News from Canada

Over 6 million Canadians are without a family doctor. This is outrageous! A family doctor from the U.K:

Based on the application process, the doctor did not meet the threshold for permanent residency because of factors like not being married and being over the age of 45.

“You got a physician who dearly wants to work here, who has a practice here, who is seeing patients and fulfilling a need desperately needed in the province,” said Dr. Barry Dworkin

https://ottawa.ctvnews.ca/ottawa-fa...t-residency-over-marital-status-age-1.6668246
 
Naturopathic doctors aren't the solution to primary care: doctors, health experts

Amid a family doctor shortage in Canada, many naturopathic doctors position themselves as a solution, arguing that they have the training to be a patient’s primary care provider.

That’s raising alarm among medical doctors and health experts who say they are not equipped to be a patient’s principal source of medical care.

“Naturopaths presenting themselves as a solution to our current crisis is at the very least misleading. And from the perspective of a family physician, it’s quite horrifying,” said Dr. Sarah Bates, acting president of the Alberta Medical Association’s family medicine section.

https://ottawa.citynews.ca/2024/03/...o-primary-care-crisis-doctors-health-experts/
 
Mij said:
Naturopathic doctors aren't the solution to primary care: doctors, health experts

Amid a family doctor shortage in Canada, many naturopathic doctors position themselves as a solution, arguing that they have the training to be a patient’s primary care provider.

That’s raising alarm among medical doctors and health experts who say they are not equipped to be a patient’s principal source of medical care.

“Naturopaths presenting themselves as a solution to our current crisis is at the very least misleading. And from the perspective of a family physician, it’s quite horrifying,” said Dr. Sarah Bates, acting president of the Alberta Medical Association’s family medicine section.

https://ottawa.citynews.ca/2024/03/...o-primary-care-crisis-doctors-health-experts/
Click to expand...
Yes, yes, yes.
 
Dietary supplement for mood symptoms in early postpartum: a double-blind randomized placebo controlled trial
Summary
Background
Postpartum blues (PPB) is a frequent syndrome of sad mood, crying spells, anxiety, restlessness, reduced appetite, and irritability, typically peaking day 5 postpartum. When severe, it greatly increases risk for later postpartum depression. This trial compared a dietary supplement to placebo on PPB severity. The supplement was designed to counter downstream effects of elevated monoamine oxidase A level, implicated in causing PPB.
Methods
Participants recruited by advertisement from the Toronto region completed procedures at CAMH, Canada and/or participants’ homes. Oral supplement or identical appearing relatively inert placebo were administered in randomised, double-blind fashion. Supplement was blueberry juice and extract given four times between nighttime day 3 and morning day 5 postpartum; tryptophan 2 g nighttime day 4 postpartum, and tyrosine 10 g morning day 5 postpartum. On day 5, depressed mood induction procedure (MIP) and postpartum blues were assessed. All data is presented (NCT03296956 closed, clinicaltrials.gov).
Findings
Between January 2019 and December 2022, participants took supplement (n = 51) or placebo (n = 52). There was no significant effect on primary outcome MIP on visual analogue scale for depressed mood (mean difference = −0.39 mm, 95% CI: −6.42 to 5.65 mm). Stein Maternity Blues scores, exploratory PPB measure, was lower in the active group (effect size 0.62; median, interquartile range (IQR): active 2.00 (IQR 1, 4); placebo 4.00 (IQR 1.5, 6); regression with general linear model, supplement effect, β coefficient = −1.50 (95%: CI −2.60, −0.40), p = 0.008; effect of CES-D crying category before supplement, p = 0.03–0.00000023). Twenty-six and 40 different adverse events occurred within 25% and 42% of supplement and placebo cases respectively (Chi-Square, p = 0.06).
Interpretation
The primary outcome was negative for effect on depressed mood induction, however the supplement moderately reduced PPB.
Click to expand...

Evidence before this study
To identify studies using dietary supplements to prevent or reduce symptoms of postpartum blues or postpartum depression, Pubmed, Psychinfo and Cochrane databases were searched for any relevant articles from 1995 to March 2020 using key words including postpartum blues, postpartum depression, postnatal depression and prevention. The search was done prior to the start of the study and repeated March 23, 2020; and published as part of a review. There was one negative trial of docosahexaenoic acid with or without arachidonic acid versus placebo on postpartum blues. One trial was positive for lower risk scores for postpartum depression within 8 weeks of giving birth after oral selenium supplementation in a region with frequent selenium deficiency.
Added value of this study
The supplement reduced postpartum blues with an effect size of 0.62 but did not have effect on depressed mood induction.
Click to expand...

https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00172-X/fulltext
 
Or we could, as a society, make sure that women who have recently given birth or have very young children have adequate post-natal social and economic support.

Now that is something the psychosocial crowd should be sinking their teeth into.
 
Sean said:
Or we could, as a society, make sure that women who have recently given birth or have very young children have adequate post-natal social and economic support.

Now that is something the psychosocial crowd should be sinking their teeth into.
Click to expand...
No, no social, no bio, only psycho. That's the biopsychosocial way, most letters are actually silent, need to be spoken with a dog whistle.
 
