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Are clinicians being prepared to care for abused women? A survey of health professional education in Ontario, Canada.

ABSTRACT: BACKGROUND: The current project undertook a province-wide survey and environmental scan of educational opportunities available to future health care providers on the topic of intimate partner violence (IPV) against women. METHODS: A team of experts identified university and college programs in Ontario, Canada as potential providers of IPV education to students in health care professions at the undergraduate and post-graduate levels. A telephone survey with contacts representing these programs was conducted between October 2005 and March 2006. The survey asked whether IPV-specific education was provided to learners, and if so, how and by whom. RESULTS: In total, 222 eligible programs in dentistry, medicine, nursing and other allied health professions were surveyed, and 95% (212/222) of programs responded. Of these, 57% reported offering some form of IPV-specific education, with undergraduate nursing (83%) and allied health (82%) programs having the highest rates. Fewer than half of undergraduate medical (43%) and dentistry (46%) programs offered IPV content. Postgraduate programs ranged from no IPV content provision (dentistry) to 41% offering content (nursing). CONCLUSION: Significant variability exists across program areas regarding the methods for IPV education, its delivery and evaluation. The results of this project highlight that expectations for an active and consistent response by health care professionals to women experiencing the effects of violence may not match the realities of professional preparation.

SUBMITTER: Wathen CN

PROVIDER: S-EPMC2709616 | biostudies-literature | 2009

REPOSITORIES: biostudies-literature

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Are clinicians being prepared to care for abused women? A survey of health professional education in Ontario, Canada.

Wathen C Nadine CN Tanaka Masako M Catallo Cristina C Lebner Adrianne C AC Friedman M Kinneret MK Hanson Mark D MD Freeman Clare C Jack Susan M SM Jamieson Ellen E Macmillan Harriet L HL

BMC medical education 20090618

<h4>Background</h4>The current project undertook a province-wide survey and environmental scan of educational opportunities available to future health care providers on the topic of intimate partner violence (IPV) against women.<h4>Methods</h4>A team of experts identified university and college programs in Ontario, Canada as potential providers of IPV education to students in health care professions at the undergraduate and post-graduate levels. A telephone survey with contacts representing thes ...[more]

PMID: 19575776

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Project description:ImportanceWomen who experience imprisonment have higher rates of cervical cancer. Lack of access to cervical cancer screening in the community or in prison may contribute to increased cervical cancer incidence.ObjectivesTo determine cervical cancer screening rates for women in provincial prison in Ontario, Canada, and to compare these data with data for the general population.Design, setting, and participantsThis retrospective cohort study used correctional and health administrative data from January 1, 2006, to December 31, 2013. Participants included Ontario women aged 21 to 69 years during the follow-up period with no history of cervical cancer or hysterectomy. Analyses were conducted between July 2017 and September 2018.ExposuresWomen admitted to Ontario provincial prison in 2009 or 2010 and released in 2010 were considered exposed, and women in the general population of Ontario were considered unexposed.Main outcomes and measuresWhether women were overdue for cervical cancer screening at the time of admission to prison or on July 1, 2010, for the general population, defined as not having been screened in the previous 3 years, and whether women who were overdue were still overdue after 3 years.ResultsThere were 4553 women in the prison group and 3?647?936 women in the general population group. The median (interquartile range) age was 36 (29-43) years in the prison group and 43 (34-53) years in the general population. Women in the prison group had 2.20 times (95% CI, 2.08-2.33) the odds of being overdue for cervical cancer screening compared with women in the general population after adjusting for neighborhood income quintile, at 53.9% (95% CI, 51.8%-56.1%) compared with 32.9% (95% CI, 32.8%-33.0%) (P?<?.001). Women in the prison group also had nearly twice the odds of still being overdue at 3 years, with an odds ratio of 1.87 (95% CI, 1.76-1.99) after adjusting for neighborhood income quintile, and rates of still being overdue of 36.2% (95% CI, 34.5%-38.0%) compared with 21.9% (95% CI, 21.8%-21.9%) (P?<?.001).Conclusions and relevanceWomen who experience imprisonment have worse cervical cancer screening access than women in the general population. Work should be done to promote cervical cancer screening awareness and to improve access to acceptable screening in prison and in the community after prison release.

