Author: UBC Abbotsford-Mission Family Practice Residency Program

KEY POINTS

• Testing for high-risk human papillomavirus (HPV) will soon replace the Pap test for primary cervical cancer screening in Canada, as it is a more sensitive test that has been shown to be cost-effective and safe.
• Given the success of school-based HPV vaccination programs, the prevalence of cervical cancer and its precursors is expected to decline, which is why a highly sensitive test is preferrable to strengthen detection rates while minimizing false positives.
• Widespread public education is needed to overcome natural resistance to change and prevent misinterpretation of new recommendations as a merely cost-saving measure.

“Infection with high-risk strains of the human papillomavirus (HPV) is a known prerequisite for developing cervical cancer. Soon, a test for high-risk strains of HPV will replace the Papanicolaou (Pap) test for routine cervical cancer screening in Canada. Unlike the Pap test, which requires a cytopathologist to detect precancerous cervical cells, testing of a cervical sample for HPV subtypes uses polymerase chain reaction (PCR). Australia, the Netherlands and the United Kingdom have adopted the HPV testing model for cervical screening, and it is also endorsed by the American Cancer Society. A recent review by the Canadian Agency for Drugs and Technologies in Health considered available evidence; its report concluded that HPV PCR testing of cervical samples is better at detecting precancer or cancer than Pap testing and would decrease the overall cost of screening. However, shifting to this new screening modality will mean overhauling existing algorithms for age and screening intervals, changing resource allocation and educating physicians and patients. We discuss why and how cervical screening will need to change in Canada with the adoption of the new test.”

Shifting from cytology to HPV testing for cervical cancer screening in Canada via CMAJ.

More on the Human Papillomavirus vaccine via ImmunizeBC.

“Both Whitmer and Planned Parenthood have sued to overturn Act 328. But their arguments depend heavily on rulings the Supreme Court now appears ready to reverse: Roe v. Wade and Planned Parenthood v. Casey.

Michigan residents seeking abortions will likely turn first to Illinois — but for a woman in Detroit, Windsor could be closer. The average cost of an abortion in Canada is also slightly lower than in many U.S. states.

Robert Currie is an expert on transnational criminal law at Dalhousie University in Halifax.

‘I think there’s certainly a possibility that people will cross the border into Canada,’ he said, ‘either to avoid criminal prosecution for having obtained an abortion or to be able to obtain one. In either situation, there’s the potential for it to create an international incident of some kind.'”

More on Roe v. Wade is on the brink — and Canada could be pulled into U.S. brawls over abortion law via CBC.

“Skill is the child of patience.”~ Obi-Wan Kenobi
#MayThe4thBeWithYou

Abstract

“This was a qualitative study utilizing a phenomenological approach. The purpose was to determine what rehabilitation strategies physical therapists use with dancers and to discuss techniques for implementing these strategies from both the dancer’s and the physical therapist’s perspectives. Self-administered questionnaires were sent via email to dancers and physical therapists. Purposeful sampling was done through use of a criterion sampling method that required participants to have experienced dancer rehabilitation. Data were correlated to find common strategies and to encourage modification of current approaches. Physical therapists returned 29 surveys, while dancers returned eight. Five themes were identified in the areas of: 1. evaluation, 2. dance modification, 3. interventions, 4. education, and 5. communication. The conclusion of this study was that successful rehabilitative strategies involve ongoing evaluation that incorporates knowledge of dance technique and performance, dance-centered movement modification that is clearly defined, and an understanding of dance lingo.”

Read more on Physical therapy rehabilitation strategies for dancers: a qualitative study via J Dance Med Sci.

In efforts to support residents, the Postgraduate Deans’ Office (PGME), has arranged for limited leased accommodations at training sites throughout the province for residents’ use during mandated rotations.

ARTICLE 28 – DISTRIBUTED TRAINING LOCATIONS

Those Residents who are required, as part of their training, to leave the base Hospital on mandatory rotations will be reimbursed for reasonable travel and accommodation expenses.

The PGME support aims to provide some pre-paid accommodation in regularly used distributed training locations so residents do not have to incur out-of-pocket expenses. Where leased accommodations are not available, residents are required to secure their own housing as per the reimbursement provisions in the Collective Agreement (see Accommodation Policy – Mandated Rotations and Resident Mandated Travel and Reimbursement Policy). 

Further details can be found at the new Housing FAQ page.

Another round of The Lancet’s Picture Quiz!

“What is…?”

Cue the Jeopardy Bublé jingle.

Click here to answer.

Have a great weekend ;)!

~ Jacqueline

“Almost two billion people are deficient in key vitamins and minerals, mostly women and children in low- and middle-income countries (LMICs). Deficiencies worsen during pregnancy due to increased energy and nutritional demands, causing adverse outcomes in mother and child, but could be mitigated by interventions like micronutrient supplementation.

