New obesity treatment: Fasting, exercise and low carb diet - The NOT-FED study.

INTRODUCTION: Due to high rates of obesity in Canada, weight loss is an important primary care challenge. Recent innovations in strategies include intermittent fasting and low-carbohydrate diets, with limited research in a rural setting. METHODS: This prospective 1-year observational study provided patients in Sioux Lookout, Northwestern Ontario with information on fasting and low-carbohydrate diets. Patients were recommended to attend every 3 months for measurements of weight, waist circumference, body mass index (BMI) and blood pressure. Initial and 6-month bloodwork included A1c and Lipids. A survey of health status and diet was administered at 6 months. RESULTS: Of the 94 initial registrants, 36 participants completed 1 year and achieved a 9% weight loss and an 8.6% decrease in BMI and waist circumference. Most participants were female with an average age of 60 years. Clinically insignificant changes in blood pressure and serology were observed. Participants reported few side effects and good compliance with intermittent fasting, averaging 15 h/day, 6 days/week. As in other dietary studies, the dropout rate was high at 62%. CONCLUSION: This low-resource initiative was successful in assisting self-selected patients at a rural primary care clinic to achieve significant weight loss at 1-year. This approach is practical and is fertile ground for ongoing research.

Introduction: En raison du taux élevé d'obésité au Canada, la perte pondérale est un énorme défi en première ligne. Les récentes innovations stratégiques incluent le jeûne intermittent et les régimes faibles en glucides, qui ont fait l'objet de peu de recherche dans les contextes ruraux. Méthodologie: Cette étude prospective d'observation d'un an a fourni aux patients de Sioux Lookout, du Nord-Ouest de l'Ontario de l'information sur le jeûne et les régimes faibles en glucides. On recommandait aux patients de se présenter tous les 3 mois pour mesurer le poids, le tour de taille, l'IMC et la tension artérielle. Les analyses sanguines initiales et à 6 mois comptaient les taux d'HbA1C et de lipides. Un sondage sur l'état de santé et le régime alimentaire était administré à 6 mois. Résultats: Sur les 94 personnes initialement inscrites, 36 participants ont terminé l'étude d'un an et ont perdu 9 % de leur poids et ont réduit l'IMC et le tour de taille de 8,6 %. La plupart des participants étaient de sexe féminin et l'âge moyen était de 60 ans. Des variations significatives sur le plan clinique de la tension artérielle et de la sérologie ont été observées. Les participants ont signalé peu d'effets indésirables et ont bien observé le jeûne intermittent, en moyenne pendant 15 heures/jour, 6 jours sur 7. Tout comme dans les autres études sur les régimes alimentaires, le taux d'abandons était élevé, à 62 %. Conclusion: Cette initiative nécessitant peu de ressources a réussi à aider les patients volontaires recrutés dans une clinique rurale de première ligne à perdre significativement de poids à un an. Cette approche est pratique et est un terreau fertile pour la recherche qui continue. Mots-clés: diabète, obésité, régimes faibles en glucides, jeûne intermittent.

Characterizing high-frequency emergency department users in a rural northwestern Ontario hospital: a 5-year analysis of volume, frequency and acuity of visits.

INTRODUCTION: High-frequency emergency department users contribute substantially to urban emergency department workloads. The scope of this issue in rural emergency care provision is largely unknown. METHODS: We retrospectively analyzed emergency department visits at the Sioux Lookout Meno Ya Win Health Centre and associated primary care data from 2010 to 2014 for high-frequency (≥ 6 annual visits) and non-high-frequency(< 6 annual visits) emergency department users. RESULTS: High-frequency use of the emergency department was stable over the study period. High-frequency users constituted 7.2% of the emergency department patient population and accounted for 31.3% of the emergency department workload and 24.3% of hospital admissions. High-frequency users had similar clinical presentations as non-high-frequency users but required fewer admissions per emergency department visit (5.3% vs. 7.6%, p < 0.001). High-frequency users had more low-acuity presentations and concurrently accessed primary care services twice as often as non-high-frequency users. Females outnumbered males across all age categories in both user groups. CONCLUSION: High-frequency emergency department use is an important issue for rural hospitals. High use of this rural emergency department was not associated with limited use of primary care services. Aside from accepting that "they will always be with us," more research, particularly qualitative, is needed to understand why some patients frequently visit a rural emergency department.

INTRODUCTION: Les grands utilisateurs des services d'urgence contribuent substantiellement au fardeau de ces unités en milieu urbain. On connaît mal l'ampleur de cet enjeu lorsqu'il est question des services d'urgence en milieu rural. METHODS: Nous avons analysé rétrospectivement les consultations aux services d'urgence du Centre de santé Meno Ya Win de Sioux Lookout et les données associées concernant les soins primaires de 2010 à 2014 chez les grands utilisateurs (≥ 6 consultations/année) et les autres utilisateurs (< 6 consultations/année) des services d'urgence. RESULTS: Chez les grands utilisateurs, le recours aux services d'urgence est demeuré stable pendant la période de l'étude. Ils ont représenté 7,2 % de l'achalandage de ces services, 31,3 % du fardeau de travail et 24,3 % des hospitalisations. Les grands utilisateurs présentaient des tableaux cliniques similaires à ceux des autres utilisateurs, mais ont nécessité moins d'hospitalisations par consultation (5,3 % c. 7,6 %, p < 0,001). Les grands utilisateurs présentaient plus de tableaux peu aigus et accédaient concomitamment aux services de soins primaires 2 fois plus souvent que les autres utilisateurs. Les femmes étaient plus nombreuses que les hommes, toutes catégories d'âge confondues, chez les 2 types d'utilisateurs. CONCLUSION: Les grands utilisateurs des services d'urgence constituent un enjeu de taille pour les hôpitaux ruraux. La grande utilisation de ces services d'urgence n'a pas été associée à une utilisation limitée des services de soins primaires. À part se résigner au fait que « les grands utilisateurs feront toujours partie du tableau ¼, il faut approfondir la recherche, qualitative principalement, pour comprendre pourquoi certains patients consultent souvent les services d'urgence de l'hôpital rural.

