UBC Abbotsford-Mission Family Practice Residency Program

The entire capital city of Canada’s Northwest Territories has been ordered to evacuate as hundreds of wildfires scorch the region, officials say

“Hundreds of wildfires burning in Canada’s Northwest Territories have prompted emergency declarations and the evacuation of the capital city of Yellowknife by road and air.

About 20,000 residents in Yellowknife are being urged to get out of the way of fast-moving flames as more than 230 fires char the territory and smoke creeps south, impacting air quality in the US. Yellowknife accounts for about half of the total population of the remote territory, which sits north of Alberta and east of Yukon.

‘We’re all tired of the word unprecedented, yet there is no other way to describe this situation in the Northwest Territories,’ Premier Caroline Cochrane said in a statement Wednesday night.

‘Residents living along the Ingraham Trail, in Dettah, Kam Lake, Grace Lake and Engle Business District are currently at highest risk and should evacuate as soon as possible. Other residents have until noon on Friday, August 18, 2023 to evacuate,’ Northwest Territories officials said in a news release Wednesday.

The community of N’dilo is also under an evacuation order, officials said in the release. Those unable to leave by vehicle can register for an air evacuation, officials said.

‘If you are able to evacuate by road, obey all warning signs, emergency management officials, traffic control devices and posted speed limits,’ Cochrane added. ‘Do not make any rash decisions that can put other people in danger.'”

Read more here via CNN.
Also see NWT wildfire updates via Environment and Climate Change.

UBC Abbotsford-Mission Family Practice Residency Program

Emergency Healthcare Providers’ Perceptions of Preparedness and Willingness to Work during Disasters and Public Health Emergencies

Abstract: This study evaluates the perceptions of preparedness and willingness to work during disasters and public health emergencies among 213 healthcare workers at hospitals in the southern region of Saudi Arabia by using a quantitative survey (Fight or Flight). The results showed that participants’ willingness to work unconditionally during disasters and emergencies varied based on the type of condition: natural disasters (61.97%), seasonal influenza pandemic (52.58%), smallpox pandemic (47.89%), SARS/COVID-19 pandemic (43.56%), special flu pandemic (36.15%), mass shooting (37.56%), chemical incident and bombing threats (31.92%), biological events (28.17%), Ebola outbreaks (27.7%), and nuclear incident (24.88%). A lack of confidence and the absence of safety assurance for healthcare workers and their family members were the most important reasons cited. The co-variation between age and education versus risk and danger by Spearman’s rho confirmed a small negative correlation between education and danger at a 95% level of significance, meaning that educated healthcare workers have less fear to work under dangerous events. Although the causes of unsuccessful management of disasters and emergencies may vary, individuals’ characteristics, such as lack of confidence and emotional distractions because of uncertainty about the safety issues, may also play a significant role. Besides educational initiatives, other measures, which guarantee the safety of healthcare providers and their family members, should be established and implemented.

Learn more here on Emergency Healthcare Providers’ Perceptions of Preparedness and Willingness to Work during Disasters and Public Health Emergencies via Healthcare.

UBC Abbotsford-Mission Family Practice Residency Program

Heat Warnings issued for southern B.C. August 14, 2023

Heat Warnings have been issued by Environment and Climate Change Canada for areas in the following regions of British Columbia (via EmergencyInfoBC):

More information:

Recommended actions

If you are in the area under a Heat Warning:

  1. Know the symptoms of heat-related illness and seek medical care if you or someone you are caring for are unwell:
    • Call 9-1-1 or your local emergency number in case of a medical emergency. 
  2. Take steps to keep your home cool or seek cooler locations, such as a community Cooling Centre. 
  3. Check on family, friends and neighbours who are at higher risk of heat-related illness, particularly if they live alone. 
  4. Drink plenty of water. Be aware that sugary or alcoholic drinks cause dehydration. 
  5. If you must be outdoors, take precautions to stay cool like wearing protective clothing and sunscreen, seeking cooler outdoor spaces and staying in shaded areas as much as possible. 
  6. Monitor local sources of information and follow all instructions from your municipality, Local Authority or First Nation. 

