BACKGROUND: The Delta Oasis program was launched in New Brunswick in 2006 to offer patients from rural areas who were undergoing breast cancer surgery and their families 1 night of free accommodations and a postoperative consultation with an extramural nurse. We sought to investigate patient experiences with this program.
METHODS: This mixed-method retrospective study took place from 2020 to 2022 and compared the preoperative anxiety and quality of recovery of program participants and control patients who were discharged home over 100 km from hospital. We conducted 2 × 2 analysis of variance to evaluate the effects of intervention group and surgery type. We conducted semistructured interviews with intervention participants, which we then thematically analyzed. Two patient partners were engaged during data synthesis to support the interpretation of results.
RESULTS: We included 34 patients who participated in the program and 18 control patients. No statistically significant differences were found between treatment groups in preoperative anxiety and quality of recovery, regardless of surgery type. Thematic analysis of interviews with 17 intervention participants revealed that they were highly satisfied with the program and that the experience helped reduce stress and discomfort related to their surgery.
CONCLUSIONS: The Delta Oasis program is a cost-effective alternative to inpatient care after breast cancer surgery and is highly regarded by rural patients; expansion to other regions with the inclusion of additional low-risk surgeries could help address hospital capacity issues. This study contributes to our understanding of the patient experience with the Delta Oasis program and informs the development of similar programs elsewhere.

OBJECTIVE: To explore the career decisions and aspirations of early-career registered nurses in New Brunswick, Canada.
METHODS: A qualitative study using an interpretive description approach was conducted.
METHODS: Semi-structured one-on-one interviews were conducted with a purposive sample of nurses (n = 22) currently working in New Brunswick, Canada, with up to 5 years of experience from February to April 2022.
RESULTS: Participants described diverse career paths and aspirations. Personal factors affecting these included the desire for meaningful work, career satisfaction, work-life balance, spending time with family, working in a preferred location, and finances. Professionally, working conditions were the dominant factor influencing early-career nurses\' career decisions and aspirations. Participants described how short staffing, safety, support, and scheduling influenced their day-to-day work, mental and physical health, job and career satisfaction, and intent to leave.
CONCLUSIONS: The findings highlighted the abundant and diverse career opportunities available to nurses early in their careers. Early-career nurses are interested in finding nursing positions with a high degree of person-job fit and value opportunities for ongoing professional education and growth.
CONCLUSIONS: This study in New Brunswick, Canada, explores early-career nurses\' career decisions and aspirations during nursing shortages and the pandemic, emphasizing the importance of person-job fit. Recommendations include improving working conditions and career pathways to enhance the sustainability of the nursing profession.
UNASSIGNED: Standards for Reporting Qualitative Research (SRQR).
UNASSIGNED: No patient or public contribution.

BACKGROUND: The COVID-19 pandemic has highlighted human resource gaps and physician shortages in healthcare systems in New Brunswick (NB), as evidenced by multiple healthcare service interruptions. In addition, the New Brunswick Health Council gathered data from citizens on the type of primary care models (i.e. physicians in solo practice, physicians in collaborative practice, and collaborative practice with physicians and nurse practitioners) they use as their usual place of care. To add to their survey\'s findings, our study aims to see how these different primary care models were associated with job satisfaction as reported by primary care providers.
METHODS: In total, 120 primary care providers responded to an online survey about their primary care models and job satisfaction levels. We used IBM\'s \"SPSS Statistics\" software to run Chi-square and Fisher\'s exact tests to compare job satisfaction levels between variable groups to determine if there were statistically significant variations.
RESULTS: Overall, 77% of participants declared being satisfied at work. The reported job satisfaction levels did not appear to be influenced by the primary care model. Participants reported similar job satisfaction levels regardless of if they practiced alone or in collaboration. Although 50% of primary care providers reported having symptoms of burnout and experienced a decline in job satisfaction during the COVID-19 pandemic, the primary care model was not associated with these experiences. Therefore, participants who reported burnout or a decline in job satisfaction were similar in all primary care models. Our study\'s results suggest that the autonomy to choose a preferred model was important, since 45.8% of participants reported choosing their primary care models, based on preference. Proximity to family and friends and balancing work and family emerged as critical factors that influence choosing a job and staying in that job.
CONCLUSIONS: Primary care providers\' staffing recruitment and retention strategies should include the factors reported as determinants in our study. Primary care models do not appear to influence job satisfaction levels, although having the autonomy to choose a preferred model was reported as highly important. Consequently, it may be counterproductive to impose specific primary care models if one aims to prioritize primary care providers\' job satisfaction and wellness.

