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The Evidence Speaks

The Evidence Speaks (January 2020)

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The Evidence Speaks Series is a recurring feature highlighting the latest in CHÉOS research. This series features summaries of select publications as well as in-depth features on the latest work from our investigators. The Series is designed to keep media and the research community up-to-date with CHÉOS’ current research results in the health outcomes field.

Hedden L, Munro S, McGrail KM, Law MR, Bourgeault IL, Barer ML. Is attending birth dying out? Trends in obstetric care provision among primary care physicians in British Columbia. Can Fam Physician. 2019 Dec;65(12):901-9.

A team of researchers from B.C. and Ontario, including CHÉOS Scientist Dr. Sarah Munro, have recently published a study examining the factors that could influence obstetric care among primary care physicians in British Columbia. Their research revealed that between 2005-2006 and 2011-2012, there has been a 16.1% decline in the proportion of family physicians who attended deliveries or provided obstetric care, despite investments aimed at encouraging involvement in this service and the implementation of a new training program. This decline could potentially impact individuals seeking obstetric care or labour support in remote or rural communities where family physicians may be the only providers. Though rural physicians were more likely than urban physicians to provide these services, the proportion declined over time. This decline could also impact socioeconomically disadvantaged people who rely on family physicians for their obstetric care and/or deliveries. Furthermore, it could reduce the options available to women who are seeking a suitable obstetric care provider. The researchers concluded that, with an apparent decline in the number of primary care physicians who are involved in obstetric care and deliveries, research is required to determine what interventions could be implemented to attract and retain primary care physicians in this field.

Axelrod D, Veljkovic A, Zochowski T, Marks P, Mahomed N, Wasserstein D. Risk of ankle fusion or arthroplasty after operatively and non-operatively treated ankle fractures – a matched cohort population study. J Orthop Trauma. 2019 Dec 4 epub ahead of print.

Ankle arthroplasty and fusion are most commonly used to treat end-stage arthritis of the ankle, but are there any factors that increase the likelihood of someone requiring this treatment in the first place? CHÉOS Scientist Dr. Andrea Veljkovic and her fellow researchers from Ontario have published new research highlighting that rotational ankle fractures that require surgical intervention are 3.5 times more likely to require arthroplasty or fusion in the future than those that do not require surgery. The team identified 44,133 patients who had undergone operative management of ankle fracture (OAF) and 88,266 patients who had undergone non-operative management of ankle fracture (NOAF). Of these, 0.65% OAF patients eventually underwent fusion or arthroplasty, whereas 0.17% NOAF patients underwent fusion or arthroplasty – both higher proportions than in the general population. The researchers note that age, comorbidities, and post-injury infection could increase the risk of fusion or arthroplasty. Overall, this study could help health care professionals more accurately identify which patients are at higher risk of developing end-stage arthritis following ankle fracture, as measured by the surrogates of arthroplasty and ankle fusion.

Magee C, Norena M, Hubley AM, Palepu A, Hwang SW, Nisenbaum R, Karim ME, Gadermann A. Longitudinal Associations between Perceived Quality of Living Spaces and Health-Related Quality of Life among Homeless and Vulnerably Housed Individuals Living in Three Canadian Cities. Int J Environ Res Public Health. 2019 Nov 29;16(23).

Results recently published as part of the Health and Housing in Transition (HHiT) Study have shone a light on how homeless and vulnerably housed individuals perceive the quality of their living spaces and how these perceptions may be associated with their health-related quality of life (HRQoL). Understanding the predictors of HRQoL significantly contributes to predicting morbidity and mortality. CHÉOS Scientists Drs. Anita Palepu, Ehsan Karim, and Anne Gadermann, alongside Statistician Monica Norena and a team from UBC, St. Michael’s Hospital, and the University of Toronto, assessed the association between perceived quality of life and both mental and physical HRQoL at baseline and four annual follow-up points. At baseline, there were 595 homeless and 595 vulnerably housed participants, who were equally spread between Ottawa (33.3%), Vancouver (33.2%), and Toronto (33.5%). In both the adjusted and unadjusted models, it was discovered that perceived quality of life was positively associated with mental and physical HRQoL across the participant population. These findings indicate that policies aimed at increasing HRQoL among homeless and vulnerably house populations should prioritize improving how they perceive the quality of their living spaces.