Physicians' Update

Issue 96, February 2014

(Read previous issues)

In partnership with the Academy of Medicine Ottawa

In this issue: 

Immunization:

Health Promotion and Disease Prevention:

Sexual health:

Mental health:

Substance misuse and addiction:

Infection Control:

Did you know?

Upcoming professional development:

Other: 

Additional documents:

Message from the Medical Officer of Health

Dear colleagues,

Dr. Isra Levy Medical Officer of Health

February often has us wondering when winter will end – and along with it the flu season. This year, we raised influenza immunization coverage by bringing vaccination services closer to where people live, work and play. Ottawa physicians have provided or recommended flu vaccine to their patients, pharmacists have really stepped up their participation in this program, and hospitals have raised immunization coverage among health care providers by offering vaccination to their staff and families. We are grateful for our partnership with all of you in this and many other programs that benefit our community.

In this edition of Physicians’ Update, it is my pleasure to share with you a pot-pourri of articles and news briefs covering immunization updates, where you can find support for patients who want to quit smoking or curb their gambling, tips for helping patients recover from a stressful event, resources for cancer screening, guidelines for management of gonorrhoea, and other pearls. I thank our staff, fellow physicians, community partners and public health physicians-in-training for these articles.

For Ottawa Public Health, 2014 also ushers in the final year of our strategic plan under the first Ottawa Board of Health. In preparation for the next cycle of 2015 to 2018, we are reflecting on the major public health initiatives in which we have been privileged to participate, identifying ways to collectively further our objectives, and charting innovative strategies to protect and improve the health of our community. For example, we are excited about the manner in which public support for the Ottawa Smoke-free strategy – Let’s Clear the Air – has gained momentum, with bylaw amendments further protecting the air we breathe in public space and community housing, construction companies engaging in worksite smoking cessation strategies with tremendous enthusiasm, and other joint projects led by the Champlain Region Cardiovascular Disease Prevention Network and the Ottawa Heart Institute showcasing innovation in schools and hospitals. We continue to work with the City of Ottawa and the city’s four public school boards to improve our physical and social environment and encourage residents to lead more active lives.  We trust these efforts will prove the perfect complement to the work you do every day to support your patients in their quest for better health.

We look to you to partner with us in these and many other initiatives, and of course, let us know what we can do for you. 

Yours, 
Isra

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Take note! Amendments to the Immunization of School Pupils Act are coming soon!

Have you heard?
On September 18, 2013, amendments were made to the Immunization of School Pupils Act (ISPA) to further protect the health of Ontario school children by reducing the risk of vaccine-preventable disease outbreaks in schools. Amongst other changes, three additional vaccines are now required for school attendance: meningococcal, pertussis, varicella.

Why were changes made to the ISPA?
The ISPA was revised to reflect current clinical guidelines and the recommendations of the Publicly Funded Immunization Schedules for Ontario (2011) and the National Advisory Committee on Immunization  (NACI).

As a physician, what changes should you know about?
The schedule of required vaccinations in the ISPA will align with the Publicly Funded Immunization Schedule for Ontario (2011). Regulatory amendments include the addition of meningococcal disease, pertussis and varicella as diseases requiring proof of immunization for school attendance (unless a valid exemption is provided to the local Medical Officer of Health) due to the risk of these infections for school-aged children.

Why were other vaccines not included?
Other diseases for which publicly funded vaccines are available were not added at this time. For example, although influenza often causes outbreaks in schools, it was not included since the Ministry of Health and Long Term Care (MOHLTC) is exploring other strategies to raise influenza immunization coverage among children.

When do these changes come into effect?
Updates to the provincial immunization schedule and inclusion of these additional designated diseases in the ISPA will come into effect on July 1, 2014. Your patients will be required to provide immunization records according to the revised legislation for the 2014/2015 school year.

Where can you get more information?
The MOHLTC will provide further details regarding the implementation of the amendments. In the meantime, feel free to consult:

  • the updated ISPA e-Law
  • Ottawa Public Health by phone at 613-580-6744 or by e-mail

Oh, one last thing!Personal Immunization record
Please remind your patients that it is their duty to update their child’s immunization record with Ottawa Public Health! Less than five minutes will ensure that they do not receive a Notice of Incomplete Immunization that could result in frantic calls to your office from parents worried that their child will be suspended from school.

Written by Vickie Paulin, R.N., B.Sc.N., Public Health Nurse, Ottawa Public Health

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Vaccine related FAQs

The following questions and answers on various immunization issues were discussed at a Continuing Medical Education Event held on October 3, 2013 by Ottawa Public Health (OPH) with over 100 health care providers in attendance.

You have a 15 year old diabetic patient who has never previously received pneumococcal vaccine. What vaccine(s) should you give her?

Answer: All persons ≥ two years of age with medical conditions listed under the high risk eligibility criteria of the Ontario Publicly Funded Immunization Schedule (including those with diabetes) should receive a dose of Pneu-P-23.

Some experts suggest that a conjugate pneumococcal vaccine may be given as the initial dose, followed by the Pneu-P-23 vaccine, for adults less than 65 years of age who are at an increased risk for invasive pneumococcal disease, as this may theoretically improve antibody response and immunologic memory. In this case, the conjugate pneumococcal vaccine would NOT be publicly funded.  

Note: If giving both (conjugate and polysaccharide pneumococcal vaccines), administer the conjugate first followed by Pneu-P-23 at least eight weeks later.

2. You have a 53 year old otherwise healthy patient who asks if he should get the shingles vaccine. He says he has never had chickenpox. What would you recommend?