Income and housing are pervasive social determinants of health. Subsidized housing is a prominent affordability mechanism in Canada; however, waitlists are lengthy. Subsidized rents should provide greater access to residual income, which may theoretically improve health outcomes. However, little is known about the health of tenants who wait for and receive subsidized housing. This is especially problematic for New Brunswick, a Canadian province with low population density, whose inhabitants experience income inequality, social exclusion, and challenges with healthcare access.  METHODS: This study will use a longitudinal, prospective matched cohort design. All 4,750 households on New Brunswick\'s subsidized housing wait list will be approached to participate. The survey measures various demographic, social and health indicators at six-month intervals for up to 18 months as they wait for subsidized housing. Those who receive housing will join an intervention group and receive surveys for an additional 18 months post-move date. With consent, participants will have their data linked to a provincial administrative database of medical records.  DISCUSSION: Knowledge of housing and health is sparse in Canada. This study will provide stakeholders with a wealth of health information on a population that is historically under-researched and underserved.

OBJECTIVE: It has been postulated that social and economic inequalities may shape the distributions of comorbid diabetes and mental illness. This observational cohort study using linked population-based administrative and geospatial datasets aimed to describe associations between neighbourhood socioenvironments and disorder-specific mental health service use among adults with diabetes in the province of New Brunswick, Canada.
RESULTS: A baseline cohort of 66,275 persons aged 19 and over living with diabetes was identified. One-quarter (26.3%) had used healthcare services for mood and anxiety disorders at least once during the six-year follow-up period 2012/2013-2017/2018. Based on Cox proportional hazards models, the risk of mental health service contacts was significantly higher among those residing in the most materially deprived neighbourhoods [HR: 1.07 (95% CI: 1.01-1.14)] compared to those in the least so, and those in areas characterized with the highest residential instability [HR: 1.13 (95% CI: 1.05-1.22)] compared to those in areas with the lowest instability. Among adults with incident diabetes (N = 4410), age and sex but not neighbourhood factors were related to differential help-seeking behaviours for mental health problems. These findings underscored the gap between theoretical postulations and population-based observations in delineating the syndemics of neighbourhood socioenvironments and mental health outcomes in populations with high diabetes prevalence.

BACKGROUND: More and more high-income countries hire internationally educated nurses as part of their workforce. While the factors that push and pull internationally educated nurses to migrate and influence their workforce integration have been widely reported in the literature, little is known about internationally educated nurses\' career development and whether they are satisfied with their nursing career in Canada.
OBJECTIVE: This study aims to identify the main correlates of internationally educated nurses\' career satisfaction.
METHODS: A cross-sectional analysis of data from a pan-Canadian survey sample of 1,951 internationally educated nurses, including registered nurses, licensed practical nurses and registered psychiatric nurses, was conducted. Measures of career satisfaction included individual, job and career characteristics as well as organizational-related and integration process factors. Non-parametric Mann-Whitney U and Spearman rank correlation tests were used to examine the association of the various factors with career satisfaction.
RESULTS: Overall, internationally educated nurses showed a high degree of career satisfaction. At the same time, career satisfaction varied greatly depending on sociodemographic characteristics, organizational setting, and geographic location. Older and more experienced internationally educated nurses tended to be more satisfied with their career than their younger or less experienced colleagues were. Furthermore, male were inclined to be less satisfied than their female counterparts, and having children tended to make all three groups (men, women and overall) more satisfied. The higher the level of education prior to immigrating the lower the career satisfaction. Internationally educated nurses who identified as White or Asian had the highest level of career satisfaction, whereas those who identified as Black tended to be the least satisfied. Career satisfaction was the highest among those who live in the Prairie Provinces (Alberta, Saskatchewan and Manitoba), and Ontario, the lowest in the Atlantic Provinces (New Brunswick, Nova Scotia, Prince Edward Island, Newfoundland and Labrador). As for organizational characteristics, full-time nurses were more satisfied than those working part-time or with occasional employment. Finally, internationally educated nurses who thought they had achieved their career goals were more satisfied, while those who experienced discrimination were less satisfied with their career.
CONCLUSIONS: Our findings highlight the need for organizations to ensure a healthy work environment for internationally educated nurses, free of discrimination, where they can attain their career goals. Tweetable abstract: More and more countries rely on internationally educated nurses to ease their nursing shortages. This study aims to identify the main correlates of internationally educated nurses\' career satisfaction, using non-parametric Mann-Whitney U and Spearman rank correlation tests on data from a pan-Canadian survey sample of 1,951 internationally educated nurses, including registered nurses, licensed practical nurses and registered psychiatric nurses. Overall, internationally educated nurses showed a high degree of career satisfaction. At the same time, career satisfaction varied greatly depending on the internationally educated nurses\' sociodemographic characteristics, organizational settings and geographic location. Finally, internationally educated nurses who thought they had achieved their career goals were more satisfied, while those who experienced discrimination were less satisfied with their career. Our findings highlight the need for organizations to ensure environment free of discrimination, where internationally educated nurses can attain their career goals.