Cooling centres

In response to Heat Warnings, local governments and First Nations in affected areas may open Cooling Centres for the public.

Local governments and First Nations can post Cooling Centre locations on Emergency Map BC. If Cooling Centres are not posted in your area, visit your municipality, Local Authority or First Nation website or social media channels for more information.

Heat safety

Heat stroke is a health emergency. Call 9-1-1 or your local emergency number if you or someone you’re caring for is displaying symptoms.

Heat-related illness 

Overheating can be harmful to your health and potentially deadly. If someone is experiencing symptoms such as rapid breathing, rapid heart rate, extreme thirst, altered levels of consciousness, and decreased urination with an unusually dark yellow colour, take immediate steps to cool down and seek emergency care: 

  • Get medical attention or call 911 or your local emergency number. 
  • Move to a cooler indoor or outdoor area. 
  • Take a cold shower or bath if it is safe to do so. Or, remove clothing and apply ice packs and wet cloths, especially around the neck, armpits, and groin. Replace wet cloths regularly. 

Who is at greater risk? 

Heat affects everyone, but the risks are greater for: 

  • Older adults (i.e. over 50) 
  • People who live alone or are socially isolated 
  • People with pre-existing health conditions such as:
    • Diabetes  
    • Heart disease, or  
    • Respiratory disease 
  • People with mental illness such as:
    • Schizophrenia  
    • Depression, or  
    • Anxiety  
  • People with substance use disorders  
  • People who are marginally housed  
  • People who work in hot environments  
  • People who are pregnant  
  • Infants and young children, and 
  • People with other disabilities or limited mobility 

Check on family, friends and neighbours, who are at higher risk, particularly if they live alone. Make sure they have a cool space. For people susceptible to heat, the risk increases at indoor temperatures higher than 26°C, and temperatures higher than 31°C can be dangerous. 

Staying cool indoors 

  • If you have air conditioning, turn it on.  
  • If you do not have air conditioning, make your home cooler by:
    • Closing shutters, curtains, or blinds during the day (starting around 10am). This traps the cooler air inside and blocks the sun.  
    • Re-open curtains or blinds and windows at around 8 p.m. to let the cooler overnight air into the house.  
    • Place multiple fans around your home to help move cooler air into the home overnight.  
  • Take cool baths or showers.

Staying cool outdoors 

  • Seek cooler outdoor spaces and stay out of direct sunlight as much as possible.
  • Do errands in the morning or late in the day.  
  • Never leave children or pets in a parked car.  
  • Stay in the shade and wear a hat and protective clothing.  
  • Use sunscreen and UV-protective eyewear.  
  • Seek cooler, breezier areas when outdoors, such as large parks near trees and water. 

Resources

To prepare for heat, refer to the following resources:

For heat safety recommendations specific to your area, visit the heat information provided by your local health authority:

If you suspect heat-related illness, contact a healthcare provider or call HealthLinkBC at 8-1-1. Mild to moderate heat illness can quickly become severe. In case of a medical emergency, dial 9-1-1.

About heat alerts

There are two kinds of heat alerts issued in BC:

  • Heat Warning: daytime and overnight temperatures are higher than usual, but they’re not getting hotter every day. Take the usual steps to stay cool.
  • Extreme Heat Emergency: daytime and overnight temperatures are higher than usual, and are getting hotter every day. Activate your emergency plan for heat.

For more information about how Environment and Climate Change Canada determines Heat Warnings in BC, visit the Criteria for Public Weather Alerts.

UBC Abbotsford-Mission Family Practice Residency Program

On Sugar-Sweetened and Artificially Sweetened Beverages

Importance  Approximately 65% of adults in the US consume sugar-sweetened beverages daily.