Answer: Herpes zoster (HZ) vaccine has been shown to be safe and immunogenic in people who are 50+ years of age, but effectiveness has only been studied for people over 60 of age who received the vaccine. The risk of developing HZ and its complications increases with age.

While all adults 50+ receive some benefit if given the herpes zoster vaccine, the duration of protection is unknown beyond seven years; therefore, it is uncertain whether vaccination in people under 60 will provide ongoing protection at older ages when incidence of HZ is higher. The National Advisory Committee on Immunization (NACI) recommends the vaccine specifically for people 60 and over, but says it may be given to those 50-59. HZ vaccine is not currently publicly funded in Ontario.

HZ vaccine should be given regardless of whether or not a person has a history of chickenpox infection.  Routine testing for varicella zoster virus (VZV) antibody to confirm prior chickenpox is not recommended, as most people over 50 in Canada had naturally acquired infection.  However, if a person is inadvertently tested and does not show immunity to VZV, he/she should be vaccinated with two doses of varicella vaccine, instead of HZ vaccine (the two doses of varicella are NOT publicly funded if born prior to January 1, 2000, unless considered to be at high risk).

3. You have a four year old asthmatic patient who has had an anaphylactic reaction to eggs. What would you recommend?

Answer: The 2013-2014 National Advisory Committee on Immunization (NACI) Statement on Seasonal Influenza Vaccine states that egg allergic individuals may be vaccinated against influenza using TIV, without prior influenza skin test and with the full dose, irrespective of a past severe reaction to egg. Those who have suffered from anaphylaxis with respiratory or cardiovascular symptoms should be vaccinated in a medical clinic, allergy office or hospital. These individuals should always be kept under observation for 30 minutes. Those with milder reactions, such as hives, may be vaccinated in regular vaccination clinics.

For more vaccine related information, please refer to the latest version of the Canadian Immunization Guide (available only online), or request an in-service by the Physician Outreach Team at OPH.

Written by Ginette Smith, RN, Public Health Nurse, Ottawa Public Health

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Introducing Ottawa’s latest, Ministry funded, Childhood Obesity Treatment Program

Childhood overweight and obesity affects nearly 30% of children and if weight were straightforward to manage, no doubt the world would weigh less, as weight not only confers medical risk, but society is full of weight bias and discrimination. Consequently, children with overweight or obesity are not only at an increased risk of medical problems, they’re also at higher risk of bullying, lowered self-esteem, and depression.

Childhood obesity isn’t something that a child can cure, but it may be something that a family can change, and Ottawa’s latest Ministry of Health funded childhood obesity treatment program aims to help families to do so. Rather than risk teaching children that their weights are their fault, BMI’s Family Reset program is designed to help re-engineer a child’s entire family’s lifestyle, with the weight-focused portion of the program being delivered exclusively to parents without children present.

BMI’s Family Reset Program helps parents navigate the main areas of healthy lifestyles - Nutrition, Behaviour, Fitness, and the ability to put it all together - Fusion.  Family Reset includes unlimited parental access to BMI’s physicians, registered dietitians, behavioural social workers and certified trainers along with cooking classes and an offsite, non-weight focused, group program for the children on issues surrounding self-esteem, anti-bullying, body image and stereotypes, depression, anxiety, and anger management .

As part of Ontario’s childhood obesity strategy, BMI’s Family Reset program is offered at no cost to families with children between the ages of 5-12 with weights between the 85th-99th percentiles. For more information please call 613-730-0264 or visit www.ottawahealthykids.ca to print referral forms including forms for referral to CHEO’s child obesity program.

Program Highlights:

  • Parents receive 6 months of unlimited one-on-one counselling from registered dietitians, behaviourists, and exercise specialists regarding family health, parenting, nutrition, healthy active living and healthy attitudes surrounding weight and body image. Parents will continue to meet team members following those 6 months at prescribed intervals, but if the need arises, urgently as well.
  • Parents who have overweight or obesity will be provided with BMI’s existing 6 month behavioural weight management program which also includes unlimited access to team members, as well as on-site group fitness classes 3x weekly.
  • Five social worker led groups for children with sessions focusing on self-esteem, anti-bullying, body image, depression, anxiety, and anger management. There will be no discussion of weight at these meetings.
  • One clinical psychologist led group for parents on mental health issues and their impact on self-efficacy, stress management, self-esteem, relationships and their interplay with weight management.
  • Up to ten hours of one-on-one therapy with a clinical psychologist for parents struggling with mental health issues, such as improving the treatment of mood disturbances, will likely improve those parents' interactions with their children.
  • Monthly group fitness outings led by exercise specialists to introduce different active living options.
  • Two group cooking classes for parents designed to teach basic cooking skills.

Written by Dr. Yoni Freedhoff, Medical Director, Bariatric Medical Institute

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Program enhancements: cancer screening resources from Cancer Care Ontario (CCO)

In the Champlain region (including Ottawa, Renfrew, Lanark, Prescott and Russell, Stormont, Dundas, and Glengarry) 69% of eligible women had at least one Pap test in a three-year period, 63% of eligible women had a mammogram within a two-year interval, and just 35% of eligible adults had at least one fecal occult blood test (FOBT) in a two-year period.1

New resources are available from CCO to help you promote cancer screening to your patients.

Cervical cancer screening

Letters to women - A new enhancement to the Ontario Cervical Screening Program (OCSP) since September 2013. 

