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Health-care labour shortage a long time coming, requires shift to team-based care

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OTTAWA — Nearly two and a half years since the onset of the COVID-19 pandemic, the staffing conundrum initially driven by high infection rates has evolved into an acute labour challenge.

Herb Emery, the Vaughan Chair in regional economics at the University of New Brunswick, said when it comes to staff shortages, the pandemic was “like the straw that broke the camel’s back.”

“These emerging shortages have been present for decades,” Emery said. “So, no one should be surprised that we’re short on doctors that we’re short on nurses.”

In recent weeks hospitals across the country have taken drastic measures to cope with the staff shortages, including temporarily closing emergency departments.

The labour shortage is not unique to health care. Nationwide Statistics Canada says about one million jobs sit empty. But the shortages in health care are the most pronounced.

Statistics Canada said job vacancies in health during the first quarter of this year were nearly double what they were two years ago. Nurses and nurses aides were among the top ten occupations with the largest job vacancy increases over that period.

Emery says shortages in healthcare are a result of policies introduced in the 1980s and 1990s that were aimed at cutting healthcare costs. Doctors, who are paid with a fee-for-service compensation structure, were identified as a major driver of elevated costs for health care and policies were introduced to limit the supply of doctors, he said.

The Canadian Institute for Health Information said in a 2002 report that policies like reduced medical school enrolments and restrictions on international medical graduates contributed to a smaller inflow of new doctors.

On the nursing side, Emery said the stress of the pandemic and increased workloads has led to high rates of retirement and exits from the profession, and enrolment in nursing schools hasn’t been high enough to compensate for the outflow of nurses.

Some experts say one solution could be a move toward a team-based approach to care that ensures health-care professionals working at their skill level. This would mean relieving doctors of tasks nurses or pharmacists could take on while having nurses only doing work that requires nursing training.

Armine Yalnizyan, an economist and Atkinson Fellow on the Future of Workers, has been calling on provinces to develop a plan to address today’s healthcare problems, including outlining a health human resources strategy.

“You get the most expensive parts of the system being overworked to doing stuff they shouldn’t be doing, like cleaning rooms or moving patients down the hall on a gurney,” Yalnizyan said.

The idea of changing the scope of practice for healthcare workers is far from new. In 2002, Royal Commission on the Future of Health Care in Canada, also known as the Romanow Report, highlighted the need for this shift in practice.

“Changes in the way health care services are delivered, especially with the growing emphasis on collaborative teams and networks of health providers, means that traditional scopes of practice also need to change.,” the report said. “This suggests new roles for nurses, family physicians, pharmacists, case managers and a host of new and emerging health professions.”

Emery said the fee-for-service compensation structure for physicians is a barrier to moving toward team-based care.

“What [fee-for-service] discourages is having a nurse do some of the tasks that they’re qualified to do and can do quite well because the doctor whose office they’re working in can’t bill for that,” Emery said.

Moving to team-based care would also require the restructuring of collective agreements, he said, which dictate “who does what” in hospitals.

“There are things that can be done, but they’re politically contentious,” Emery said.

In Ontario, the provincial government has said it’s considering healthcare privatization as a solution to the challenges faced in hospitals. The suggestion has led to considerable backlash from politicians in the opposition as well as advocates.

However, Emery says privatization in this context refers to the delivery of services, not how the services are paid for.

“It’s really about, I think, changing the site of where care is provided from settings which tend to have more rigid rules on who can do what to whom and on what basis, to a setting where there’s more potential to have that scope of practice, team-based care, and basically get more patients seen with the same numbers of doctors and nurses.”

Yalnizyan says the health-care system has been coping with low staffing levels for far too long because of a lack of funding.

“It isn’t just a question of not preparing for the future. It’s being absolutely committed to not spending money,” she said.

However, Emery warns that more funding won’t solve the underlying issue, which is how workers are allocated within the system.

Not addressing these issues, he says, is what led to these shortages and healthcare strain in the first place.

“The frustrating part is now that it’s hit, we’re sort of wringing our hands saying, ‘well, what do we do,’ because there’s no easy fix in the short-run,” Emery said.

This report by The Canadian Press was first published Sept. 5, 2022.

 

Nojoud Al Mallees, The Canadian Press

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Feds lift border vaccine requirements, mandatory masks on planes and trains

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OTTAWA — Federal ministers say all COVID-19 border restrictions will be removed as of Saturday, including mandatory vaccination, testing and quarantine of international travellers, as well as the requirement for masks on planes and trains.

The cabinet order maintaining COVID-19 border measures will not be renewed when it expires on Sept. 30.

But Health Minister Jean-Yves Duclos is once again warning that pandemic restrictions could be reinstated if they are needed.

“We have learned over the last (two-and-a-half) years the type of measures that can work,” Duclos said Monday.

“We will therefore leave open all possible options when it comes to protecting the health and safety of Canadians.”