Opioid use in pregnancy and parenting: An Indigenous-based, collaborative framework for Northwestern Ontario.

Opioid use affects up to 30% of pregnancies in Northwestern Ontario. Health care providers in Northwestern Ontario have varying comfort levels providing care to substance-involved pregnant women. Furthermore, health care practitioners, social service agencies and community groups in Northwestern Ontario often work in isolation with little multidisciplinary communication and collaboration. This article describes two workshops that brought together health and social service providers, community organizations, as well as academic institutions and professional organizations involved in the care of substance-involved pregnant and parenting women. The initial workshop presented best practices and local experience in the management of opioid dependence in pregnancy while the second workshop asked participants to apply a local Indigenous worldview to the implementation of clinical, research and program priorities that were identified in the first workshop. Consensus statements developed by workshop participants identified improved transitions in care, facilitated access to buprenorphine treatment, stable funding models for addiction programs and a focus on Indigenous-led programming. Participants identified a critical need for a national strategy to address the effects of opioid use in pregnancy from a culturally safe, trauma-informed perspective that takes into account the health and well-being of the woman, her infant, her family and her community.

A 5 year retrospective study of emergency department use in Northwest Ontario: a measure of mental health and addictions needs.

OBJECTIVE: The main objective of this study was to understand the five-year trend in total emergency department (ED) visits, frequency of use, and diagnoses and disposition of patients. Since the region has experienced a profound increase in opioid use disorder since 2009, we were particularly interested in changes in the volume of mental health and addiction (MHA) ED presentations. METHODS: Retrospective aggregate data analysis of ED visits to the Sioux Lookout Meno Ya Win Health Centre 2010-2014. RESULTS: ED visit volume increased 29% over the five-year study period, while MHA ED visits increased 73%. The admission rate remained stable at 6.9% of ED visits. Five-year trends in clinically grouped diagnostic categories identified respiratory, MHA, and abdominal/pelvic complaints as the three most common ED presentations. In 2014, MHA presentations accounted for 10.3% of ED visits, 8.7% of admissions, and 20.0% of inter-hospital transfers. CONCLUSION: The dramatic increase in MHA ED visits mirrors the opioid epidemic the region is experiencing. MHA may soon become the commonest ED presentation. If reasons for ED visits serve as a proxy for unmet outpatient needs, increased efforts at developing community MHA services and addressing the related social determinants of health are required.

Delivering away from home: the perinatal experiences of First Nations women in northwestern Ontario.

INTRODUCTION: Our objective was to understand the perinatal knowledge and experiences of First Nations women from northwestern Ontario who travel away from their remote communities to give birth. METHODS: A systematic review of MEDLINE, HealthSTAR, HAPI, Embase, AMED, PsycINFO and CINAHL was undertaken using Medical Subject Headings and keywords focusing on Canadian Aboriginal (First Nations, Metis and Inuit) prenatal education and care, and maternal health literacy. This qualitative study using semistructured interviews was conducted in a rural hospital and prenatal clinic that serves First Nations women. Thirteen women from remote communities who had travelled to Sioux Lookout, Ont., to give birth participated in the study. RESULTS: We identified 5 other qualitative studies that explored the birthing experiences of Aboriginal women. The studies documented a negative experience for women who travelled to access intrapartum maternity care. While in Sioux Lookout to give birth, our participants also experienced loneliness and missed their families. They were open to the idea of a culturally appropriate doula program and visits in hospital by First Nations elders, but they were less interested in access to tele-visitation with family members back in their communities. We found that our participants received most of their prenatal information from family members. CONCLUSION: First Nations women who travel away from home to give birth often travel great cultural and geographic distances. Hospital-based maternity care programs for these women need to achieve a balance of clinical and cultural safety. Programs should be developed to lessen some of the negative consequences these women experience.

Traditional First Nations birthing practices: interviews with elders in Northwestern Ontario.

OBJECTIVES: Traditionally, First Nations maternity care was provided by community-based midwives trained through apprenticeship. Obstetrical practices and beliefs were integrated to provide holistic care. The Sioux Lookout Meno Ya Win Health Centre has a mandate to be a centre of excellence for Aboriginal health care. We undertook a literature review and performed a qualitative research study to understand some of the traditional practices in maternity care. METHODS: We conducted qualitative semi-structured interviews in English and Oji-Cree with 12 elders who had knowledge and experience of historical birthing practices in their home communities. Research team members included nursing and medical personnel and Anishinabe First Nation members. Interviews were analyzed and themes developed and verified by member checking and triangulation. RESULTS: The hands-on training for a community-based midwife often began in her teenage years with observation of childbirth practices. Practices were handed down by oral tradition and included prescriptions for healthy diet and moderate exercise during pregnancy; intrapartum care with preparation of clean cloths, moss, and scissors; the involvement of certain supportive family and community members; careful attention to the sacred handling of the placenta and umbilical cord; and careful wrapping of the newborn in fur. Complications, sometimes fatal, included retained placentas and stillbirths. CONCLUSION: The provision of modern maternity care to Aboriginal patients should include acknowledgement of, and respect for, traditional birthing practices. Facilities providing care for these patients should consult with the relevant Aboriginal communities to understand their needs and initiate appropriate programming.