  • Women who recently had a Pap test will receive a letter to let them know about the OCSP, informing them of CCO’s privacy guidelines and giving them the choice to opt out of receiving correspondence.
  • Unless their Pap tests was processed in a hospital or a public health lab, women age 21 and older who have recently had a Pap test will receive a letter with the result of their test. 
  • Women aged 21 to 69 who were screened 35 months ago will receive a reminder letter to let them know they are due for their three-year re-screening.
  • Invitation letters will then be sent to women aged 30 to 69 years who were not screened within the prior 36 months.

Women can opt out of the correspondence program at any time.

Although this correspondence program is intended to promote cervical cancer screening, it is not intended to replace the role of primary care in promoting screening, notifying women of their test results and managing follow-up of results.

The Expanded Free Mobile App includes quick access to Ontario’s cervical screening guidelines, easy-to-navigate recommendations for follow-up of abnormal cytology, and instant viewing, printing and emailing of patient resources.

  • Now available on BlackBerry, Android and Windows Phone
  • Updated to support iOS 7 and the iPad

Additional FAQ’s

  • “Were the screening guidelines changed as a cost-cutting measure?” (FAQ #19)
  • “Will provider incentives be changed to reflect the new guidelines?” (FAQ #14)

Breast cancer screening

An updated handout provides health care providers a quick reference tool for information on the Ontario Breast Screening Program including:

  • Screening recommendations
  • Eligibility criteria
  • Enrolment process for women at average risk vs. high risk for breast cancer.

ColonCancerCheck

CCO recommends that individuals participate in ColonCancerCheck—Ontario’s colorectal cancer screening program. ColonCancerCheck offers screening free of charge through FOBTs every two years for eligible individuals at average risk aged 50 to 74. People who have a first-degree relative (i.e., parent, sibling or child) with a history of colorectal cancer should be screened with colonoscopy beginning at age 50, or 10 years earlier than the age at which their relative was diagnosed, whichever occurs first.

Serologic blood testing is not part of ColonCancerCheck

Serologic blood tests for colorectal cancer screening are beginning to make their way onto the market in Canada and are generally being promoted by laboratories and distributers as acceptable alternatives to fecal occult blood tests (FOBTs). These tests are not covered by the Ontario Health Insurance Plan (OHIP).

CCO does not support the use of serologic blood tests for colorectal cancer screening. CCO is examining the evidence for serologic blood tests as a part of broader clinical practice guidelines for colorectal cancer screening. CCO will revise its position if the evidence is sufficient to support the use of serology. 

For further information, please visit www.cancercare.on.ca/pcresources, call 1-866-662-9233 or e-mail primarycare@cancercare.on.ca.  

Colorectal cancer screening ColonCancerCheck Screening Activity Report (CCC SAR)
Register to access a secure electronic report with a comprehensive summary of your patients’ colorectal cancer screening activity updated with data as of September 30, 2013.

Adapted by Diane Desjardins, R.N. BScN, Public Health Nurse, Ottawa Public Health

 References:

  1. Cancer Care Ontario. Cancer Quality Council of Ontario [Internet]. Toronto: Cancer Care Ontario; updated 2013 May 15; cited 2013 November 18. Cancer System Quality Index (CSQI). Available from: http://www.csqi.on.ca/cms/One.aspx?portalId=258922&pageId=259142

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Do you have patients wanting to quit smoking? Refer them to Smokers’ Helpline!

Meet Jeff Smith. Jeff smoked one pack of cigarettes a day for 33 years. He attempted to quit smoking several times in the past, but unfortunately he always started up again. Jeff finally made the decision to quit when his health was failing and he had developed chronic obstructive pulmonary disease (COPD) as well as a chronic cough. Through an internet search, he discovered Smokers’ Helpline. 

Smokers' Helpline is a free, confidential, evidence-based service operated by the Canadian Cancer Society offering support and information about quitting smoking and tobacco use.

Smokers’ Helpline is available in both English and French to people who:

  • Want to quit
  • Are thinking about quitting
  • Have quit and need support
  • Think they should quit, but are not ready
  • Do not want to quit
  • Want to help someone else quit

The service is personalized, non-judgmental, and is available over the phone at 1-877-513-5333, via text messaging or online at smokershelpline.ca.  Interpreter services in over 100 languages are also available by phone in Ontario.

Looking back on his experience with Smokers’ Helpline, Jeff states, “Smokers’ Helpline was a great way to help me quit smoking and receive much needed support. It provided me with the tools and advice I needed to quit once and for all, and it gave me the opportunity to share my experience with others, which in turn helps them out.” 

On average, Ontario smokers will make 3.5 quit attempts before they quit for good. Each quit attempt is an important step in learning about their smoking behavior and moving towards being tobacco-free. Once your patient connects with Smokers’ Helpline, he or she is significantly more likely to make a quit attempt than if the referral was not made.

How to refer your patients

The Canadian Cancer Society and Ottawa Public Health both recommend the ‘5 As’ model of referral:

  • Ask your patient about their current and past tobacco use.
  • Advise your patient that quitting is the best thing they can do for their health.
  • Assess your patient’s readiness to quit.
  • Assist your patient by providing brief counseling and pharmacotherapy.
  • Arrange follow-up by obtaining consent to fax a referral to Smokers’ Helpline:
  1. Patients can contact Smoker’s Helpline directly: 1-877-513-5333 or smokershelpline.ca
  2. Health care professionals can make a referral using our Quit Connection Fax referral form

How will Smokers’ Helpline follow up with your patients?

