Author: UBC Abbotsford-Mission Family Practice Residency Program

“Brady, a dietitian and occasional columnist for CBC’s Information Morning Halifax, has lymphedema. It’s a disease that causes an accumulation of fluid and can result in painful swelling, increased risk of blood infection, cellulitis and hardening of the skin. In her case, it’s a side-effect from having her lymph nodes removed during a radical hysterectomy to treat cervical cancer. 

In June, Brady applied for medical assistance in dying (MAID). Following intake, the MAID team brought her case to the attention of clinical lead Dr. Gord Gubitz, who then wrote a letter addressed to the special adviser to the Minister of Health and Wellness. Brady shared the letter with CBC. 

‘I have reviewed dozens of atypical MAID requests, but have never found myself in the position of writing a letter such as this,’ wrote Gubitz on July 7.

‘In my experience, people do not request MAID unless their life circumstances have become so dire that it is the only option. To request a MAID assessment is not an easy thing for most people; to do so when one is only 46 years old, otherwise healthy, and has two children at home is almost unthinkable.'”

Read more on the case of a Halifax woman who has spent years fighting for out-of-province care. Now she’s ready to end her life via CBC News.

Celebrating the 30th year Anniversary. 

We’re excited to introduce a unique format for this year’s event, with an in-person gathering on Friday, October 18, followed by hybrid (virtual and in-person) sessions on Saturday, October 19. Hosted at UBC Robson Square in downtown Vancouver, this central location offers convenient access to nearby popular attractions, making it ideal location for attendees and family members to explore the city’s offerings outside of conference hours. 

Keynote presentations will be delivered by internationally renowned experts, Dr. Derelie (aka Dee) Mangin (Professor, McMaster University) and Dr. John Mandrola (Cardiac Electrophysiologist, Baptist Health). In addition, a diverse lineup of both new and veteran faculty members from the Therapeutics Initiative will present on various relevant topics.

To celebrate Therapeutics Initiative’s 30th anniversary, Portrait Online subscribers are eligible for a 30% discount. Please email portrait@ti.ubc.ca to receive your unique code before registering. Not yet subscribed? Please click here or visit https://www.ti.ubc.ca/portrait/ to sign up and receive the discount code prior to registering for this event. 

“The conflict in Gaza presents distinct difficulties that significantly impact the psychological well-being of healthcare workers (HCWs) making it imperative to understand and address their mental health needs in this specific context. This article highlights the unique challenges of the ongoing Gaza conflict and its critical impact on the mental health of HCWs. Observations in the paper revealed that HCWs in Gaza face extraordinary challenges, including the targeting of medical facilities, severe shortages of medical supplies, and the ethical dilemmas of providing care in such constrained conditions. These factors contribute to heightened stress, anxiety, and a pervasive sense of helplessness among HCWs.

The paper also notes the compounded emotional burden due to the loss of colleagues and the need to navigate complex interactions with patients’ families under extreme conditions. Furthermore, the lack of basic needs like adequate nutrition and safe drinking water for HCWs themselves further compromises their ability to provide care effectively, contributing further to worsened mental health. The paper also notes the lack of sufficient media coverage and support for these workers, contributing to a sense of isolation and neglect.

HCWs in Gaza find themselves in a uniquely challenging situation, one that is marked not only by the immediate stresses of the ongoing conflict but also by the deep-seated psychological scars from past wars. The circumstances in Gaza are clinically relevant as they directly affect the HCWs’ ability to provide care and maintain their well-being. These findings highlight the need for targeted mental health interventions and support tailored to the specific challenges faced by HCWs in Gaza. Addressing these issues is crucial for their well-being and ability to provide effective healthcare under such demanding and traumatic circumstances.”

Learn more on the “Echoes of conflict: the enduring mental health struggle of Gaza’s healthcare workers” via Conflict & Health Journal.

Image source: Why this neurosurgeon chose to stay in his beloved Gaza — and why he left via NPR.

Question  What is the association between universal free school meals (UFSMs) and school and student outcomes in US schools?

Findings  The search identified 2784 records, with 6 studies included, representing more than 11 000 elementary, middle, and high schools. Nonrandomized intervention studies performed difference-in-difference or rate ratio analysis to investigate CEP participation rates, attendance, anthropometrics, and/or suspensions. CEP was associated with increased lunch (3 studies; moderate certainty) and breakfast (1 study; very low certainty) participation. School attendance was unchanged or improved in schools with CEP compared with schools without UFSM (2 studies; low certainty). CEP was associated with lower obesity prevalence (1 study; very low certainty) and fewer suspensions (1 study; very low certainty). Reasons for downgrading the certainty ratings included indirectness (data not fully representative of the United States) and inconsistency (small number of studies limiting ability to assess consistency). Despite the limitations, the evidence reflected well-designed longitudinal intervention studies appropriate for decision-making.