The changes mean foreign nationals will no longer require an approved series of vaccinations to enter the country.

In addition, Canada-bound travellers will no longer be subject to random COVID-19 tests, and unvaccinated Canadians will not need to isolate when they return to the country.

Cruise passengers will not have to do pre-board tests or prove they have been vaccinated.

And people who enter the country after Saturday will not need to monitor and report if they develop signs or symptoms of COVID-19.

The five federal ministers making the announcement said the changes are informed by science and epidemiology, adding that modelling indicates the peak of the latest wave of the disease has “largely passed.”

But they did face questions about whether the move is at least partially politically motivated as the Liberals contend with the newly elected Opposition leader, Pierre Poilievre.

The Public Health Agency of Canada is still strongly recommending that people wear masks, particularly in crowded environments such as planes and trains.

“The science is clear: wearing a mask is clearly a means of personal protection that is extremely effective,” said Dr. Howard Njoo, Canada’s deputy chief health officer.

“I hope Canadians will make an enlightened decision about this.”

Duclos said the negative attitudes of some passengers have made things very difficult for airlines and crews to enforce the mask mandate in recent months, and cited that as a factor in the decision.

“The transmission of the variants of COVID are domestic-based, for the most part, and therefore, this is what we should stress: masking is highly recommended … but it is not something that can be, in a sense, forced.”

That is a change in messaging from earlier in the summer, when the government and public health officials insisted that maintaining measures at the border was necessary to track and prevent the introduction of new variants.

Public Safety Minister Marco Mendicino said there have been 38 million entries at the border in 2022 so far, more than double the number in all of last year. “We want to keep that momentum going.”

The controversial ArriveCan app will no longer be mandatory when the order expires.

“Going forward, use of ArriveCan will be optional, allowing travellers who so choose to submit their customs declaration in advance at major airports,” Mendicino said.

So far that option is available at international airports in Toronto, Montreal and Vancouver, but that will be expanded to include Calgary, Edmonton, Winnipeg, Ottawa, Quebec City, Halifax and Billy Bishop airport in Toronto.

In addition, the Canada Border Services Agency is looking at adding features to ArriveCan to be able to provide information such as border wait times.

The changes do not remove the quarantine or testing requirements for people who enter Canada before Saturday.

This report by The Canadian Press was first published Sept. 26, 2022.

 

The Canadian Press

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Using artificial sweeteners may raise the risk of heart disease, study shows – Prestige Online Malaysia

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‘Debilitating’ heart palpitations could be sign of Long Covid – do you have the condition? – Express

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Heart palpitations can be a sign of several different problems – both mental and physical. Often, they’re caused by stress and anxiety. But over the course of the last few years, Long Covid has reportedly caused palpitations. A recent study has explored why this might happen.

Long Covid is when people suffer ongoing symptoms of Covid, 12 weeks after infection.

Some people with the condition have struggled with heart palpitations, chest pain, dizziness, or feeling faint.

Researchers, observing their patients, have concluded that these symptoms could be caused by problems with the autonomic nervous system – the part of your nervous system that monitors automatic activities such as heart rate, breathing, and blood pressure.

Doctors and nurses at Hammersmith Hospital and Imperial College London believe that the “debilitating” palpitations and other symptoms were caused by “orthostatic intolerance syndrome”.

READ MORE: Princess Beatrice’s ongoing difficulty with ‘muddled’ thoughts swirling in her head

Orthostatic intolerance syndromes are when moving from a sitting or lying position to an upright position causes a low blood pressure in your arteries.

The British Heart Foundation explains: “When a healthy person stands up, some of the blood in the body will flow downwards with the pull of gravity.

“The body responds to prevent blood pressure falling – blood vessels narrow and there is a slight increase in heart rate.

“But in people with orthostatic problems, these automatic changes don’t happen.

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“Moving to an upright position causes a drop in the blood supply to the heart and brain and a fast heart rate as the body tries to compensate.”

For people that struggle with these issues with moving to an upright position, the study by Hammersmith Hospital and Imperial College London made recommendations.

It suggested: “Non-upright exercise such as cycling on a recumbent exercise bike and swimming are encouraged.”

It added: “The patient should be advised on rising cautiously from a lying or seated position and avoiding exacerbating factors such as prolonged standing, warm environments, and dehydration.”

READ MORE: Princess Beatrice’s ongoing difficulty with ‘muddled’ thoughts swirling in her head

Shingles, memory loss, tinnitus, itchy skin, and tremors were among the more abnormal symptoms experienced.

Some studies have suggested that long Covid is an autoimmune disease, similar to Parkinson’s disease. An autoimmune disease is when the body’s immune system attacks itself.

The body cannot tell the difference between your own cells and foreign cells so causes the body to attack healthy cells.

According to one small study from 2021, 44 percent of long Covid patients involved had high levels of a type of antibody connected with other autoimmune diseases and lupus.

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