Upon receipt of a faxed consent form (to 1-877-513-5334), the referral is entered into the Smokers’ Helpline confidential database.  A call is then made to your patient at a time that he/she has identified as being ‘preferred.’ Three attempts will be made to contact the patient. Tobacco Cessation Specialists (Quit Coaches) provide information about the service, assess a patient’s readiness to quit, and offer services based on each individual patient’s situation.

For more information on this service, please contact Barbara Hollander, Sr. Coordinator Smokers’ Helpline, East Region, either by phone at 613-723-1744 ext. 3603 or by e-mail at bhollander@ontario.cancer.ca

Ottawa Public Health offers a variety of resources to support people who would like to quit smoking such as workshops and group programs.  Nicotine Replacement Therapy can also be requested. For more information visit Ottawa.ca/quitsmoking or by phone at 613-580-6744

Submitted by Susan Fekete, Canadian Cancer Society, 613-723-1744 ext. 3616

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Older Adults Falls Prevention Survey

Ottawa Public Health (OPH) is proud to share the findings of the Older Adults Falls Prevention Survey and its current activities on the issue.   The telephone survey was conducted by Nanos Research on behalf of OPH in 2012. The topic-specific reports and summary infographics are on our website at www.Ottawa.ca/healthreports.   They are as follows:

  • Annual Physical and Vision Exam and Medication Review
  • Falls Prevention Home Safety
  • Perception of Falls Risk and Prevention
  • Physical Activity
  • Vitamin D and Calcium Intake

The reports and infographics will help service providers who work with older adults to tailor awareness and education campaigns on preventing falls, support client education, and inform program priorities and policy development. A description of OPH and community falls prevention services are included at the end of each report.   

Ottawa Public Health also provides programs that focus on healthy aging, outreach to isolated seniors and supporting informal caregivers.

Telephone advice and information –The public can obtain health information and confidential counselling on various topics, talk with a Public Health Nurse (PHN) or find out more about the programs described below, phone 613-580-6744 between 9:00 a.m. and 4:00 p.m. from Monday to Friday (closed on statutory holidays).

Healthy Aging / Falls prevention

  1. Group Education PHNs deliver group education sessions on adopting healthy behaviours and reducing the risk of falls.
  2. Screening Clinics  PHNs offer falls screening clinics for older adults at various community locations.

The Friendly Corner St Laurent Shopping Centre – This health information and activity centre is located in the lower level at the St Laurent Shopping Centre.  PHNs and volunteers offer activities to promote healthy aging.

Community Connect – The Community Connect Team helps Ottawa residents who are isolated, at risk of losing their home or living in poor conditions that could affect their health and / or safety.  PHNs link clients to support services and work with community agencies to improve access to the help they may need to remain safe and independent in their homes.  The service is bilingual and city wide with no age limit.

Caregiver Support Program – PHNs provide telephone counselling and group education sessions for caregivers and a free resource guide to local services. 

OPH is proud to launch the “Taking Care of My Health” falls prevention videos.  You may view the two videos on Youtube.   To receive a copy, please contact OPH at 613-580-6744. 

For more information on these healthy aging programs, to book a group education session and to find screening clinic locations, call:
613-580-6744 / 1-866-426-8885
TTY: 613-580-9656
www.ottawa.ca/health  

Written by Jacqueline Roy, R.N. MScN., Program Manager, Ottawa Public Health

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Guidelines for Testing and Treatment of Gonorrhea in Ontario, 2013

In April 2013, Public Health Ontario (PHO) released new Guidelines for Testing and Treatment of Gonorrhea in Ontario, 2013. These Guidelines were developed to address the rising resistance of gonorrhea to all available antibiotics including cephalosporins. They are designed to guide effective treatment of patients with gonorrhea and to make up-to-date local and provincial information available regarding trends in antimicrobial resistance.

Highlights of these Guidelines are as follows:

  • Gonorrhea culture and sensitivity (C+S) testing is now recommended for all symptomatic patients at the site of symptoms (including urethral and cervical).
  • First-line treatment for all patients over age nine with uncomplicated urogenital or pharyngeal gonorrhea is Ceftriaxone 250 mg IM x 1 dose PLUS Azithromycin 1g PO x 1 dose.
  • Cefixime is no longer considered effective for treatment of gonorrhea in Ontario.
  • Clinical situations in which test of cure is required have been updated, including some new clinical scenarios.

For further information, consult the following two PHO documents:

  1. A two-page Quick-Reference Guide to the Guidelines
  2. Responses to a compilation of FAQs about the Guidelines.

Antibiotics are available free of charge from Ottawa Public Health (OPH) for treatment of patients with gonorrhea and some other STIs. To obtain antibiotics, please contact OPH through the STI Reporting line at 613-580-6744 ext. 12580.  Where necessary, patients can be referred for assessment and treatment to the Sexual Health Centre (located at 179 Clarence Street) at 613-234-4641.

Written by Gila Metz, MD CCFP, Medical Director, Ottawa Public Health

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Supporting patients who have experienced stressful events

When tragedies happen (like the bus and train collision in Ottawa in Sept 2013), or when people experience large scale damage (caused by tornadoes, floods, fires, etc.), patients may visit you with unresolved issues related to these or previous traumatic events.

The psychological impact of a stressful event can be immediate or delayed, and those affected directly or indirectly can feel a range of emotions and reactions. In the wake of stressful events, your patient can be affected physically, emotionally or cognitively, making it difficult to think clearly, or may develop unhealthy coping mechanisms.

