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Canada grapples with challenge of drawing psychiatrists to small towns from big cities – The Globe and Mail

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Sarah Levitt, who completes her psychiatric residency this year, outside her home in Toronto on Saturday, January 18, 2020.

Tijana Martin/The Globe and Mail

With psychiatrists in rural areas aging and demand rising, Canada is grappling with a crucial challenge: how to lure the next generation of doctors out of cities.

Pitching a rural practice to a pool of young specialists educated mainly in major centres needs to start early in medical school, experts say, and perhaps with a push: more mandatory time spent in northern locations, and more training in how to deliver telepsychiatry to smaller communities.

A Globe and Mail analysis found that the country’s psychiatrists are heavily concentrated in urban areas, with more than one third in Toronto, Vancouver and Montreal. Many regions have no permanent psychiatrists at all, a problem that will grow as more psychiatrists enter retirement age with no replacements.

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Young doctors, who primarily study in big cities and often do their residencies at academic hospitals, aren’t rushing to small towns and more northern parts of the country. A 2016 study published in the Canadian Journal of Psychiatry that surveyed Canadian psychiatry residents found that 69 per cent were interested in practising in large urban centres, compared with 29 per cent who expressed interest in rural medicine.

David Cochrane, who has been a hospital-based psychiatrist in North Bay for 25 years, concedes it is a lot to ask a new psychiatrists to come to an area where they will have few colleagues and limited support staff – which is why hospital-based psychiatrists push for more team-based work and better funding for services such as psychotherapy.

Big-city psychiatry “tends to attract individuals who want a better work-life balance and don’t want to be on call, and that puts us behind the eight ball,” Dr. Cochrane said. But there are perks, too, he points out, ones residents may not value unless they spend time in a smaller community: less bureaucracy, room to innovate, the chance to treat a wide range of patients.

The Ontario Psychiatric Association has suggested that increasing pay in rural areas would attract more psychiatrists. But Dr. Cochrane suggests an even more important step is training more psychiatrists who come from smaller towns and complete their residencies in those areas. This is similar to approach of the Northern Ontario School of Medicine (NOSM), which opened seven years ago with campuses in Sudbury and Thunder Bay. NOSM is now training 15 psychiatry residents and has graduated four psychiatrists, three of whom remained in the region.

Studies in Australia and New Mexico, for instance, have found that the more time psychiatric residents spend training in smaller communities, the more likely they are to remain there when they begin practising.

Some of Canada’s medical schools do require students to do training in rural communities, but those requirements vary widely in length and timing, as well as the definition of “rural.” For instance, one psychiatry resident of the University of Toronto said that Barrie, Ont., a city with a population of more than 150,000 and 100 kilometres from downtown Toronto, counted as a rural elective.

Saadia Sediqzadah, who will finish her psychiatry residency this year at U of T – where one quarter of the country’s psychiatrists study – says she could have completed her medical degree and residency in Toronto, without ever being required to work in a smaller community. (The University of Toronto has recently added a requirement for psychiatric residence to do rotations with “underserved” populations, but those may still be completed in the city.)

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As an elective, Dr. Sediqzadah recently finished a short stint in Iqaluit. She was reluctant to go: “I thought I would be left totally alone with very complicated cases and no support.” Instead, she encountered a collaborative team of counsellors and nurses able to offer patient histories and provide follow-up care. She has accepted a job at St. Michael’s Hospital in Toronto, but is now applying to work as a regular temporary psychiatrist in Iqaluit – a job she wouldn’t have considered if she had not first travelled to the North. “How do you know you like it if you don’t try it?” she asked.

The requirement to spend time in a smaller cities and towns during her medical school degree at the University of Western Ontario helped North de Pencier, now a first-year psychiatry resident at the University of Toronto, see herself in a rural community at the start of her career. Raised in Ottawa, she wasn’t sure she’d like the small-town lifestyle, but she came to appreciate the collegiality of a small hospital and the opportunity to get a wide-range of clinical experience. “I had a spark of interest at the start of medical school, but having all these experience makes it seems a lot more real and feasible,” said Dr. de Pencier, working regular shifts in Parry Sound, Ont., during her Toronto-based residency.

