Issue 99, February 2015 In this issue:

· Message from the Medical Officer of Health

News Flash:

· New “Parenting in Ottawa” Facebook page and online web portal · Survey: Ottawa Public Health wants to hear from you

Articles: Tobacco:

· New easy referral for patients who want to quit smoking Infants and Children

· The Rourke Baby Record and the 18 Month Well-Baby Visit Referral Pathway · Early diagnosis of Scoliosis in a healthy active child will make all the difference

Older Adults · Free Fall Prevention Exercise Program for Adults

Upcoming professional development: · Tuberculosis Prevention Workshop · Academy of Medicine Ottawa (AMO) 8th Annual Clinical Day · Champlain Primary Care Congress on complex patients and chronic care · Journées Montfort · 64th Annual Refresher for Family Physicians

Other: · Why become an AMO member? · Contact Us · Reminder: You must subscribe to receive future communications from OPH! · Version française · Read previous issues

Physicians’ Update In partnership with the Academy of Medicine Ottawa

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Message from the Medical Officer of Health Dear colleagues,

In this edition of Physicians’ Update, we are pleased to launch major new resources that can support your practice. Ottawa Public Health is hosting a new Facebook page – Parenting in Ottawa – that offers tips and resources to parents of infants, children and adolescents. I invite you to consult it for resources and referrals, share the information with parents and caregivers in your practice, and ‘like’ it on your own Facebook page. We are also proud to partner in the recently launched MyQuit.ca– a new coordinated referral service throughout the Champlain Region for people who want to quit smoking.

We are exploring new ways to enhance our collaboration and provide you with the resources you need to promote health and prevent illness and injury in our community. A new tool we will use is e-consult, which already brings you consultation and referral support for 40 medical specialities. We are excited to be joining this collaborative effort to bring seamless and efficient support for patient and population-based care in Ottawa. You can share your perspective on how we might engage further with physicians through the enclosed survey. It is also my pleasure to share with you articles and news briefs covering the 18-month well baby visit, recent updates of the Rourke Baby Record, tips for early diagnosis of scoliosis, a falls prevention exercise program for older adults, and opportunities for Continuing Professional Development in Ottawa. I look forward to the continuing evolution of our programs and services and of our relationships with you. Isra [ Top ]

New “Parenting in Ottawa” Facebook page and online web portal Parenting in Ottawa is about to get a little bit easier. Based on a literature review and focus testing, Ottawa Public Health (OPH) found that most parents are looking for health information online, and that their preferred social media network is Facebook. Consequently, Ottawa Public Health recently launched two new tools for parents of children aged birth to 18 years:

· The “Parenting in Ottawa” Facebook Page. · The “Parenting in Ottawa” Interactive Web Portal.

These new resources help Ottawa parents:

· To access parenting information, · To locate resources in their community, and · To provide peer support.

OPH’s intent is to support your patients with non-emergency health issues related to babies, children, and youth.

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1. Facebook Page (Launched November 18, 2014) The “Parenting in Ottawa” Facebook page helps connect parents with their peers as well as with health experts. A Public Health Nurse (PHN) operates the page Monday to Friday from 8am to 3pm. Every day, a PHN posts new engaging material on a specific theme, and replies to incoming questions. OPH is engaging community experts from different domains to create variety and a shared expert base. Be sure to “Like” the Facebook page, as well as “Share” Facebook pages with your patients, colleagues, and personal connections:

· www.facebook.com/ParentinginOttawa [English] · www.facebook.com/EtreParentaOttawa [French]

2. Interactive Web Portal (Launch date - March 16, 2015) The “Parenting in Ottawa” Interactive Web Portal is where parents go to get in the know about parenting in Ottawa. The website is divided into 5 sections:

· Becoming a Parent and Pregnancy · Breastfeeding · Babies and Toddlers (birth to 3 years) · Children (4 to 11 years) · Youth (12 to 18 years)

The site features:

· Web content structured in an intuitive and accessible way. · Articles that rotate monthly in each of the 5 sections listed above. · An E-newsletter informing parents with site updates and new relevant content. · A resource section that links to community resources and services.

The site will be available at the links below March 16 2015.