After an emergency or a disaster, people may feel dazed or numb. They may feel sad, helpless, or anxious or suffer from flashbacks or nightmares. They might have trouble sleeping, eating, or paying attention. Many people have short tempers and get angry easily. They may have strong feelings right away or not notice a change until much later. Patients experiencing stressful events can change how they interact with friends and family, and may avoid places or persons that remind them of the disaster. In the wake of fatal trauma or tragedy in the community, those affected may suffer from survivor's guilt.

These are normal reactions to stress, and it may take time before your patient feels better, and life returns to normal. People need to give themselves time to heal.

What your patient can do:

Following stressful events, remind your patient to focus on what needs to happen today and to identify what can wait until tomorrow. Remind your patient to:

  • Follow a normal routine as much as possible.
  • Eat healthy meals. Be careful not to skip meals or to overeat.
  • Exercise and stay active.
  • Help other people in their community
  • Accept help from family, friends, co-workers, or clergy. Talk about their feelings with them.
  • Limit their time around the sights and sounds of what happened; not to dwell on TV, radio, or newspaper reports on the tragedy.

Online resources available to your patients include:

Ottawa Public Health:

The Royal:

Public Health Agency of Canada:

What you can do:

Your patient may seek your help soon, or some time after a traumatic event, or he or she may be seeing you for another concern. In some cases (e.g. new patients, refugees, immigrants), the occurrence of recent or prior trauma may not be known to you.

  • Be vigilant for signs of distress.
  • Encourage use of natural family and community supports.
  • Consider offering additional support or referral in view of
    • the duration and intensity of symptoms of grieving or distress, or
    • appearance of impairment in daily activities and relationships.
  • Consider screening or referral.

When should your patient be referred for additional support?

Following a stressful event, some patients may need additional support.

Consider offering extended support or a referral if your patient is experiencing symptoms below, especially if they exceed two weeks' duration:

  • Feeling sad or depressed.
  • Feeling extremely helpless.
  • Difficulty returning to a normal routine.
  • Inability to do their job.

Consider immediate referral if the following are present:

  • Thoughts of hurting self or others
  • Suicidal thoughts.
  • Unusual, increasing or excessive alcohol or drug use
  • Dangerous or risky behaviours.
  • Inability to care for self or children/dependents.

Of particular concern is the potential for development of trauma- and stressor-related disorders, such as adjustment disorders, acute stress disorder (ASD), and post-traumatic stress disorder (PTSD). Adjustment disorders usually occur within 3 months, and are characterized by intense distress that appears out of proportion to the severity of the stressor or trauma.

Acute stress disorder typically occurs 3 days to 1 month after the stressful event. Symptoms include:

  • Numbing, detachment, absence of emotional responsiveness
  • Increased anxiety or hyperarousal — being 'on guard.'
  • Altered sense of reality of one’s surroundings or oneself
  • Inability to remember an important aspect of the traumatic event
  • Avoidance
  • Intrusive memories, flashbacks and nightmares

These symptoms are also characteristic of PTSD. Acute stress disorder may resolve or develop into PTSD or another mental health problem or psychiatric disorder. When PTSD occurs, it typically starts within 3 months of a traumatic event. However, it can appear years later and is not always preceded by acute stress disorder.

Where to refer:

The Special issue of the OPH Physicians’ Update on Mental Health, published in April 2012, provides detailed information about referral to mental health services in Ottawa including those offered by The Royal and the AMO’s “Find a Psychiatrist” to name a few. Please consult this issue for more information.

At any time, your patients and their families can access community mental health resources available in Ottawa without referral:

  • The Distress Centre answers calls 24 hours a day, seven days a week, with crisis line specialists providing confidential support. Callers can reach the Centre at 613-238-3311.
  • The Mental Health Crisis Line answers calls for people ages 16 or older 24 hours a day, seven days a week. Callers can reach the line at 613-722-6914.
  • Tel-Aide Outaouais offers French-language mental health telephone support from 8 a.m. to midnight every day. Ottawa residents can call 613-741-6433, and Gatineau residents can contact 819-775-3223.
  • The Kids Help Phone (1-800-668-6868) provides confidential 24/7 phone and web counselling for children ages 20 and under.
  • The Youth Services Bureau (YSB) provides youth and family counselling, crisis support and a 24/7 crisis line at 613-260-2360.
  • Ottawa Public Health Information at 613-580-6744 (TTY 613-580-9656).
  • 211 connects callers to community, social, government and health service information in Ottawa 24 hours a day, seven days a week. The service is free, confidential and multilingual.

References:

  1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing, 2013.
  2. Bryant RA, Creamer M, O'Donnell M, Silove D, McFarlane AC. The capacity of acute stress disorder to predict posttraumatic psychiatric disorders. J Psychiatr Res. 2012 Feb;46(2):168-73.
  3. Friedman MJ, Resick PA, Bryant RA, Strain J, Horowitz M, Spiegel D. Classification of trauma and stressor-related disorders in DSM-5. Depress Anxiety. 2011 Sep;28(9):737-49.

Written by Dr Rosamund Lewis, Associate Medical Officer of Health, with thanks to Joanne Kukulka and Dr Natalia Abraham. 

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Gambling problems series (Part 2 of 2): Local treatment and referral options for patients

In Ottawa, only 280 out of an estimated 13,000 people with gambling problems access treatment services every year. Physicians can help bridge this gap by screening for gambling problems when patients present with mental health issues, especially depression and anxiety (see Part 1 of gambling problem series).