Project description:ImportanceWomen who experience imprisonment have high morbidity and an increased risk of adverse pregnancy outcomes. Antenatal care could modify pregnancy-related risks, but there is a lack of evidence regarding antenatal care in this population.ObjectivesTo examine antenatal care quality indicators for women who experience imprisonment and to compare these data with data for the general population.Design, setting, and participantsThis population-based, retrospective cohort study used linked correctional and health administrative data from women released from provincial prison in Ontario, Canada, in 2010 and women in the general population with deliveries at 20 weeks' gestation or greater from January 1, 2005, to December 31, 2015. Data analysis was performed from January 1, 2017, to May 4, 2020.ExposuresPregnancies in women with time in prison during pregnancy (prison pregnancies), pregnancies in women with time in prison but not while pregnant (prison control pregnancies), and pregnancies in women in the general population (general population pregnancies).Main outcomes and measuresAntenatal care quality indicators: first-trimester visit, first-trimester ultrasonography, and 8 or more antenatal care visits.ResultsA total of 626 prison pregnancies in 529 women (mean [SD] age, 26.6 [5.4] years), 2327 prison control pregnancies in 1570 women (mean [SD] age, 26.2 [5.4] years), and 1 308 879 general population pregnancies in 884 063 women (mean [SD] age, 30.3 [5.3] years) were studied. Of 626 prison pregnancies, 193 women (30.8%; 95% CI, 27.1%-34.6%) had a first-trimester visit, 272 (48.4%; 95% CI, 44.4%-52.4%) had at least 8 antenatal care visits, and 209 (34.6%; 95% CI, 31.0%-38.4%) received first-trimester ultrasonography. In 2327 prison control pregnancies, 1106 women (47.5%; 95% CI, 45.3%-49.8%) had a first-trimester visit, 1356 (59.2%; 95% CI, 56.9%-61.4%) had 8 or more antenatal care visits, and 893 (38.5%; 95% CI, 36.4%-40.6%) received first-trimester ultrasonography. Compared with 1 308 879 general population pregnancies, the odds of antenatal care were lower for the first-trimester visit (odds ratios [ORs], 0.11 [95% CI, 0.09-0.13] in prison pregnancies and 0.23 [95% CI, 0.21-0.25] in prison control pregnancies), 8 or more antenatal care visits (ORs, 0.16 [95% CI, 0.14-0.19] in prison pregnancies and 0.25 [95% CI, 0.23-0.28] in prison control pregnancies), and first-trimester ultrasonography (ORs, 0.43 [95% CI, 0.36-0.50] in prison pregnancies and 0.51 [95% CI, 0.46-0.55] in prison control pregnancies).Conclusions and relevanceThis study found that women who experienced imprisonment were substantially less likely to receive adequate antenatal care than were women in the general population whether or not they were in prison during pregnancy. Efforts are needed to improve antenatal care for this population both in prison and in the community.

Project description:Removal of cows from dairy cattle production is a routine and unavoidable practice of the dairy industry and is often referred to as culling. The objectives of this study were to use a survey to describe current on-farm cull cow management, farmers' perception of cull cows' journeys to slaughter, and the adoption of current recommendations and regulations by Ontario dairy farmers. All Ontario dairy farmers were invited to complete a cull cow management survey between December 2020 and March 2021 that included 44 questions covering farmer demographic information, farm characteristics, and cull cow management. The survey response rate was 7.4% (n = 248); a total of 226 of the responses were included in this study for analysis. Most respondents indicated they have a written standard operating procedure (SOP) for cull cows (62%), and 48, 13, and 15% of those identified they use their cull cow SOP "always," "sometimes," and "never," respectively. The more confident respondents were that cull cows arrived at slaughter in the condition they left the farm the less likely they were to have a cull cow SOP [odds ratio (OR) 0.83]. The most important sources of information for the management of cull cows were the herd veterinarian (64%) and members of the marketing/regulatory organization the Dairy Farmers of Ontario (44%). Drug withdrawal time was the only factor most respondents (73%) considered "very important" for the assessment of cull cows prior to transport. Most farmers believe cull cows journey from the farm to slaughter is three or less days (55%), and the confidence of farmers that cull cows arrive at slaughter in the condition they left their farm was generally high. Lastly, most farmers (66%) identified they were familiar with recent regulatory changes around the fitness, duration of transport, and lactation status for cull cows. These results highlight farmers' perceptions of the impacts and durations of the journey of cull cows differs from reality, and there are misunderstandings of the requirements for cull cow management. Further research should investigate how different strategies for training farmers may lead to improved cull cow welfare and regulatory compliance.

Project description:BACKGROUND:To meet the complex needs of healthcare delivery, the Ministry of Health and Long Term Care (MOHLTC) introduced Physician Assistants (PAs) into the Ontario health care system in 2006 with the goal of helping to increase access to care, decrease wait times, improve continuity of care and provide a flexible addition to the healthcare workforce. The characterization of healthcare organizations as complex adaptive systems (CAS) may offer insight into the relationships and interactions that optimize and restrict successful PA integration. The aim of this study is to explore the integration of PAs across multiple case settings and to understand the role of PAs within complex adaptive systems. METHODS:An exploratory, multiple-case study was used to examine PA role integration in four settings: family medicine, emergency medicine, general surgery, and inpatient medicine. Interviews were conducted with 46 healthcare providers and administrators across 13 hospitals and 6 family medicine clinics in Ontario, Canada. Analysis was conducted in three phases including an inductive thematic analysis within each of the four cases, a cross-case thematic analysis, and a broader, deductive exploration of cross-case patterns pertaining to specific complexity theory principles of interest. RESULTS:Forty-six health care providers were interviewed across 19 different healthcare sites. Support for PA contributions across various health care settings, the importance of role awareness, supervisory relationship attributes, and role vulnerability are interconnected and dynamic. Findings represent the experiences of PAs and other healthcare providers, and demonstrate how the PAs willingness to work and ability to build relationships allows for the establishment of interprofessional, collaborative, and person-centered care. As a self-organizing agent in complex adaptive systems (i.e., health organizations), PA role exploration revealed patterns of team behavior, non-linear interconnections, open relationships, dynamic systems, and the legacy of role implementation as defined by complexity theory. CONCLUSIONS:By exploring the role of PAs across multiple sites, the complexity theory lens concurrently fosters an awareness of emerging patterns, relationships and non-linear interactions within the defined context of the Ontario healthcare system. By establishing collaborative, interprofessional care models in hospital and community settings, PAs are making a significant contribution to Ontario healthcare settings.

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Are clinicians being prepared to care for abused women? A survey of health professional education in Ontario, Canada.

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Are clinicians being prepared to care for abused women? A survey of health professional education in Ontario, Canada.

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