their urban counterparts, residents of semi-urban communities were as likely (odds ratio 1.03; 95% confidence interval [CI] 0.84-1.26) not to have a regular doctor and residents of rural communities were 4.03 (95% CI 3.50-4.65) times more likely than their urban counterparts not to have a regular doctor. CONCLUSION: In 1995, fewer adult Newfoundlanders than previously estimated did not have a regular doctor. Rural residents were more likely not to have a regular doctor than residents of either urban or semi-urban communities.

The G8 Heart Health Projects Database: testing the compatibility of an Internet-based resource with health promotion planning processes.

This study examined the context and processes in which health promotion policy and program decisions are made to ensure that an Internet-based information system on heart health promotion programs provides appropriate information for decision makers' needs and is compatible with their decision-making processes. Five focus groups and six individual interviews were conducted with potential users of and contributors to the G8 Heart Health Projects Database. Results suggest that Internet-based systems such as this are seen as useful tools, but will only be used at certain critical points in program development and then, only when they meet several rigorous criteria. Systems must be completely credible and up-to-date, providing instant answers to complex questions about program design, implementation, and effectiveness, with adequate qualitative information for assessing contextual applicability. Participants also provided information about the conditions required if they were to submit project information to the system.