Determine what your patient is ready to hear

You’ve done the appropriate screening and found that your patient has a gambling problem. Tread carefully! Be aware that some patients:

  • Haven’t made the connection between their current difficulties and gambling behaviour
  • Are ambivalent about gambling
  • Are afraid of what might happen in counselling
  • Are afraid of being labelled and stigmatized
  • Don’t know that effective help is available.

Allay fears: tell your patients what they can expect in treatment

Counsellors don’t make patients stop gambling – only the patient can make that choice. Counsellors explore issues the patient considers to be priorities. They can help patients:

  • Heal family relationships
  • Gain control over their lives
  • Find balance
  • Think more clearly
  • Gain control over debts.

Most patients find treatment helpful; for example, they say they feel better equipped to deal with life.

Treatment and management options

There are three main subtypes of gamblers, each requiring different treatment regimens and having different prognoses. Even if you practice Cognitive Behavioural Therapy (CBT), effective gambling therapy is more complex than one might suspect. Training includes:

  • Gambling focused Brief Solution-Focused Therapy and CBT
  • Pathways Model (an organizational framework developed by Dr. Alex Blaszczynski)
  • Harm reduction counselling
  • Motivational interviewing.

Unless you develop an interest and expertise in this area, don’t try to treat problems with gambling.

Your role as a family doctor

Consider the following options:

  • Provide print resources listed below and assess your patient’s motivation when you next meet.
  • Have your office set up an appointment for treatment at one of Ottawa’s gambling treatment programs (listed below).
  • Provide supportive counselling while waiting for gambling treatment (One to two day wait for acute issues, such as extreme financial duress; approximately one to two weeks for non-acute issues).
  • Manage or treat co-morbidities as appropriate (eg., depression and anxiety).
  • Address possible history of physical and sexual abuse.
  • Consider family intervention.
  • Consider social work or case management agency referral (for severe financial debt).
  • Consider psychiatric consultation (for complex psychiatric problems or suicidal thoughts).
  • Follow up after two to four weeks (check treatment attendance; if absent, inquire about obstacles).

Don’t leave it up to the patient to set up gambling therapy for themselves.  Motivation wavers!

Does treatment for gambling actually work?
Yes, for most patients and families, treatment works. For all subtypes of problem gamblers, early identification and intervention can limit the damage caused to patients, families and the community. A Cochrane Review (2012) and DARE Abstract (2013) support that CBT for gambling works within three months. As more time passes, further support or treatment may be necessary to prevent or treat relapses.  

Gambling treatment resources in Ottawa

Treatment Service

Population

Phone Number

Description

Amethyst Women’s Addiction Centre

Women

613-563-0363

Free two-year outpatient program.

Lifestyle Enrichment For Senior Adults (Centretown Community Health Centre)

Senior adults (55+)

613-233-4697

In-home counselling, support groups and a recreation therapy program.

Sandy Hill Community Health Centre

Adults

613-789-8941

Counselling for individuals and groups. 

Gambling Anonymous

Adults

613-567-3271

Eight meetings offered per week.

Gam-Anon

Families and friends

416-366-7613

One meeting per week.

Serenity Renewal for Families

Individuals and families

613-523-5143

Counselling, workshops, and group sessions.

Rideauwood Addiction and Family Services

Youth, adults, families, and friends

613-724-4881

Free support groups.  One-on-one counselling at extra cost.

Ontario Problem Gambling Helpline

Individuals, families, and friends

1-800-230-3505

Free counselling 24/7 (via telephone, live chat, or email).

Problem Gambling Service (Centre for Addiction and Mental Health (CAMH) Website)

Individuals, families, and friends

1-888-647-4414

Clinical consultations available. Informative website.

Downloadable pamphlets:

The following information pamphlets are available to you and your patients:

A description of these resources is provided in the “Resources for patient education and referral” section of this publication.

Written by Natalia Abraham MD, BSc, MA, MSc(c), Medical Resident, Public Health and Preventive Medicine, University of Ottawa, (OPH), with thanks to Dr. Rosamund Lewis, Jason Haug, and Lorette Dupuis at OPH for their input

References:

  1. Ottawa Public Health. 2013. Board of Health Report – Health and Social Impacts Related to Problems with Gambling in Ottawa. Ottawa (ON).
  2. Problem Gambling Institute of Ontario. Information for Primary Health Care Professionals. Retrieved Sept 9, 2013.
  3. Tessier, C and Ballon, B. 2003. Problem Gambling - Part II: Treatment and Referral. Ontario Medical Review. 
  4. Cowlishaw S, Merkouris S, Dowling N, Anderson C, Jackson A, Thomas S. Psychological therapies for pathological and problem gambling. Cochrane Database of Systematic Reviews 2012, Issue 11. Art. No.: CD008937. DOI:10.1002/14651858.CD008937.pub2.cochorane. Retrieved Sept. 12, 2013.
  5. Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews. York (UK): Centre for Reviews and Dissemination; 2013. A systematic review and meta-analysis of cognitive-behavioural interventions to reduce problem gambling: hedging our bets?; 2009. Available from: http://www.crd.york.ac.uk/crdweb/ShowRecord.asp?AccessionNumber=12009106147&UserID=0#.Uj4ZTXNDsX4.  Retrieved Sept 12, 2013.

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Infection Prevention and Control for Clinical Office Practice

All the information you need in one place!

Experience gained from SARS in 2003 and subsequent infectious disease outbreaks shows the importance of infection prevention and control in any health care setting. Now there is one document where you can find what you need for clinical office practice. The College of Physicians and Surgeons of Ontario (CPSO) has collaborated with the Provincial Infectious Diseases Advisory Committee to develop Infection Prevention and Control for Clinical Office Practice – a best practice document published by Public Health Ontario. It replaces the CPSO 2004 publication, Infection Control in the Physician’s Office.