· www.ParentinginOttawa.com (and .ca) [English] · www.EtreParentaOttawa.com (and .ca) [French]

The site was created with equity in mind. It is accessible, bilingual, and non-judgmental. We are asking for your help as leaders in healthcare to help promote these resources to your patients. Author: Jason Haug, Program and Project Management Officer, Health Promotion and Disease Prevention, Ottawa Public Health

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OPH wants to hear from you! Please take a moment to fill out the Ottawa Public Health Primary Health Care Provider Survey [Top]

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New easy referral for patients who want to quit smoking The Challenge

· There are 220,000 residents of the Champlain region in Eastern Ontario who currently smoke and 157,000 smoke daily.1

· In general, sixty percent of smokers want to quit smoking2, which represents over 132,000 people in the Champlain region or approximately 51,000 in Ottawa.

· Forty percent make at least one quit attempt every year but only 5% are successful without assistance.2

What we know People who stop smoking with support are 4 times more likely to stop successfully compared with smokers who stop without any form of support. The combination of counselling and medication is the most effective. 1 A physician’s advice to quit has been shown to increase a smoker’s motivation to quit. While many group practices offer cessation services such as the Ottawa Model for Smoking Cessation in Primary Care or STOP, smaller practices may not have the resources to deliver services.

The Services · A new toll-free number (1-877-376-1701) where your patients can seamlessly connect

to cessation services in their community that best meet their unique needs; · A new bilingual interactive website (MyQuit.ca) will provide your patients with tips from

ex-smokers and health care professionals in addition to information to help them develop their own strategies based on best practices;

· Cessation services provided by the MyQuit partners include one-on-one counselling, group counselling and cessation workshops; Services are free!

· Access to pharmacotherapy will vary depending on the program. If you would like to receive MyQuit posters for your office please contact: Ottawa Public Health Information Line 613-580-6744. The MyQuit program has been developed by health professionals with the feedback of smokers and ex-smokers. Whether people are looking to reduce or quit smoking, MyQuit will support them in finding the best service that will suit their needs. In addition, practices such as FHTs and CHCs that currently provide smoking cessation services can opt-in to receive referrals through the common site.

1. Champlain Cardiovascular Disease Prevention Network. Champlain CVD prevention strategic planning 2013-2016. Expert task group recommendations. Regional integrated smoking cessation strategy. June 2012.

2. Program summary, Ottawa Model for Smoking Cessation in primary care expansion, 2011.

3. Fiore M, Jaen C, Baker T, et al. Treating tobacco use and dependence: 2008 update. Clinical Practice Guideline; 2008

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The Rourke Baby Record and the 18 Month Well-Baby Visit Referral Pathway The Well Baby visit for 18 month olds is an important time to identify concerns and supports for early childhood development. Two tools you can use in these visits are:

1. The Rourke Baby Record (RBR), now updated (2014) with these key changes: · significant changes to the nutrition sections of the 6 and 9 month visits; · a new section on environmental health; · impacts on children; · an improved immunization section; and · more information and web links.

To access a complete list of all the recent changes and download the form, visit www.rourkebabyrecord.ca.

2. The 18 Month Well-Baby Visit Referral Pathway, a made-in-Ottawa tool to help you know where to refer families who need more support. Feedback on the pathway has been very positive with many physicians reporting that they were not aware of all the community resources available to families. A hard copy of the 18 Month Well-Baby Visit Referral Pathway can be obtained by calling the Ottawa Public Health Info Line (OPHIL) at 613-580-6744 or by e-mail at healthsante@ottawa.ca. A personalized presentation given by a Public Health Nurse on how to use the 18 month pathway and community resources can be booked. The pathway can also be downloaded from the OPH website. Looking forward to hearing from your office! Author : Nathalie Meilleur, RN, BScN

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Early diagnosis of Scoliosis in a healthy active child will make all the difference Adolescent Idiopathic Scoliosis (AIS) Scoliosis school screening programs were discontinued in the early 1980’s. Since then, there has been a trend of late diagnosis. Scoliosis is an abnormal lateral curvature of the spine. It is a three-dimensional deformity where the spine forms an S-shaped or a C-shaped curve, twisting and rotating the ribcage and torso. The cause is still unknown, but 30% of cases are genetic.1 Up to 32% of AIS cases the patients are diagnosed late2, meaning that an opportunity for treating the scoliosis with bracing has been missed. At 50 degrees, surgeons recommend surgery. It has been shown that early detection and early treatment can decrease the number of surgeries. Close monitoring of young patients is crucial, as scoliosis curves progress quickly during growth spurts. The risk of progression depends on gender, remaining growth potential, and bone maturity.

