Discovery of 2-Pyridylpyrimidines as the First Orally Bioavailable GPR39 Agonists

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Workload and patterns of care in the Timmins Family Health Team in Ontario

ObjectiveTo characterize primary care physician and nurse practitioner (“GP”) workload and availability, and any relationship with daytime, low-acuity emergency department (ED) and after-hours walk-in clinic (WIC) visit counts.DesignRetrospective database review.SettingTimmins, Ont, with 5 family health team (FHT) office sites, 1 after-hours FHT WIC, and 1 ED.ParticipantsAn anonymous data set representing 21 voluntarily enrolled GPs comprising 33 211 office appointments among 15 908 patients, plus 2043 ED visits and 2713 WIC visits, over 18 months.Main outcome measuresRoster size corrections for inactive (“dormant”) patients, nursing supports, and patient complexity (age and sex). Availability of GPs was defined as the corrected number of office visits per patient per year. Linear and nonlinear relationships between GP availability and each roster’s chronic disease burden (congestive heart failure, chronic obstructive pulmonary disease, and diabetes); ED visit count per patient; and WIC visit count per patient.ResultsCorrections for dormant patients and then for each of relative nursing support and patient complexity changed roster sizes by a mean (SD) of -8.4% (14.5%), -7.1% to 5.6% (median -1.6%), and 32.0% (18.2%), respectively. Combining these corrections increased effective roster size by a mean (SD) of 18.4% (7.3%). Larger rosters were not proportionately more dormant. In the Timmins FHT, GPs saw unique patients about 2.05 times per year (range 1.39 to 3.81). Availability of GPs did not change with increasing numbers of patients with congestive heart failure, chronic obstructive pulmonary disease, or diabetes in the roster. The ED diversion model had low explanatory power and was likely unreliable. The WIC diversion model was more robust, predicting 0.08 fewer WIC visits per patient per year if GP availability increased from 2.0 to 3.0 visits per patient per year (relative risk reduction of 41%).ConclusionSampled GPs manage a more complex patient population on average than their uncorrected roster sizes imply. There was no evidence that larger rosters or those with more patients with comorbid conditions reduced GP availability. Increasing physician availability might decrease WIC attendance.     

First Time Compliance Inspections to Evaluate an Artificial Trans Fat Ban in Nassau County

Background

In 2007, Nassau County, New York, restricted the use of artificial trans fats in food establishments licensed by the Nassau County Department of Health (NCDH). The regulation took effect April 1, 2008.

Objective

This study assesses first-time inspection compliance rates with the trans fat ban and examines barriers to enforcement.

Methods

A sample of food service establishments was inspected by an NCDH employee for labels documenting trans fat. Surveys that examined operator awareness and attitudes toward the ban were administered. A separate survey was conducted among the NCDH Office of Food Protection public health sanitarians to determine organizational barriers to enforcement. All inspections and surveys were conducted in Nassau County from June to September 2010.

Results

A total of 360 food service establishments were randomly selected for inspection; 328 completed the operator surveys. Compliance was 81%, even though 52% of operators were not aware of the ban. Of those who were aware, 57% heard about the regulation from the media, and almost all (92%) reported that compliance with the ban was easy. Of noncompliant respondents, 59% cited lack of knowledge regarding the ban as the primary reason for noncompliance. Of those who indicated they had received any customer feedback (9%), almost all reported the feedback to be positive. Knowledge of trans fats was not associated with compliance, but owners who were aware of the ban were more likely to be in compliance. Among the 23 participating sanitarians, 96% believed the ban was effective; language barriers were cited as the primary obstacle to enforcement.

Conclusions

As assessed through surveys and inspections, the trans fat ban in Nassau County yielded relatively high compliance rates within 2 years and was accepted by sanitarians, establishment operators, and consumers.