Objective  To study the associations between intake of sugar-sweetened beverages, artificially sweetened beverages, and incidence of liver cancer and chronic liver disease mortality.

Design, Setting, and Participants  A prospective cohort with 98 786 postmenopausal women aged 50 to 79 years enrolled in the Women’s Health Initiative from 1993 to 1998 at 40 clinical centers in the US and were followed up to March 1, 2020.

Exposures  Sugar-sweetened beverage intake was assessed based on a food frequency questionnaire administered at baseline and defined as the sum of regular soft drinks and fruit drinks (not including fruit juice); artificially sweetened beverage intake was measured at 3-year follow-up.

Main Outcomes and Measures  The primary outcomes were (1) liver cancer incidence, and (2) mortality due to chronic liver disease, defined as death from nonalcoholic fatty liver disease, liver fibrosis, cirrhosis, alcoholic liver diseases, and chronic hepatitis. Cox proportional hazards regression models were used to estimate multivariable hazard ratios (HRs) and 95% CIs for liver cancer incidence and for chronic liver disease mortality, adjusting for potential confounders including demographics and lifestyle factors.

Results  During a median follow-up of 20.9 years, 207 women developed liver cancer and 148 died from chronic liver disease. At baseline, 6.8% of women consumed 1 or more sugar-sweetened beverage servings per day, and 13.1% consumed 1 or more artificially sweetened beverage servings per day at 3-year follow-up. Compared with intake of 3 or fewer servings of sugar-sweetened beverages per month, those who consumed 1 or more servings per day had a significantly higher risk of liver cancer (18.0 vs 10.3 per 100 000 person-years [P value for trend = .02]; adjusted HR, 1.85 [95% CI, 1.16-2.96]; P = .01) and chronic liver disease mortality (17.7 vs 7.1 per 100 000 person-years [P value for trend <.001]; adjusted HR, 1.68 [95% CI, 1.03-2.75]; P = .04). Compared with intake of 3 or fewer artificially sweetened beverages per month, individuals who consumed 1 or more artificially sweetened beverages per day did not have significantly increased incidence of liver cancer (11.8 vs 10.2 per 100 000 person-years [P value for trend = .70]; adjusted HR, 1.17 [95% CI, 0.70-1.94]; P = .55) or chronic liver disease mortality (7.1 vs 5.3 per 100 000 person-years [P value for trend = .32]; adjusted HR, 0.95 [95% CI, 0.49-1.84]; P = .88).

Conclusions and Relevance  In postmenopausal women, compared with consuming 3 or fewer servings of sugar-sweetened beverages per month, those who consumed 1 or more sugar-sweetened beverages per day had a higher incidence of liver cancer and death from chronic liver disease. Future studies should confirm these findings and identify the biological pathways of these associations.

Sugar-Sweetened and Artificially Sweetened Beverages and Risk of Liver Cancer and Chronic Liver Disease Mortality via JAMA Network

UBC Abbotsford-Mission Family Practice Residency Program

Hunger

Image by Dall-e

You regale me
with stories
of meals past
seared scallops
fresh snap peas from your garden
— not the peas of my youth
which I shamefully admit
I still cannot tolerate
—more and more your mind wanders
outside the confines of these walls
remember that last
chicken masala?
you don’t trust them anymore
those ghost flavours on your tongue
taunting you
almost bruising your wanting taste buds
You would rather
mine the pure pleasures of food
as you perch on the edge
of your hospital bed
than acknowledge the tube
in your nose
and your rising lipase levels
You’re afraid to eat now
so instead
you ask me to indulge
in some steak salad
and wine and report back
tomorrow

Hunger by Poet Hollis Roth via Ars Medica

About the Poet Hollis Roth is a palliative care physician, graduate student, and writer. She uses narrative medicine and poetry to explore themes of grief, loss, and hope. Hollis lives in Lethbridge, Alberta, with her two beloved cats Iggy and Roy. Email: hollis.roth@dfm.queensu.ca