Month: June 2024

Abstract

Introduction

Patient-centred care is more than just an aspiration, it represents a fundamental shift in the way healthcare must be delivered. Patient-centred emergency care is important for improving the patient and clinician experience and is essential for optimizing health outcomes. Creating a patient-centred emergency department emphasizes the importance of the patient's experience, preferences, and values.

Methods

To formulate recommendations for patient-centred care, we synthesized a literature review, stakeholder interviews, consensus from an expert panel of diverse healthcare professionals and a patient advocate, and reviewed our recommendations for feedback with a presentation at the Canadian Association of Emergency Physicians (CAEP) 2023 Annual Conference Academic Symposium.

Results

This paper gives practical recommendations for areas and strategies to improve patient-centredness in Emergency Medicine. It delves into the various dimensions of this approach, including the role of the physical environment, communications and interpersonal interactions, systems of care, and measurement, all of which are essential in providing optimal care to match the patients’ needs.

Conclusion

We seek to inspire a renewed commitment of placing the patient at the heart of emergency care, recognizing that patient-centredness is not merely an option but a fundamental aspect of delivering high quality, compassionate and effective healthcare in the emergency setting. In an era marked by technological advancements and evolving healthcare paradigms, the essence of medicine as a deeply human endeavour is becoming in some ways more possible, if we seize the opportunities.

Abstract

Purpose

This study aims to review the escalating prevalence of chronic kidney disease (CKD) and end-stage renal disease (ESRD) among Canada’s Indigenous population, focusing on risk factors, hospitalization and mortality rates, and disparities in kidney transplantation. The study explores how these factors contribute to the health outcomes of this population and examines the influence of genetic variations on CKD progression.

Methods

The review synthesizes data on prevalence rates, hospitalization and mortality statistics, and transplantation disparities among Indigenous individuals. It also delves into the complexities of healthcare access, including geographical, socioeconomic, and psychological barriers. Additionally, the manuscript investigates the impact of racial factors on blood characteristics relevant to dialysis treatment and the genetic predispositions influencing disease progression in Indigenous populations.

Results

Indigenous individuals exhibit a higher prevalence of CKD and ESRD risk factors such as diabetes and obesity, particularly in regions like Saskatchewan. These patients face a 77% higher risk of death compared to their non-Indigenous counterparts and are less likely to receive kidney transplants. Genetic analyses reveal significant associations between CKD and specific genomic variations. Through analyses, we found that healthy Indigenous individuals may have higher levels of circulating inflammatory markers, which could become further elevated for those with CKD. In particular, they may have higher levels of C-reactive protein (CRP) fibrinogen, as well as genomic variations that affect IL-6 production and the function of von Willebrand Factor (vWF) which has critical potential influence on the compatibility with dialysis membranes contributing to complications in dialysis.

Conclusion

Indigenous people in Canada are disproportionately burdened by CKD and ESRD due to socioeconomic factors and potential genetic predispositions. While significant efforts have been made to assess the socioeconomic conditions of the Indigenous population, the genetic factors and their potential critical influence on compatibility with dialysis membranes, contributing to treatment complications, remain understudied. Further investigation into these genetic predispositions is essential.

Abstract

Australia’s Indigenous children are 12 times more likely than non-Indigenous children to be in out-of-home care, a rate that has been increasing. Since 2009, government policies have committed to keeping children safe in families through support, early intervention, and Indigenous self-determination. Action has not matched policy. Quantitative and qualitative survey data from third parties (n = 29 Indigenous and n = 358 non-Indigenous) are analysed with a view to understanding expectations and visions for reform. Third parties expressed distrust and resistance toward child protection authorities. Indigenous third parties more so. Achieving reform objectives depends on child protection authorities initiating relational repair with third parties through addressing ritualism, implementing policy and investing in genuine partnering. Indigenous third parties, in addition, identified institutional racism and cultural disrespect as obstacles to reform.

Abstract

This paper studies how the North American Free Trade Agreement (NAFTA) affected the wage gap between high and low-paid workers within Mexico, considering internal migration. In low-skilled, labor-abundant developing countries, trade liberalization should theoretically increase the wages of low-skilled workers, decreasing income inequality. However, anecdotal evidence indicates that NAFTA increased the gap between rich and poor in Mexico, and empirical evidence is mixed (Hirte et al. 2020; Brülhart 2011; Bosch and Manacorda 2010; Nicita 2009; Chiquiar 2008; Hanson 2007; Gonzalez-Rivas 2007). Because trade may affect wages differently across regions within the country, accurate measures of wage effects must incorporate internal migration; otherwise, apparent wage convergence or divergence might only reflect a geographic resorting of workers. We evaluate wage changes by considering rural-to-urban migration. We first find a slight decrease in both internal and external migration in the years after NAFTA. Then, we find that all male workers see a wage reduction from trade openness, although the harm of high-wage workers almost doubled that of their counterparts with low wages. NAFTA also mitigated some of the wage differentials between the North and South. In summary, trade liberalization has reduced wage differentials among working-age men in urban areas.

Abstract

This paper examines the literature on the Sustainability in the Arctic region, using a bibliometric analysis of 213 English-language articles published between 1980 and 2022 exploiting Bibliometrix, an R package. To find relevant literature using the Web of Science (WOS) database, we searched for documents using mesh terms based on the query of two terms, “Arctic & Sustainability”. We used the Boolean operator “AND” to combine the two terms and the Boolean operator “OR” to include synonyms of the terms. The articles retrieved were authored by 724 researchers, published in 98 journals, representing 132 countries, and growing at 5.08% annually. The findings reveal that a substantial portion of the Arctic sustainability literature placed significant emphasis on the examination of climate change, adaptation, and vulnerabilities affecting local communities. Furthermore, the more recent publications in this field concentrate predominantly on exploring perceptions and governance.

Abstract

In November 1815, the deadliest “natural” disaster in Balinese history was caused by the exceptional combination of multiple natural hazards that occurred simultaneously and cascaded in the present-day province of Buleleng. This major disaster, which is thought to have claimed more than 10,000 lives, has never been scientifically analyzed. The study conducts an in-depth analysis of this cascading disaster, from the root causes and chronology of natural hazards to their environmental and societal effects, by thoroughly examining all available written sources about this event, whether colonial or Indonesian. Seven months after the Tambora eruption, a magnitude 7.3 earthquake, which occurred in the Bali Sea off the northern coast of the island, triggered a very large landslide on the northern flank of the Buyan-Bratan caldera. The initial mass movement evolved into a cohesive debris flow that reached the sea after traveling up to twenty kilometers through Banyumala River Valley and Singaraja City downstream. According to historical accounts, fifteen villages were buried or devastated by the debris flow. The large volume of sediment entering the sea triggered a local tsunami along Buleleng’s coast. This geohistorical approach offers a comprehensive overview of various sources describing Singaraja’s situation before the crisis, the hazard succession, the cascading hazard intensities, and the short- to long-term impacts on Buleleng. Based on the written sources, Bali took around fifteen years to recover from the 1815 disasters.