Delayed Access to Medical Care and Psychological Distress among Chinese Immigrants in Canada during the Pandemic.

The psychological impact of medical care accessibility during the pandemic has been widely studied, but little attention has been given to Asian immigrants in Canada. This study aimed to fill this literature gap by using a cross-sectional survey, which aimed to evaluate the impact of the COVID-19 pandemic on Chinese immigrants in North America during the second wave of the pandemic. The study focused on Chinese immigrants aged 16 or older in Canada. Covariates included sociodemographic variables, delayed access to medical care (i.e., treatment or health assessment), and other COVID-19 related variables. We used logistic LASSO regression for model selection and multivariate logistic regression models to evaluate the association between delayed access to treatment/health assessment and psychological distress outcome, as measured by the COVID-19 Peritraumatic Distress Index (CPDI). Missing data were handled using multiple imputation. Our study included 746 respondents, with 47.18% in the normal CPDI group and 36.82% in the mild-to-severe CPDI group. Most respondents were originally from Mainland China and residing in Ontario. Over half have stayed in Canada for at least 15 years. The multivariate logistic regression models identified significant risk predictors of psychological distress status: delayed access to medical care (OR = 1.362, 95% CI: 1.078-1.720, p = 0.0095), fear of COVID-19 (OR = 1.604, 95% CI: 1.293-1.989, p < 0.0001), and social loneliness (OR = 1.408, 95%CI: 1.314-1.508, p < 0.0001). Sociodemographic variables and other COVID-19-related variates did not significantly impact the study's outcome. Our findings shed light on the importance of timely medical care access to psychological well-being among Chinese Canadians. Reliable health information, mental health support, and virtual care tailored to immigrants should be considered to mitigate this impact and promote their overall health and well-being.

Telepharmacy in oncology care: A scoping review.

INTRODUCTION: Telepharmacy has the potential to enhance pharmacy services in oncology care, especially in remote areas. This scoping review explored the range, critical benefits and barriers of using telepharmacy services in oncology care. METHODS: The scoping review followed the Arksey and O'Malley's five-stage framework to identify available evidence. PubMed, CINAHL, Embase, PsycINFO, Ovid MEDLINE and Scopus databases were searched for original research published between 2010 and 2020. The five dimensions of the Alberta Quality Matrix for Health were used to analyse reported outcomes. RESULTS: Eligible articles (n = 21) were analysed. Telepharmacy in oncology care was used for follow-up, monitoring and counselling, intravenous chemotherapy and sterile compounding, expanding availability of pharmacy services, and remote education. Telepharmacy obtained high acceptability among cancer patients (n = 5) and healthcare professionals (n = 5), and increased accessibility of pharmaceutical services to underserved cancer populations (n = 2). Commonly cited effectiveness and safety outcomes were improved patient adherence (n = 5), increased pharmacy services (n = 3) and early identification of medication-related problems (n = 5). Telepharmacy improved efficiency in staffing and workload (n = 3), and increased cost savings (n = 3). A shortage of resources (n = 5), technical problems (n = 4) and prolonged turnaround time (n = 4), safety concerns (n = 2) and patient willingness to pay (n = 1) were identified barriers to implementing telepharmacy in oncology care. DISCUSSION: Despite evidence pointing to the advantages and opportunities for expanding oncology pharmacy services through telepharmacy, certain challenges remain. Further research is needed to investigate safety concerns and patient willingness to pay for telepharmacy services.

A single-entry model and wait time for hip and knee replacement in eastern health region of Newfoundland and Labrador 2011-2019.

BACKGROUND: A single-entry model in healthcare consolidates waiting lists through a central intake and allows patients to see the next available health care provider based on the prioritization. This study aimed to examine whether and to what extent the prioritization reduced wait times for hip and knee replacement surgeries. METHOD: The survival regression method was used to estimate the effects of priority levels on wait times for consultation and surgery for hip and knee replacements. The sample data included patients who were referred to the Orthopedic Central Intake clinic at the Eastern Health region of Newfoundland and Labrador and had surgery of hip and knee replacements between 2011 and 2019. RESULT: After adjusting for covariates, the hazard of having consultation booked was greater in patients with priority 1 and 2 than those in priority 3 when and at 90 days after the referral was made for both hip and knee replacements. Regarding wait time for surgery after the decision for surgery was made, while the hazard of having surgery was lower in priority 2 than in priority 3 when and indifferent at 182 days after the decision was made, it was not significantly different between priority 1 and priority 3 among hip replacement patients. Priority levels were not significantly related to the hazard of having surgery for a knee replacement after the decision for surgery was made. Overall, the hazard of having surgery after the referral was made by a primary care physician was greater for patients in high priority than those in low priority. Preferring a specific surgeon indicated at referral was found to delay consultation and it was not significantly related to the total wait time for surgery. Incomplete referral forms prolonged wait time for consultation and patients under age 65 had a longer total wait time than those aged 65 or above. CONCLUSION: Patients with high priority could have a consultation booked earlier than those with low priority and prioritization in a single entrance model shortens the total wait time for surgery. However, the association between priority levels and wait for surgery after the decision for surgery was made has not well-established.

Temporal increase in organic mercury in an endangered pelagic seabird assessed by century-old museum specimens.

Methylmercury cycling in the Pacific Ocean has garnered significant attention in recent years, especially with regard to rising mercury emissions from Asia. Uncertainty exists concerning whether increases in anthropogenic emissions over time may have caused increased mercury bioaccumulation in the biota. To address this, we measured total mercury and, for a subset of samples, methylmercury (the bioaccumulated form of mercury) in museum feathers from an endangered seabird, the black-footed albatross (Phoebastria nigripes), spanning a 120-y period. We analyzed stable isotopes of nitrogen (δ(15)N) and carbon (δ(13)C) to control for temporal changes in trophic structure and diet. In post-1940 and -1990 feathers, we detected significantly higher mean methylmercury concentrations and higher proportions of samples exhibiting above deleterious threshold levels (∼ 40,000 ng · g(-1)) of methylmercury relative to prior time points, suggesting that mercury toxicity may undermine reproductive effort in the species. We also found higher levels of (presumably curator-mediated) inorganic mercury in older specimens of albatross as well as two nonpelagic species lacking historical exposure to bioavailable mercury, patterns suggesting that studies on bioaccumulation should measure methylmercury rather than total mercury when using museum collections. δ(15)N contributed substantially to models explaining the observed methylmercury variation. After simultaneously controlling for significant trends in δ(13)C over time and δ(15)N with methylmercury exposure, year remained a significant independent covariate with feather methylmercury levels among the albatrosses. These data show that remote seabird colonies in the Pacific basin exhibit temporal changes in methylmercury levels consistent with historical global and recent regional increases in anthropogenic emissions.