The Lived Experiences and Challenges Faced by Male Nursing Students: A Canadian Perspective

Background: Despite the impending shortage of nurses inCanada and globally, the recruitment and retention of malesto the profession has been a challenge in the new millenniumdue to a variety of social barriers and negative stereotypespropagated by the mass and social media, and in part byschools of nursing themselves.Purpose: To examine the lived experiences of male nursingstudents in Ontario, Canada and their perceptions ofreported educational and practice barriers, and socialstereotypes.Design: A phenomenological approach was employed toexamine the lived experiences of 37 male nursing students.Methods: Purposive and snowball sampling techniques wereemployed to recruit male students from a mid-sizeduniversity school of nursing. In depth, face-to-faceinterviews were conducted and guided by semi-structuredopen-end questions. Interviews were transcribed verbatim,coded and thematically categorized to make sense of theessential meanings.Results: Barriers to recruitment and retention of males inschools of nursing included the feminization of nursingcurriculums; reverse discrimination by female nursingstudents, faculty and nursing clinical staff; a lack of positivemale role models in academia, and negative socialstereotypes including that men in nursing are effeminate,gay or are labeled as inappropriate caregiversConclusion: The active recruitment and retention of malesinto schools of nursing may help to address, in part, thepredicted global shortages facing the profession, while alsohelping to promote gender diversity and social equity in thiscritical health care profession

Exposure to Video Display Terminals and Associated Neuromuscular Pain and Discomfort in Male and Female Undergraduate University Students

This paper explores the gender differences with respect to potential negative physical effects associated with prolonged Video Display Terminal (VDT) use. In this cross-sectional survey, we distributed self- reported health questionnaire along with the Nordic Musculoskeletal Questionnaire (NMQ) to 278 University of Ontario students (95 males and 183 females, aged between 17-32 years) in Oshawa, Ontario, Canada. Results showed that female students suffered more pain/discomfort in the neck/shoulder/hand and wrist (64.1%) in comparison to males (45.7%). Location of pain was also different in female students when compared to male students. This study provides preliminary evidence to suggest that female UOIT students experienced increased negative health effects on exposure to VDTs in comparison to male students. This study will help facilitate more targeted interventions towards millennials and assist them in reducing pain/discomfort they may experience when using devices with VDTs

Mechanical circulatory support in advanced heart failure - patient selection, treatment strategies and outcomes

Background: Heart transplantation (HTx) remains the major treatment option for selected patients with end-stage heart failure. In hemodynamically unstable patients, or when there is a considerable risk of deterioration or death during the waiting time for transplantation, treatment with mechanical circulatory support (MCS) can be lifesaving. Durable MCS usually involves either a left ventricular assist device (LVAD) or a biventricular assist device (BiVAD) and can be either fully implantable or paracorporeal. Optimizing patient selection and the choice of pump strategy may lead to fewer complications and better patient outcomes. Aims: (I) To investigate patients receiving a paracorporeal ‘EXCOR’ pump due to ineligibility for implantable MCS and to study their outcomes and pump-related complications. (II) To study adult patients receiving an EXCOR BiVAD as a bridge to transplantation and to compare them with contemporary LVAD recipients. (III) To investigate the effect of durable MCS treatment and consequent HTx on renal function. (IV) To compare post-transplantation outcomes between patients treated with or without durable MCS as a bridge to HTx. Methods: Papers I–II are based on a local registry covering all patients who received durable MCS at Sahlgrenska University Hospital. Papers III–IV are based on the Transplant Registry at Sahlgrenska University Hospital. Data from these registries were analyzed retrospectively. Results: (I) Treatment with paracorporeal ‘EXCOR’ pumps resulted in high survival in both children and adults. Safety was acceptable, but thromboembolism, mechanical pump problems and infections were the most significant complications. (II) Furthermore, survival was comparable between adult contemporary LVAD and BiVAD patients, although the latter were in a hemodynamically more compromised state at baseline. (III) Treatment with durable MCS led to an improvement in measured glomerular filtration rate (mGFR). After HTx, mGFR tended to decline again, but in some subgroups of patients a steady improvement in mGFR was seen. (IV) No differences were observed in graft survival, biopsy-proven rejections or renal function compared with HTx patients not bridged with MCS. Conclusions: Durable MCS devices of different types can achieve good long-term outcomes as a bridge to transplantation. The results, especially in BiVAD patients, were similar to or better than those previously described. Treatment with durable MCS can be used to stabilize renal function before HTx and was not associated with worse post-HTx outcomes

Colon cancer care and survival: income and insurance are more predictive in the USA, community primary care physician supply more so in Canada