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Who is most affected? Scoliosis affects 2 to 4% of the pre-teen and teen population. Slight curves are equally prevalent between boys and girls, but for curves requiring treatment, girls are affected 7 times more often than boys. Adults can also suffer from scoliosis, which may or may not have been diagnosed at a young age. As people age, untreated scoliosis can become challenging to treat when mixed with arthritis and other conditions. Adult scoliosis affects 30% of the older population.

How is it diagnosed? A simple and fast test, the Adam’s Forward Bend Test with a scoliometer reading exceeding 5 degrees, allows quick clinical detection of scoliosis, which should be confirmed by a follow-up radiograph. (Even an I-phone app has been validated for screening, and it’s called, Scoligauge.) Dr. Timothy Hresko from Boston Children's Hospital's Spinal Program demonstrates how to complete a postural screening exam and Scoliosis exam.

What treatments exist for your patients?3 The ‘wait and see” method has been recommended for small curves (Cobb angles between15-24 degrees) and involves monitoring the curve through the child’s growth. In some cases Scoliosis specific physiotherapy exercises4,5 may be beneficial. When progression of the scoliosis occurs or when Cobb angles reach 25 degrees, bracing is recommended, according to the Scoliosis Research Society guidelines.6 Full time bracing works in 72% of the cases7 to halt the progression and to avoid surgery. Spinal fusion surgery is suggested by orthopedic surgeons for curves over 50 degrees.8

What support exists for your patients? The Curvy Girls Scoliosis Support Group of Ottawa(CGO) supports teens in the Ottawa community with this condition. CGO is a peer lead support group empowering pre-teen and teen to become leaders, make healthy lifestyle choices and improve self-esteem by diminishing the emotional impact of scoliosis. CGO seeks to help them find their voice through support and acceptance. Please share this SCOLIOSIS AWARENESS VIDEO with your patients. The Adult Scoliosis Support Group of Ottawa meets 4 times a year. For more information, patients can contact: adultscoliosis@gmail.com Please add scoliosis screening on your patient’s checklist for pre-teen and teen patient’s annual checkup. Females should be screened between the ages of 10 to 12, and males at age 13 or 14. Author: Andrea Lebel M.PT, RPT, MCPA, Certified Scoliosis Specific Schroth Physiotherapist, Director of Ottawa & District Physiotherapy Clinic, Scoliosis and Posture Center, Active Member of SOSORT. Edited by Dr. Eric Parent, P.T., M.Sc., Ph.D. University of Alberta, Associate Professor Dept. of

Physiotherapy

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References: 1. Scoliosis Research Society (SRS)

http://www.srs.org/patient_and_family/scoliosis/idiopathic/adolescents/ 2. Beausejour M, Roy-Beaudry M, Goulet L, Labelle H: Patient characteristics at the initial

visit to a scoliosis clinic: a cross-sectional study in a community without school screening. Spine 2007, 32:1349-1354. http://journals.lww.com/spinejournal/Abstract/2007/05200/Patient_Charact...

3. Bunnell, W.; “The Natural History of Idiopathic Scoliosis Before Skeletal Maturity.” Spine 1986, Lippincott-Raven Publishers http://journals.lww.com/spinejournal/Abstract/1986/10000/The_Natural_His...

4. Monticone M, Ambrosini E, Cazzaniga D, Rocca B, Ferrante S (2014) Active self-correction and task-oriented exercises reduce spinal deformity and improve quality of life in subjects with mild adolescent idiopathic scoliosis. Results of a randomised con- trolled trial. Eur Spine J Feb 28.

5. Negrini S, Aulisa AG, Aulisa L, Circo AB, de Mauroy JC, Durmala J, Grivas TB, Knott P, Kotwicki T, Maruyama T (2012) 2011 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis 7(1):3

6. Scoliosis Research Society (SRS) http://www.srs.org/professionals/conditions_and_treatment/adolescent_idi...

7. Stuart L. Weinstein, M.D., Lori A. Dolan, Ph.D., James G. Wright, M.D., M.P.H., and Matthew B. Dobbs, M.D. “Effects of Bracing in Adolescents with Idiopathic Scoliosis” N Engl J Med 2013; 369:1512-1521October 17, 2013 http://www.nejm.org/doi/pdf/10.1056/NEJMoa1307337

8. Maruyama, T.; Takeshita, K.; “Surgical treatment of scoliosis: a review of techniques currently applied” (2008) Scoliosis 2008, 3:6 http://www.scoliosisjournal.com/content/3/1/6

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Better Strength, Better Balance! Free fall prevention exercise program for adults 65+ Being physically active is one of the most important behaviours that older adults can do to maintain their independence and reduce their risk of falling. Ottawa Public Health is collaborating with The City of Ottawa’s Parks, Recreation, and Cultural Services to offer an expanded evidenced-based fall prevention program through project funding from the Champlain LHIN. This initiative is part of the provincial Seniors Strategy to increase community based fall prevention and exercise programming.