If young psychiatrists won’t, or can’t, go to smaller communities, the next best solution is to stream them in with technology, suggests Antonio Pignatiello, a University of Toronto psychiatrist and the Medical Director of TeleLink Mental Health Program at The Hospital for Sick Children.

Learning how to conduct video consultations with patients in remote communities can also make residents more familiar with the needs in those communities and with building relationships with the local staff. (In research, telepsychiatry has been found to be a cost-effective approach, well-received by patients, but more hesitantly adopted by clinicians.)

Dr. Pignatiello says the training should be mandatory and more extensive than what is offered now, and that psychiatrists need to see telepsychiatry as central to their practice. In fact, Dr. Pignatiello suggests it should be a mandatory chunk of their clinical work. “It needs to be second nature,” he said.

For Sarah Levitt, who completes her psychiatric residency this year, telepsychiatry has become second nature. At U of T, along with time working in Northern communities, she elected to do two six-month rotations that involved training in telehealth – well beyond the mandatory requirements of a couple of consultations. By combining both on-the-ground knowledge of a community and the ability to support a rural team with telepsychiatry, she imagines at some point having a practice that may locate her in Toronto, while working half time in rural medicine.

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It can be intimidating going into places with overwhelming need, she said, which makes strong mentorship important. “There is so much to learn” in smaller centres, she says, including how to be nimble with challenging cases, flexible in a team and mindful of cultural context – such the mental-health consequences of climate change in the North. Acquiring those skills made her a better doctor, she said, wherever she practises.

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What’s the greatest holiday gift: lips, hair, skin? Give the gift of great skin this holiday season

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Give the gift of great skin this holiday season

Skinstitut Holiday Gift Kits take the stress out of gifting

Toronto, October 31, 2024 – Beauty gifts are at the top of holiday wish lists this year, and Laser Clinics Canada, a leader in advanced beauty treatments and skincare, is taking the pressure out of seasonal shopping. Today, Laser Clincs Canada announces the arrival of its 2024 Holiday Gift Kits, courtesy of Skinstitut, the exclusive skincare line of Laser Clinics Group.

In time for the busy shopping season, the limited-edition Holiday Gifts Kits are available in Laser Clinics locations in the GTA and Ottawa. Clinics are conveniently located in popular shopping centers, including Hillcrest Mall, Square One, CF Sherway Gardens, Scarborough Town Centre, Rideau Centre, Union Station and CF Markville. These limited-edition Kits are available on a first come, first served basis.

“These kits combine our best-selling products, bundled to address the most relevant skin concerns we’re seeing among our clients,” says Christina Ho, Senior Brand & LAM Manager at Laser Clinics Canada. “With several price points available, the kits offer excellent value and suit a variety of gift-giving needs, from those new to cosmeceuticals to those looking to level up their skincare routine. What’s more, these kits are priced with a savings of up to 33 per cent so gift givers can save during the holiday season.

There are two kits to select from, each designed to address key skin concerns and each with a unique theme — Brightening Basics and Hydration Heroes.

Brightening Basics is a mix of everyday essentials for glowing skin for all skin types. The bundle comes in a sleek pink, reusable case and includes three full-sized products: 200ml gentle cleanser, 50ml Moisture Defence (normal skin) and 30ml1% Hyaluronic Complex Serum. The Brightening Basics kit is available at $129, a saving of 33 per cent.

Hydration Heroes is a mix of hydration essentials and active heroes that cater to a wide variety of clients. A perfect stocking stuffer, this bundle includes four deluxe products: Moisture 15 15 ml Defence for normal skin, 10 ml 1% Hyaluronic Complex Serum, 10 ml Retinol Serum and 50 ml Expert Squalane Cleansing Oil. The kit retails at $59.