American studies have shown that higher provider and hospital volumes are associated with reduced risk of mortality following colorectal surgical interventions. Evidence from Canada is limited, and to our knowledge only a single study has considered outcomes other than death. We describe associations between provider surgical volume and all-cause mortality and postoperative complications following colorectal surgical interventions in New Brunswick.
We used hospital discharge abstracts linked to vital statistics, the provincial cancer registry and patient registry data. We considered all admissions for colorectal surgeries from 2007 through 2013. We used logistic regression to identify odds of dying and odds of complications (from any of anastomosis leak, unplanned colostomy, intra-abdominal sepsis or pneumonia) within 30 days of discharge from hospital according to provider volume (i.e., total interventions performed over the preceding 2 years) adjusted for personal, contextual, provider and hospital characteristics.
Overall, 9170 interventions were performed by 125 providers across 18 hospitals. We found decreased odds of experiencing a complication following colorectal surgery per increment of 10 interventions performed per year (odds ratio 0.94, 95% confidence interval 0.91-0.96). We found no associations with mortality. Associations remained consistent across models restricted to cancer patients or to interventions performed by general surgeons and across models that also considered overall hospital volumes.
Our results suggest that increased caseloads are associated with reduced odds of complications, but not with all-cause mortality, following colorectal surgery in New Brunswick. We also found no evidence of volume having differential effects on outcomes from colon and rectal procedures.
Des études américaines ont montré que le volume d’activité des chirurgiens et des hôpitaux est inversement proportionnel au risque de mortalité après la chirurgie colorectale. Les données pour le Canada sont limitées, et à notre connaissance, une seule étude a porté sur d’autres paramètres que le décès. Nous avons décrit les liens entre volume d’activité des chirurgiens et mortalité de toute cause/complications postopératoires après la chirurgie colorectale au Nouveau-Brunswick.
Nous avons utilisé les registres de congés des hôpitaux reliés aux données de la Statistique de l’état civil, du registre provincial du cancer et du registre des patients. Nous avons recensé toutes les admissions pour chirurgie colorectale de 2007 à 2013. Nous avons utilisé la régression logistique pour établir le risque de décès et le risque de complications (fuite anastomotique, colostomie non planifiée, infection intra-abdominale ou pneumonie) dans les 30 jours suivant le congé de l’hôpital par rapport au volume d’activité des chirurgiens (c.-à-d., interventions totales des 2 années précédentes) ajusté en fonction des caractéristiques individuelles et contextuelles, propres aux chirurgiens et aux hôpitaux.
En tout, 125 chirurgiens ont effectué 9170 interventions dans 18 hôpitaux. Nous avons observé un risque moindre de complications après la chirurgie colorectale pour chaque palier de 10 interventions effectuées annuellement (risque relatif 0,94, intervalle de confiance de 95 %, 0,91–0,96). Nous n’avons observé aucun lien avec la mortalité. Les liens sont demeurés constants, peu importe que les modèles soient restreints aux patients cancéreux ou aux interventions effectuées par des chirurgiens généraux et entre les modèles qui tenaient également compte du volume global d’activité des hôpitaux.
Selon nos résultats, l’augmentation du volume d’activité est associée à un risque moindre de complications, mais n’a pas de lien avec la mortalité de toute cause après la chirurgie colorectale au Nouveau-Brunswick. Nous n’avons pas non plus constaté de lien entre le volume d’activité et l’issue différentielle de la chirurgie du côlon et du rectum.