To our knowledge, this is the first systematic review that aimed to compile evidence from both efficacy and effectiveness trials, evaluating different supplementation interventions on maternal, birth, child health, and developmental outcomes. We evaluated randomized controlled trials and quasi-experimental studies published since 1995 in peer-reviewed and grey literature that assessed the effects of calcium, vitamin A, iron, vitamin D, and zinc supplementation compared to placebo/no treatment; iron-folic (IFA) supplementation compared to folic acid only; multiple micronutrient (MMN) supplementation compared to IFA; and lipid-based nutrient supplementation (LNS) compared to MMN supplementation. Seventy-two studies, which collectively involved 314 papers (451,723 women), were included.

Meta-analyses showed improvement in several key birth outcomes, such as preterm birth, small-for-gestational age (SGA) and low birthweight with MMN supplementation, compared to IFA. MMN also improved child outcomes, including diarrhea incidence and retinol concentration, which are findings not previously reported. Across all comparisons, micronutrient supplementation had little to no effect on mortality (maternal, neonatal, perinatal, and infant) outcomes, which is consistent with other systematic reviews.

IFA supplementation showed notable improvement in maternal anemia and the reduction in low birthweight, whereas LNS supplementation had no apparent effect on outcomes; further research that compares LNS and MMN supplementation could help understand differences with these commodities. For single micronutrient supplementation, improvements were noted in only a few outcomes, mainly pre-eclampsia/eclampsia (calcium), maternal anemia (iron), preterm births (vitamin D), and maternal serum zinc concentration (zinc). These findings highlight that micronutrient-specific supplementation should be tailored to specific groups or needs for maximum benefit. In addition, they further contribute to the ongoing discourse of choosing antenatal MMN over IFA as the standard of care in LMICs.”

More on Vitamin and Mineral Supplementation During Pregnancy on Maternal, Birth, Child Health and Development Outcomes in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis via Nutrients.

The word “sustainability” doesn’t often come up in medical education and training and yet in order to have a robust healthcare system we need to think about areas where we can improve and innovate in order to advance our objectives. Here’s an opportunity below that I encourage those in medicine to consider applying to:

The Sustainability Education Grant program provides funding for faculty members at UBC Vancouver looking to advance and diversify sustainability education opportunities for students across campus in all disciplines.

The funding supports curriculum development centred on transformative learning that incorporates experiential, applied and/or interdisciplinary sustainability education principles.

Submit your application by May 16 here.

Warm regards,

Jacqueline

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“For decades, researchers have been asking if sperm counts are decreasing worldwide, and if so, whether this presages a global decline in male fertility. Most recently, a large systematic review and meta-regression analysis sought to identify trends in sperm counts between 1981 and 2013 and found that sperm counts appeared to be declining rather than stabilizing. One of the complicating features of relying on sperm count as a marker of fertility is that a low sperm count does not guarantee an inability to conceive. A large variety of factors, including tobacco, alcohol, and drug use; psychological stress; obesity; insufficient sleep; and environmental factors such as air pollutants and heavy metals, have been identified as potential risk factors affecting semen quality. Initial investigations recommended for a patient presenting with fertility concerns include a detailed history, physical examination, investigations based on the clinical context, and semen analysis for most patients. Although the evidence is conflicting, our review suggests that the potential decline in male sperm counts does not necessarily translate to a decline in male fertility.”

Global decline of male fertility: Fact or fiction? via BCMJ.

“Eating disorders are complex brain-based illnesses with both psychological and physical components. They affect almost 10% of the population and have become much more prevalent since the COVID-19 pandemic began.[1] They are characterized by significant disturbances in behaviors and attitudes that surround eating, body weight, and body shape[2] and include anorexia nervosa, bulimia nervosa, binge-eating disorder, night-eating syndrome, and other specified feeding and eating disorders. Eating disorders can lead to life-threatening medical complications and frequently co-occur with other debilitating mental illnesses such as bipolar, depressive, and anxiety disorders.[3] People with a family history of an eating disorder or any other significant mental illness are at increased risk of developing an eating disorder. Other factors affecting the onset of an eating disorder include the influence of media and diet culture, a history of trauma, and stressful life transitions and certain personality traits such as perfectionism.[4] Eating disorders occur across the gender spectrum, and people identifying as nonbinary or transgender are particularly at risk. Dieting for weight loss increases susceptibility to the development of these conditions. Since the COVID-19 pandemic began, the prevalence of eating disorders has increased dramatically as social isolation, job losses, financial insecurity, and uncertainty about the future have created a fertile environment where eating disorders can develop and thrive.

In Canada, wait times for treatment of eating disorders are unacceptably long—months or even years. Treatment programs are usually located in large urban centres, creating barriers for people living in remote and rural areas. Only when people become extremely ill are they eligible for inpatient treatment. People with serious eating disorders are at high risk for suicide, and difficulty in accessing services exacerbates this problem. Since the start of the pandemic, many hospital-based eating disorder treatment programs have cut back their services, deploying personnel to other areas of need. Many of these programs were slow to transition to a virtual format, leaving a critical gap in services.”

Learn more about what family physicians can do to help via BCMJ.