Meaning  In this systematic review, UFSMs were associated with increased meal participation, no or slight improvements in attendance, and decreased obesity prevalence and suspension rates; certainty of evidence was moderate for lunch participation and low or very low for other outcomes. Studies did not report several important outcomes, such as diet quality and food security, suggesting the need for more high-quality research encompassing policy-relevant indicators.

Read more on Universal Free School Meals and School and Student Outcomes via JAMA.

“On the night of Aug 8, 2024, a 31-year-old female trainee doctor was raped and murdered towards the end of a 36-h shift at a hospital in Kolkata, India. A male civic volunteer has been arrested for the crime, the shocking nature of which motivated the Indian Medical Association (IMA) to call for a national strike. Much of the coverage has focused on the incident as an example of attacks on health workers. Globally, health workers experience high rates of workplace violence, with up to 62% of health workers suffering physical violence or non-physical violence at some point. But crucially, this was not only an attack on a doctor; it was also an attack on a woman. The misogynistic nature of the crime has thus far been underappreciated.

Violence against female health workers can manifest in many ways. Rape and murder represent extremes on the spectrum of workplace violence, defined by WHO as ‘incidents where staff are abused, threatened or assaulted in circumstances related to their work’. Non-physical violence includes verbal abuse, threats, bullying, discrimination, and sexual harassment. Although reporting is often patchy, a scoping review found that 64% of studies reported a higher prevalence of all forms of workplace violence for women than for men in the health workforce. There are myriad reasons why health workers are particularly vulnerable to violence. Hospitals can be highly stressful and emotive environments. Patients and visitors can be at their most vulnerable. Behaviour can be influenced by mental health or substance use issues, and work in the community can be highly precarious. Staff work unsociable hours under enormous pressure. Women make up around 67% of global employment in the health and care sector, so they are statistically at greater risk of experiencing workplace violence. But this fact is a gross oversimplification of the situation.”

Read more on The structural roots of violence against female health workers via The Lancet.

Image source “Murdered Indian doctor’s father speaks out: ‘All I can do now is get her justice’” via The Guardian.

“Machine learning hit the public awareness after spectacular advances in language translation and image recognition. These are typically problems of classification — does a photo show a poodle, a Chihuahua or perhaps just a blueberry muffin? Surprisingly, the latter two look quite similar (E. Togootogtokh and A. Amartuvshin, preprint at https://arxiv.org/abs/1801.09573; 2018). Less widely known is that machine learning for classification has an even longer history in the physical sciences. Recent improvements coming from so-called ‘deep learning’ algorithms and other neural networks have served to make such applications more powerful.”

Read more on The Power of Machine Learning via Nature Physics

“Recently, artificial intelligence and machine-learning algorithms have gained significant attention in the field of osteoporosis [1]. They are recognized for their potential in exploring new research fields, including the investigation of novel risk factors and the prediction of osteoporosis, falls, and fractures by leveraging biological testing, imaging, and clinical data [2]. This new approach might improve the performance of current fracture prediction models by including all possible variables such as the bone mineral density (BMD) of all sites as well as trabecular bone score (TBS) data [3]. Also, the new model could suggest novel factors that could influence the fracture by calculating all variables through a deep learning network. Although there are a few studies in osteoporosis and fracture prediction using machine learning [4–6], a fracture-prediction machine-learning model with a longitudinal, large-sized cohort study including BMD and TBS has not been developed [3].”

Read more on Clinical Applicability of Machine Learning in Family Medicine via Korean J Family Medicine.

“To address the need to characterize long COVID in children and adolescents, the National Institutes of Health funded a pediatric program in the Researching COVID to Enhance Recovery (RECOVER) Initiative. Editorialist Suchitra Rao, MBBS, MSCS, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, discusses this and more with JAMA Senior Editor Tracy A. Lieu, MD, MPH.”

Listen and learn more on Long COVID in Children via JAMA.

Overview: Join this panel of Indigenous experts on climate change and planetary health to discuss impacts on Indigenous and non-Indigenous peoples’ health and practical steps to support their well-being.

By the end of this session, you will be able to:

• Describe how climate change impacts Indigenous peoples’ health, communities, and traditional lifestyles.
• Apply practical steps to support Indigenous health and resilience in the face of climate change.
• Engage your Indigenous patients and their families in communication around climate change and planetary health impacts on their well-being.
• Access resources on planetary health and climate change for Indigenous and non-Indigenous providers and patients.  

Presenters: Elder Roberta Price, Miles Marchand (MD FRCPC, Syilx First Nation), Shannon Waters (Public Health & Preventive Medicine Specialist), Viola Brown (Nurse Practitioner), & Ojistoh Horn (Family Physician).

Please register here.