Depression and other mood and anxiety disorders are recognized as common complications following cardiac events. Some studies report poorer cardiac outcomes among patients in socioeconomically marginalized neighbourhoods. This study aimed to describe associations between socioeconomic and built environment characteristics of neighbourhood environments and mental health service contacts following an acute myocardial infarction (AMI or heart attack) among adults in the province of New Brunswick, Canada. This province is characterized largely by residents in small towns and rural areas. A cohort of all adults aged 45 and over surviving AMI and without a recent record of mental disorders was identified by linking provincial medical-administrative datasets. Residential histories were tracked over time to assign neighbourhood measures of marginalization, local climate zones, and physical activity friendliness (i.e., walkability). Cox models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the risk of healthcare use for mood and anxiety disorders over the period 2003/04-2015/16 by neighbourhood characteristics. The baseline cohort included 13,330 post-AMI patients, among whom 32.5% were found to have used healthcare services for a diagnosed mood or anxiety disorder at least once during the period of observation. Among men, an increased risk of mental health service use was found among those living in areas characterized by high ethnic concentration (HR: 1.14 (95%CI: 1.03-1.25)). Among women, the risk was significantly higher among those in materially deprived neighbourhoods (HR: 1.16 (95%CI: 1.01-1.33)). We found no convincing evidence of associations between this outcome and the other neighbourhood characteristics considered here. These results suggest that selected features of neighbourhood environments may increase the burden on the healthcare system for mental health comorbidities among adults with cardiovascular disease. Further research is needed to understand the differing needs of socioeconomically marginalized populations to improve mental health outcomes following an acute cardiac event, specifically in the context of smaller and rural communities and of universal healthcare coverage.

To calculate patient wait times for specialist care using data from primary care clinics across Canada.
Retrospective chart audit.
Primary care clinics.
A total of 22 primary care clinics across 7 provinces and 1 territory.
Wait time 1, defined as the period between a patient\'s referral by a family physician to a specialist and the visit with said specialist.
Overall, 2060 referrals initiated between January 2014 and December 2016 were included in the analysis. The median national wait time 1 was 78 days (interquartile range [IQR] of 34 to 175 days). The shortest waits were observed in Saskatchewan (51 days; IQR = 23 to 101 days) and British Columbia (59 days; IQR = 29 to 131 days), whereas the longest were in New Brunswick (105 days; IQR = 43 to 242 days) and Quebec (104 days; IQR = 36 to 239 days). Median wait time 1 varied substantially among different specialty groups, with the longest wait time for plastic surgery (159 days; IQR = 59 to 365 days) and the shortest for infectious diseases (14 days; IQR = 6 to 271 days).
This is the first national examination of wait time 1 from the primary care perspective. It provides a picture of patient access to specialists across provinces and specialty groups. This research provides decision makers with important context for developing programs and policies aimed at addressing the largely ignored stage of the wait time continuum from the time of referral to eventual appointment time with the specialist.

Although levonorgestrel-only emergency contraceptive pills (LNg-ECPs) have been available over the counter in Canada for more than a decade, barriers to access persist. We aimed to obtain information about the availability and cost of LNg-ECPs in New Brunswick. Using a mystery-client study design, we called all 207 non-specialty pharmacies in the province posing as a 17-year-old woman seeking something to prevent pregnancy after sex. We evaluated the information provided for accuracy and quality. The overwhelming majority of pharmacies (n = 180, 87%) had at least one brand of LNg-ECPs in stock; the price averaged CAD28.69 (USD21.65). Although the majority of pharmacy representatives provided accurate information about LNg-ECPs, a small number made incorrect statements about the timeframe for use, side effects, and mechanism of action. In nine interactions (4%) pharmacy representatives incorrectly indicated that a male partner could not obtain LNg-ECPs; none indicated that parental involvement was required to procure LNg-ECPs. None of the pharmacy representatives referenced any other modality of emergency contraception, including ulipristal acetate. Our findings suggest that LNg-ECPs are widely available and that most pharmacy representatives are providing accurate medical and regulatory information. However, supporting the continuing education of pharmacists and pharmacy staff, particularly around alternative modalities of emergency contraception, appears warranted.