Background: Our research group advanced a health insurance theory to explain Canada’s cancer care advantages over America. The late Barbara Starfield theorized that Canada’s greater primary care-orientation also plays a critically protective role. We tested the resultant Starfield-Gorey theory by examining the effects of poverty, health insurance and physician supplies, primary care and specialists, on colon cancer care in Ontario and California. Methods: We analyzed registry data for people with non-metastasized colon cancer from Ontario (n = 2,060) and California (n = 4,574) diagnosed between 1996 and 2000 and followed to 2010. We obtained census tract-based socioeconomic data from population censuses and data on county-level physician supplies from national repositories: primary care physicians, gastroenterologists and other specialists. High poverty neighborhoods were oversampled and the criterion was 10 year survival. Hypotheses were explored with standardized rate ratios (RR) and tested with logistic regression models. Results: Significant inverse associations of poverty (RR = 0.79) and inadequate health insurance (RR = 0.80) with survival were observed in the California, while they were non-significant or non-existent in Ontario. The direct associations of primary care physician (RRs of 1.32 versus 1.11) and gastroenterologist (RRs of 1.56 versus 1.15) supplies with survival were both stronger in Ontario than California. The supply of primary care physicians took precedence. Probably mediated through the initial course of treatment, it largely explained the Canadian advantage. Conclusions: Poverty and health insurance were more predictive in the USA, community physician supplies more so in Canada. Canada’s primary care protections were greatest among the most socioeconomically vulnerable. The protective effects of Canadian health care prior to enactment of the Affordable Care Act (ACA) clearly suggested the following. Notwithstanding the importance of insuring all, strengthening America’s system of primary care will probably be the best way to ensure that the ACA’s full benefits are realized. Finally, Canada’s strong primary care system ought to be maintained

Better Colon Cancer Care for Extremely Poor Canadian Women Compared with American Women

Extremely poor Canadian women were recently observed to be largely advantaged on most aspects of breast cancer care as compared with similarly poor, but much less adequately insured, women in the United States. This historical study systematically replicated the protective effects of single- versus multipayer health care by comparing colon cancer care among cohorts of extremely poor women in California and Ontario between 1996 and 2011. The Canadian women were again observed to have been largely advantaged. They were more likely to have received indicated surgery and chemotherapy, and their wait times for care were significantly shorter. Consequently, the Canadian women were much more likely to experience longer survival times. Regression analyses indicated that health insurance nearly completely explained the Canadian advantages. Implications for contemporary and future reforms of U.S. health care are discussed

Palliative chemotherapy among people living in poverty with metastasised colon cancer: Facilitation by primary care and health insurance

Background: Many Americans with metastasised colon cancer do not receive indicated palliative chemotherapy. We examined the effects of health insurance and physician supplies on such chemotherapy in California. Methods: We analysed registry data for 1199 people with metastasised colon cancer diagnosed between 1996 and 2000 and followed for 1 year. We obtained data on health insurance, census tract-based socioeconomic status and county-level physician supplies. Poor neighbourhoods were oversampled and the criterion was receipt of chemotherapy. Effects were described with rate ratios (RR) and tested with logistic regression models. Results: Palliative chemotherapy was received by less than half of the participants (45%). Facilitating effects of primary care (RR=1.23) and health insurance (RR=1.14) as well as an impeding effect of specialised care (RR=0.86) were observed. Primary care physician (PCP) supply took precedence. Adjusting for poverty, PCP supply was the only significant and strong predictor of chemotherapy (OR=1.62, 95% CI 1.02 to 2.56). The threshold for this primary care advantage was realised in communities with 8.5 or more PCPs per 10 000 inhabitants. Only 10% of participants lived in such well-supplied communities. Conclusions: This study’s observations of facilitating effects of primary care and health insurance on palliative chemotherapy for metastasised colon cancer clearly suggested a way to maximise Affordable Care Act (ACA) protections. Strengthening America’s system of primary care will probably be the best way to ensure that the ACA’s full benefits are realised. Such would go a long way towards facilitating access to palliative care

Incidence and prevalence of dementia in linked administrative health data in Saskatchewan, Canada: a retrospective cohort study.

Determining the epidemiology of dementia among the population as a whole in specific jurisdictions - including the long-term care population-is essential to providing appropriate care. The objectives of this study were to use linked administrative databases in the province of Saskatchewan to determine the 12-month incidence and prevalence of dementia for the 2012/13 period (1) among individuals aged 45 and older in the province of Saskatchewan, (2) according to age group and sex, and (3) according to diagnosis code and other case definition criteria