In this well-organized and comprehensive guide, you will find information on topics such as:

  • Principles of infection prevention and control in a clinical office setting
  • Legislation relating to clinical office practice and duties of physicians as employers and supervisors
  • Issues to consider when setting up a new clinical office
  • Rationale and tools for screening and risk assessment for infection
  • Recommendations for providing a clean clinical office environment
  • Guidance for reprocessing of reusable medical equipment
  • Protection and safety issues related to staff
  • Check list for office infection prevention and control.

Time spent familiarizing yourself with this new publication will pay off by reducing the risk of infectious disease transmission in the clinic setting and the time needed to try to control it after the fact.

Written by Dr. Edward Ellis, Public Health and Preventive Medicine Consultant, Ottawa Public Health

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Did you know?

Cold weather:

  • The highest risk is to the elderly, babies, homeless, sports enthusiasts and outdoor workers. Unprotected skin freezes in a few minutes when the wind chill is -25 C or colder. Prevent hypothermia and frostbite by dressing in layers and covering skin. Cold weather tips on preventing frostbite and hypothermia can be found on the Ottawa Public Health (OPH) website.  
  • Cold  weather assistance is available in our community:
    • The City of Ottawa and community partners have a cold weather assistance plan for the homeless that includes a phone line, the Salvation Army outreach van and emergency shelters. Call 3-1-1 to request information or access to these services. 
  • Ontario Hydro delivers the Ontario Energy Board Low-Income Energy Assistance Program(LEAP). LEAP is a year-round, province-wide emergency financial assistance program for low-income energy customers experiencing difficulty paying their energy bills. To apply for the LEAP assistance, patients can call the Salvation Army Booth Centre at 613-241-1573. 
    • The Snowsuit Fund raises funds and distributes snowsuits to needy children 15 and under in Ottawa. The service is available Tuesday to Saturday from 9 to 4 p.m. as of September 3, 2013. Proof of eligibility is required. Snowsuits cost $10. For more information, patients can call 613-746-5143 or e-mail ssf@on.aibn.com
    • To register for extreme weather alerts (frostbite, humidex, UV and smog), patients can contact Ottawa Public Health Information either by phone at 613-580-6744 or by e-mail at healthsante@ottawa.ca

Written by Martha Robinson, MHA, BAA, Program and Project Management Officer, Ottawa Public Health

Encourage patients to test homes for Radon:

  • Radon is the second leading cause of lung cancer after smoking. 13% or almost 850 lung cancer deaths in Ontario are due to radon exposure.1
    • Radon is a colourless odourless radioactive gas that seeps into buildings from uranium in the ground.
    • Risk from radon gas depends on the level of exposure and duration of exposure and smoking habits.  Smoking + radon together dramatically increases the risk of developing lung cancer. 
  • Health Canada recommends lowering radon exposure when the level in a home or building exceeds the Canadian Guideline of 200 Becquerels per cubic metre (Bq/m3).  Ventilation and/or sealing entry points in building foundations are usually recommended.   The Canadian National Radon Proficiency Program  certifies radon professionals that can assist homeowners who have high radon levels in their homes.  A list of local certified contractors is posted on their website. 
  • All homes have some radon.  The only way to know if you have a radon problem is to test for it. Testing is easy and affordable ($40 to 60).  Do-it yourself test kits are available at local hardware stores, on-line and from Ottawa Public Health.
  • A poster for patient awareness and an information brochure for health professionals are available and described in the Resources for patient education and referral section of this publication.
  •  Look for a free on-line accredited CME course on radon coming soon from MacHealth.

Written by Joanne Murphy, BSc, BASc, CPHI(C), Public Health Inspector, Ottawa Public Health

References:

  1. Peterson E, Aker A, Kim J, Li Y, Brand K, Copes R. Lung cancer risk from radon in Ontario, Canada: how many lung cancers can we prevent? Cancer Causes Control. 2013:1-8.

Revised Botulism Guide for Health Care Professionals (September 2013) is now available

An updated version of the Botulism Guide for Health Care Professionals (September 2013) is now available from the Ministry of Ontario and Long-Term Care (MOHLTC) website. Please replace any previous versions of this document with this updated version.

The updated document provides clarification with respect to dosage recommendations for botulism anti-toxin, and includes an additional reminder for attending physicians to ensure that serum from blood pulled prior to any anti-toxin administration is available for testing by the Health Canada Botulism Reference Service.

Download your copy in English or in French from the MOHLTC website. 

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Upcoming professional development:

Ottawa Public Health TB Prevention Workshop

Date: Spring 2014 (date to be determined)
Cost: $20 per person, paid in advance

Learn about:

  • TB national, provincial, and local
  • TB pathology epidemiology:
  • Patient education about TB and the tuberculin skin test
  • The tuberculin skin test – how to perform, read and interpret the test
  • Follow-up of positive reactors

For further information and/or to indicate your interest in attending, contact OPH by phone at 613-580-6744 or by e-mail at healthsante@ottawa.ca

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Academy of Medicine Ottawa (AMO) workshop

Save the date! AMO 7th Annual Clinical Day

Date: Friday, February 21, 2014

Location: Ottawa Conference & Event Centre (formerly Hampton Inn Ottawa Conference Centre), 200 Coventry Rd, Ottawa

This accredited CME event is designed for physicians, nurses and allied health professionals with the objective of improving clinical practice and the health of patients.