In addition to the 2024 Holiday Gifts Kits, gift givers can easily add a Laser Clinic Canada gift card to the mix. Offering flexibility, recipients can choose from a wide range of treatments offered by Laser Clinics Canada, or they can expand their collection of exclusive Skinstitut products.

 

Brightening Basics 2024 Holiday Gift Kit by Skinstitut, available exclusively at Laser Clincs Canada clinics and online at skinstitut.ca.

Hydration Heroes 2024 Holiday Gift Kit by Skinstitut – available exclusively at Laser Clincs Canada clinics and online at skinstitut.ca.

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Here is how to prepare your online accounts for when you die

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LONDON (AP) — Most people have accumulated a pile of data — selfies, emails, videos and more — on their social media and digital accounts over their lifetimes. What happens to it when we die?

It’s wise to draft a will spelling out who inherits your physical assets after you’re gone, but don’t forget to take care of your digital estate too. Friends and family might treasure files and posts you’ve left behind, but they could get lost in digital purgatory after you pass away unless you take some simple steps.

Here’s how you can prepare your digital life for your survivors:

Apple

The iPhone maker lets you nominate a “ legacy contact ” who can access your Apple account’s data after you die. The company says it’s a secure way to give trusted people access to photos, files and messages. To set it up you’ll need an Apple device with a fairly recent operating system — iPhones and iPads need iOS or iPadOS 15.2 and MacBooks needs macOS Monterey 12.1.

For iPhones, go to settings, tap Sign-in & Security and then Legacy Contact. You can name one or more people, and they don’t need an Apple ID or device.

You’ll have to share an access key with your contact. It can be a digital version sent electronically, or you can print a copy or save it as a screenshot or PDF.

Take note that there are some types of files you won’t be able to pass on — including digital rights-protected music, movies and passwords stored in Apple’s password manager. Legacy contacts can only access a deceased user’s account for three years before Apple deletes the account.

Google

Google takes a different approach with its Inactive Account Manager, which allows you to share your data with someone if it notices that you’ve stopped using your account.

When setting it up, you need to decide how long Google should wait — from three to 18 months — before considering your account inactive. Once that time is up, Google can notify up to 10 people.

You can write a message informing them you’ve stopped using the account, and, optionally, include a link to download your data. You can choose what types of data they can access — including emails, photos, calendar entries and YouTube videos.

There’s also an option to automatically delete your account after three months of inactivity, so your contacts will have to download any data before that deadline.

Facebook and Instagram

Some social media platforms can preserve accounts for people who have died so that friends and family can honor their memories.

When users of Facebook or Instagram die, parent company Meta says it can memorialize the account if it gets a “valid request” from a friend or family member. Requests can be submitted through an online form.

The social media company strongly recommends Facebook users add a legacy contact to look after their memorial accounts. Legacy contacts can do things like respond to new friend requests and update pinned posts, but they can’t read private messages or remove or alter previous posts. You can only choose one person, who also has to have a Facebook account.

You can also ask Facebook or Instagram to delete a deceased user’s account if you’re a close family member or an executor. You’ll need to send in documents like a death certificate.

TikTok

The video-sharing platform says that if a user has died, people can submit a request to memorialize the account through the settings menu. Go to the Report a Problem section, then Account and profile, then Manage account, where you can report a deceased user.

Once an account has been memorialized, it will be labeled “Remembering.” No one will be able to log into the account, which prevents anyone from editing the profile or using the account to post new content or send messages.

X

It’s not possible to nominate a legacy contact on Elon Musk’s social media site. But family members or an authorized person can submit a request to deactivate a deceased user’s account.

Passwords

Besides the major online services, you’ll probably have dozens if not hundreds of other digital accounts that your survivors might need to access. You could just write all your login credentials down in a notebook and put it somewhere safe. But making a physical copy presents its own vulnerabilities. What if you lose track of it? What if someone finds it?