Not sure how useful this would be, but it's probably better than nothing, or an example I saw recently, a problem that only affects teenage girls.

It's the tiniest bit of progress anyone could imagine, only short stop removed from "doesn't exist". But that's medical progress for you.

There is a mention of a common co-occurence with ME/CFS, but no contraindication for the main treatment recommendation of regular aerobic exercise with a focus on conditioning, despite POTS having nothing to do with deconditioning. The review also makes no mention whatsoever of COVID, let alone Long Covid, so MDs will remain unaware of it, or worse, convinced there's no relation.

Seriously, you could take any group of 20 random people and they'd do better than this as long as they care about the outcome.


Canadian Cardiovascular Society Position Statement on Postural Orthostatic Tachycardia Syndrome (POTS) and Related Disorders of Chronic Orthostatic Intolerance
https://onlinecjc.ca/article/S0828-282X(19)31550-8/fulltext

The current definition of postural orthostatic tachycardia syndrome (POTS) dates back to a small case series of patients with a subacute illness who presented with excessive orthostatic tachycardia and orthostatic intolerance, in the absence of another recognized disease. Conventional POTS criteria require an excessive orthostatic tachycardia in the absence of substantial orthostatic hypotension, and predominant symptoms of orthostatic intolerance, worse with upright posture and better with recumbence. POTS is a heterogeneous syndrome with likely several underlying pathophysiological processes, and not a specific disease. The primary panel for this Canadian Cardiovascular Society position statement sought to provide a contemporary update of the best evidence for the evaluation and treatment of POTS.
 
How to get a referral without a Family Doctor

  • Your doctor may not believe a second opinion is necessary. That may be because they performed a thorough examination and are confident with their diagnosis,
  • They may not have understood the extent of the problem, perhaps due to a lack of time during the appointment or an accidental oversight.
  • It may also be implicit bias, where your doctor may not have taken you and your symptoms seriously due to assumptions based on your sex, race, or age.
If you feel something isn’t right—if your symptoms persist or if you’ve been experiencing them for a long time—and your doctor still doesn’t refer you to a specialist for a second opinion or testing, it’s important to advocate for yourself. Ask them why they refuse the referral and to record the request and their refusal in your patient file. If you’ve already tried your family doctor, try a walk-in clinic. If you don’t have a family doctor and tried a GP at a walk-in, try another one.

LINK
 
CreeAnn Phillips to lead recruitment for Long-COVID study

CreeAnn Phillips, who recently completed her third year in UCalgary’s Bachelor of Health Sciences Program with a major in biomedical sciences, is the 2024 recipient of the Libin Summer Studentship.

Thanks to this student award, Phillips will be leading a pilot project this summer under the supervision of Dr. Satish Raj, MD, and Dr. Derek Chew, MD. She’ll be investigating the impact of sodium on brain fog in patients with Long-COVID or postural orthostatic tachycardia syndrome (POTS), a life-altering autonomic disorder that mostly impacts young women.

“I am so excited about this opportunity,” says Phillips. “It is giving me a chance to really help people with this debilitating symptom. I am thrilled that the work I do may potentially change the lives of these patients.”

Brain fog is a cluster of cognitive symptoms that may include trouble focusing, loss of train of thought, trouble remembering familiar details, slowed reaction times and information processing and general fatigue.

It’s a common complaint of POTS and Long-COVID patients and can have a life-altering impact.

“The majority of patients with these conditions suffer from brain fog, and it can be quite debilitating,” says Phillips. “The condition varies from patient to patient, but some individuals suffer a lot. For example, they can’t go to work or school.”

According to Raj, the cause of brain fog in these patients isn’t well understood, which limits the ability to develop treatments. However, research has proven a high sodium diet can be an effective treatment for patients with POTS, who are unable to maintain a healthy blood pressure.

“This study will try to objectively assess cognitive impairment in patients with brain fog, look for brain abnormalities with functional MRI scans and other advanced MRI techniques, and test a blood volume expansion hypothesis using sodium to see if we can improve brain fog,” says Raj. “We hope this will inform us to better care for these patients who are suffering.”

Phillips will lead participant recruitment and enrollment and take part in the physiology and neurocognitive assessments in the study. She’s most excited about interacting with patients and being part of a clinical research project.

“I realized early that my pathway would lead to some kind of research,” says Phillips. “During my first year at the University of Calgary, I discovered that while I enjoy basic research, I love clinical research. My main goal is to make a big impact, and with clinical trials, researchers are testing potentially life-changing treatments. I feel lucky to have a small part in that.”

Phillips’s career aspirations involve earning a medical degree and pursuing a career as a clinical researcher in geriatric cardiology. Her interest in this demographic was sparked by an ongoing volunteer experience.

“I volunteer with seniors each week at the Foothills Medical Centre, and I have grown to love working with them,” says Phillips. “They are amazing people, and they are a vulnerable population for which I think I could really make a difference.”

Raj says Phillips is a welcome addition to the lab, adding summer studentships offer the opportunity to encourage and mentor emerging researchers.

“She has immersed herself in the lab and has emerged as a natural leader,” says Raj. “This summer studentship will provide her with the opportunity to flourish,” he says.

LINK
 
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