For more information and to register: http://academymedicineottawa.org/events

Academy of Medicine Ottawa – Physician Wellness Day 2014

Date: Wednesday, 2 April 2014
Time: Noon to 5 pm
Location: Ottawa Conference & Event Centre (formerly Hampton Inn Ottawa Conference Centre), 200 Coventry Rd, Ottawa
Cost: AMO members: $100, Non-members: $150, Residents and Medical Students: $75

Learn about building resilience throughout your medical career:

  • How to recognize burnout
  • Where to go for help
  • How to manage difficult behaviour in the workplace
  • How to cope with adverse events and medicolegal issue
  • How to stay healthy as a physician

For more information and to register: http://bit.ly/IJjrsw

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Why become an AMO member?

The Academy of Medicine Ottawa (AMO) is your local medical organization. Led by a team of elected physicians from Ottawa, the AMO works hard to advocate on behalf of physicians in the Ottawa region and to serve as an excellent source of collegiality, support, and leadership. The AMO is a branch society of the Ontario Medical Association (OMA), and delegates from the Ottawa region represent your interests at the OMA.

Please see the AMO’s Report to OMA Council for highlights of our active involvement last year.

AMO fees will not increase in 2014
AMO membership provides an opportunity for interaction with colleagues and a way to stay connected with the local medical community through educational, social and representational opportunities. Membership fees support operational costs of the Academy, which permit physician volunteers to work on projects and programs that benefit local physicians and patients.

Not an AMO member? Join now!

Enjoy the current issue of DocToc, the newsletter for AMO members.

The AMO is always keen to have more physicians involved in AMO projects, so if you're interested, please let us know. For more information about the AMO, or to share your ideas, please call or send an e-mail:

Dr. Alykhan Abdulla, President
Academy of Medicine Ottawa
1867 Alta Vista Drive
Ottawa, ON  K1G 5W8
Phone: 613-733-2604
Fax : 613-733-9083 
E-mail academy.medicine@on.aibn.com

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Contact Us:

Ottawa Public Health Logo

Ottawa Public Health

Monday to Friday 8:30 am to 4:30 pm
Phone: 613-580-6744 (Please identify yourself as a physician’s office.)
TTY: 613-580-9656
Toll-free: 1-866-426-8885
E-mail: healthsante@ottawa.ca 
Ottawa Public Health website
Follow us on Twitter @ottawahealth | @ottawasante 
Follow us on Pinterest 
Like us on Facebook (French)
Check out our Blog OttawaPublicHealth.ca | SantePubliqueOttawa.ca

Medical Officer of Health: 
Dr. Isra Levy: Medical Officer of Health ext. 23681
Dr. Vera Etches: Associate Medical Officer of Health, Clinical Programs: ext. 23675 (currently on leave)
Dr. Carolyn Pim: Associate Medical Officer of Health, Community Health Protection ext. 23684
Dr. Rosamund Lewis: Associate Medical Officer of Health, Policy and Partnerships ext. 23684

Medical Officer of Health after hours:
Call 3-1-1 and ask for the Ottawa Public Health Manager on call.

Academy of Medicine Ottawa

Academy of Medicine Ottawa Logo

Academy of Medicine Ottawa
1867 Alta Vista Drive
Ottawa, ON, K1G 5W8
Tel 613-733-2604
Fax 613-733-9083 

E-mail academy.medicine@on.aibn.com
Website: academymedicineottawa.org
Facebook: facebook.com/AMOdocs
Twitter: twitter.com/AMOdocs
Linkedin: linkedin.com/groups?gid=4688462

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Reminder: You must subscribe to receive future communications from OPH!

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Version française disponible

La Mise à jour pour les médecins est aussi disponible en français.

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Read previous issues:

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Additional documents:

Resources for patient education and/or referral 

Resource

Description

To order

 Radon poster produced by Health Canada

This poster is designed to create patient awareness of the health risks of radon gas exposure and how it damages cells which can, over time, lead to the development of lung cancer.

 

Produced by Health Canada. Endorsed by the Canadian Medical Association and the Canadian Lung Association. 

Contact the Radon Education and Awareness Office of Health Canada to request copies

e-mail: radon@hc-sc.gc.ca

Phone: 613-613-948-6384

 “Radon: Is it in your home? Information for Health Professionals” brochure

Radon: is it in your home brochure 

 

As a health professional, your patients may ask you about the health risks of radon, and the need to test their homes. This fact sheet provides you with information that may be helpful when counseling them on this topic.

Contact Health Canada at 613-948-6384 or by e-mail.

OR

Download the PDF version of this Pamphlet from the Health Canada website in English and French.

 Free on-line accredited CME course on radon

 

online

 “Problem Gambling Service” Pamphlet by CAMH

 "problem Gambling Service pamphlet

This pamphlet is an option for patients who are not ready to discuss their problem gambling behaviours, or for those who expressed interest, but do not want to book an appointment for treatment immediately.

This introductory pamphlet describes the services the helpline and website offer. It also provides basic information about gambling problems and can be given to patients, friends and families.

Download this pamphlet (in English only) from the CAMH website.

 “About Gambling” CAMH pamphlet for Youth

"About Gambling" pamphlet for youth

This four-page pamphlet is geared towards youth with gambling problems. Educational information about gambling is presented in a youth-friendly manner with easy to understand language and attractive colours. Common misconceptions about gambling are challenged, and resources for help are listed on the last page. 

Download this pamphlet (in English only) from the CAMH website.

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