Instead, consider a password manager that has an emergency access feature. Password managers are digital vaults that you can use to store all your credentials. Some, like Keeper,Bitwarden and NordPass, allow users to nominate one or more trusted contacts who can access their keys in case of an emergency such as a death.

But there are a few catches: Those contacts also need to use the same password manager and you might have to pay for the service.

___

Is there a tech challenge you need help figuring out? Write to us at onetechtip@ap.org with your questions.

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Pediatric group says doctors should regularly screen kids for reading difficulties

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The Canadian Paediatric Society says doctors should regularly screen children for reading difficulties and dyslexia, calling low literacy a “serious public health concern” that can increase the risk of other problems including anxiety, low self-esteem and behavioural issues, with lifelong consequences.

New guidance issued Wednesday says family doctors, nurses, pediatricians and other medical professionals who care for school-aged kids are in a unique position to help struggling readers access educational and specialty supports, noting that identifying problems early couldhelp kids sooner — when it’s more effective — as well as reveal other possible learning or developmental issues.

The 10 recommendations include regular screening for kids aged four to seven, especially if they belong to groups at higher risk of low literacy, including newcomers to Canada, racialized Canadians and Indigenous Peoples. The society says this can be done in a two-to-three-minute office-based assessment.

Other tips encourage doctors to look for conditions often seen among poor readers such as attention-deficit hyperactivity disorder; to advocate for early literacy training for pediatric and family medicine residents; to liaise with schools on behalf of families seeking help; and to push provincial and territorial education ministries to integrate evidence-based phonics instruction into curriculums, starting in kindergarten.

Dr. Scott McLeod, one of the authors and chair of the society’s mental health and developmental disabilities committee, said a key goal is to catch kids who may be falling through the cracks and to better connect families to resources, including quicker targeted help from schools.

“Collaboration in this area is so key because we need to move away from the silos of: everything educational must exist within the educational portfolio,” McLeod said in an interview from Calgary, where he is a developmental pediatrician at Alberta Children’s Hospital.

“Reading, yes, it’s education, but it’s also health because we know that literacy impacts health. So I think that a statement like this opens the window to say: Yes, parents can come to their health-care provider to get advice, get recommendations, hopefully start a collaboration with school teachers.”

McLeod noted that pediatricians already look for signs of low literacy in young children by way of a commonly used tool known as the Rourke Baby Record, which offers a checklist of key topics, such as nutrition and developmental benchmarks, to cover in a well-child appointment.

But he said questions about reading could be “a standing item” in checkups and he hoped the society’s statement to medical professionals who care for children “enhances their confidence in being a strong advocate for the child” while spurring partnerships with others involved in a child’s life such as teachers and psychologists.

The guidance said pediatricians also play a key role in detecting and monitoring conditions that often coexist with difficulty reading such as attention-deficit hyperactivity disorder, but McLeod noted that getting such specific diagnoses typically involves a referral to a specialist, during which time a child continues to struggle.

He also acknowledged that some schools can be slow to act without a specific diagnosis from a specialist, and even then a child may end up on a wait list for school interventions.

“Evidence-based reading instruction shouldn’t have to wait for some of that access to specialized assessments to occur,” he said.

“My hope is that (by) having an existing statement or document written by the Canadian Paediatric Society … we’re able to skip a few steps or have some of the early interventions present,” he said.

McLeod added that obtaining specific assessments from medical specialists is “definitely beneficial and advantageous” to know where a child is at, “but having that sort of clear, thorough assessment shouldn’t be a barrier to intervention starting.”

McLeod said the society was partly spurred to act by 2022’s “Right to Read Inquiry Report” from the Ontario Human Rights Commission, which made 157 recommendations to address inequities related to reading instruction in that province.

He called the new guidelines “a big reminder” to pediatric providers, family doctors, school teachers and psychologists of the importance of literacy.

“Early identification of reading difficulty can truly change the trajectory of a child’s life.”

This report by The Canadian Press was first published Oct. 23, 2024.

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