Are Health Care Professionals Prepared to Provide Care for Patients Who Have Experienced Female Genital Cutting? A Cross-Sectional Survey of Canadian Health Care Providers.

Health care professionals may be underprepared to address the unique needs of patients who have experienced female genital cutting. This cross-sectional survey found that health care professionals in a large Canadian city report an overall lack of knowledge and preparedness to provide care for these patients and to address issues of defibulation, reinfibulation, child safeguarding, and legalities surrounding female genital cutting. Barriers to providing quality care include lack of training and clinical exposure. Health care professionals have indicated strong interest in further training, and consolidated efforts should be made to implement culturally informed care into health professional education.

Impact of birth tourism on health care systems in Calgary, Alberta.

BACKGROUND: Birth tourism refers to non-resident women giving birth in a country outside of their own in order to obtain citizenship and/or healthcare for their newborns. We undertook a study to determine the extent of birth tourism in Calgary, the characteristics and rationale of this population, and the financial impact on the healthcare system. METHODS: A retrospective analysis of 102 women identified through a Central Triage system as birth tourists who delivered in Calgary between July 2019 and November 2020 was performed. Primary outcome measures were mode of delivery, length of hospital stay, complications or readmissions within 6 weeks for mother or baby, and NICU stay for baby. RESULTS: Birth Tourists were most commonly from Nigeria (24.5%). 77% of Birth Tourists stated that their primary reason to deliver their baby in Canada was for newborn Canadian citizenship. The average time from arrival in Calgary to the EDD was 87 days. Nine babies required stay in the neonatal intensive care unit (NICU) and 3 required admission to a non NICU hospital ward in first 6 weeks of life, including 2 sets of twins. The overall amount owed to Alberta Health Services for hospital fees for this time period is approximately $694 000.00. CONCLUSION: Birth Tourists remain a complex and poorly studied group. The process of Central Triage did help support providers in standardizing process and documentation while ensuring that communication was consistent. These findings provide preliminary data to guide targeted public health and policy interventions for this population.

Implications for management of ovarian cancer in a transgender man: Impact of androgens and androgen receptor status.

A 36-year-old transgender man (assigned female at birth) on exogenous testosterone therapy was found to have stage IIA ovarian endometrioid carcinoma, and underwent adjuvant chemotherapy. Diffuse androgen receptor expression in the tumor initiated a multidisciplinary discussion regarding the safety of continuing exogenous testosterone as gender-affirming hormone therapy.

Uninsured Maternity Patients in Calgary: Local Trends and Survey of Health Care Workers.

OBJECTIVE: Uninsured maternity patients comprise a small but complex group of patients and include marginalized Canadians, undocumented immigrants, visitors, and non-Canadians seeking health care and/or citizenship for their newborn. This is the first Canadian study to quantify these patients and to review health care providers' perspectives and practices of care. METHODS: Data for all deliveries in Calgary, Alberta over a 4-year period (2013-2016) were analyzed. All Calgary anaesthesiologists, family physicians, midwives, neonatologists, obstetricians, and pediatricians were surveyed about their care of these patients, ethical perspectives, and knowledge of liability protection when providing such care. RESULTS: This study found a trend of uninsured deliveries in Calgary (from 0.5% in 2013 to 0.8% in 2016; P < 0.0001) that is accounted for by non-Canadian patients. Midwives and physicians agree on provision of emergency care but not preventive care. Across medical specialties, fewer caregivers felt obliged to care for non-Canadian patients seeking citizenship for their newborn. Among physicians, 61% were aware of the Canadian Medical Protective Association's guidelines on liability coverage for non-Canadian patients, and only 28% consistently protected themselves legally. There is large variation regarding whether physicians bill for services when the patient is uninsured. CONCLUSION: In Calgary, the study observed an increase in numbers of uninsured maternity patients. Differing ethical perspectives on the care of these patients may lead to conflict within health care teams because of differences on ethical perspectives of care among team members. Health care providers require education to understand the implications and challenges of obstetrical care of non-Canadians.

An undergraduate medical curriculum framework for providing care to transgender and gender diverse patients: A modified Delphi study.

INTRODUCTION: The lack of attention to transgender and gender diverse (TGD) people in undergraduate medical education (UME) is a point of concern, particularly among medical students. A project was undertaken to develop a UME curriculum framework for teaching the healthcare needs of TGD people. METHODS: Using a modified Delphi methodology, four rounds of surveys were presented to an expert stakeholder group that included content experts, generalist physicians, UME teaching faculty, and medical students. Questions covered what content should be taught, who should teach the content, and how much time should be dedicated for this teaching. Once the Delphi process was complete, feedback on the provisional framework was sought from members of the TGD community to ensure it represented their needs and perspectives. RESULTS: 71 panel members and 56 community members participated in the study. Core values included the scope of the framework, and topics such as inclusivity, and safety in practice and in teaching. The framework included terminology, epidemiology, medical and surgical treatment, mental health, sexual and reproductive health, and routine primary care. There was also guidance on who should teach, time to be allocated, and the learning environment. DISCUSSION: There is a clear need to train tomorrow's doctors to provide competent and respectful healthcare services to and for TGD patients. Although local factors will likely shape the way in which this framework will be implemented in different contexts, this paper outlines a core UME-level curriculum framework for Canada and, potentially, for use in other parts of the world.

A review of intrapartum fetal deaths, 1982 to 2002.

This study identifies cases of unexpected intrapartum fetal deaths over 20 years in a Canadian tertiary hospital. Of 121,659 births, 82 were intrapartum deaths. Eleven fetuses were considered viable and nonanomalous. Six deaths were deemed ideally preventable. Application of electronic fetal heart rate monitoring and rapid operative delivery may reduce the already low rate of intrapartum fetal deaths.