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Program details: Group exercise program for adults aged 65+:

· Strength and balance exercises led by a certified fitness instructor · Participants learn tips on how to prevent falls · No cost to participate · Offered twice a week for 12 weeks · This is a beginner level class for those wishing to improve strength and balance

Patient’s can be referred to the program, or they may self-refer by calling Ottawa Public Health at 613-580-6744. Better Strength, Better Balance! Poster to print or distribute. www.ottawa.ca/seniors or www.ottawa.ca/aines [Top]

Upcoming professional development: Ottawa Public Health TB Prevention Workshop Thursday, April 16, 2015 9 to 11 am Ron Kolbus-Lakeside Centre 102 Greenview Ave, Ottawa, K2B 8J8 or Wednesday, October 21, 2015 9 to 11 am Peter D. Clark Place 255 Centrum Blvd, room 340, Orleans, K1E 3V8 Cost: $20 per person. Make cheque payable to: City of Ottawa Ottawa Public Health is offering health care professionals a TB Prevention Workshop covering the following areas:

· The pathogenesis and transmission of TB · The epidemiology of TB · The tuberculin skin test (TST): administration, reading and interpretation · Management of a positive TST result and treatment of latent tuberculosis infection

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 To register, return this completed form with the registration fee to: Ottawa Public Health, Communicable Disease Control Program 100 Constellation Drive, 8th floor East, Ottawa, ON K2G 6J8 Attention: Debra Hawkes For questions or cancellation, call 613-580-6744 ext 15759.

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Academy of Medicine Ottawa (AMO) 8th Annual Clinical Day To support your clinical practice and promote better health for your patients. The AMO Clinical Day is designed for physicians, nurses and allied health professionals, to support clinical best practice and promote health for patients. We offer the highest quality accredited continuing medical education with an interdisciplinary program, to build awareness of options, strategies and resources. Topics and speakers

1. Slaying the zombies of smoking cessation - Andrew Pipe, CM, MD, LLD(Hon), DSc(Hon)

2. Autism spectrum disorder - Susan Farrell, PhD 3. Mindfulness starts here - Lynette Monteiro, PhD 4. Helping our patients keep their marbles - Tony Hakim, OC, MD, PhD, FRCPC 5. Choosing Wisely: prevention of unnecessary tests, treatments and procedures - Chris

Simpson, MD, FRCPC, FACC, FHRS 6. Sport concussion - Taryn Taylor, BKIN, MSc, MD, CCFP, DipSportMed 7. Suicide prevention - Simon Hatcher, MD, MRCPsych, FRANZCP, FRCPC 8. Lyme disease, MERS-CoV and other scary bugs - Carolyn Pim, MD, FRCPC

CME credits This program has been accredited by the College of Family Physicians of Canada and the Ontario Chapter for up to 6 Mainpro-M1 credits. This event is an accredited group learning activity (section 1) as defined by the Maintenance of Certification Program of the Royal College of Physicians and Surgeons of Canada, approved by the Canadian Psychiatric Association (CPA). The specific opinions and content of this event are not necessarily those of the CPA, and are the responsibility of the organizer(s) alone. Register now! Registration includes continental breakfast, nutritional morning snack and lunch. Parking is free. Download the brochure. Champlain Primary Care Congress March 27, 2015 St. Elias Banquet Center – 750 Ridgewood Avenue, Ottawa, ON Brochure and online registration avalaible: www.med.uottawa.ca/cme

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Journées Montfort Save the date! Thursday April 16 & Friday April 17, 2015 Hampton Inn Conference Centre, 200, Coventry Road Journées Montfort 2015 promises to be an event not to be missed. This conference is aimed at general physicians, but all healthcare professionals are welcome. There will be relevant and diversified topics presented by speakers selected with the utmost care. For more information, click here.

64th Annual Refresher Course for Family Physicians Save the Date! April 29 - May 1, 2015 200 Coventry Rd, Ottawa, ON More information will be provided as soon as possible. [ Top ]

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 c ollegiality, 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 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 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 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 [ Top ]

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

12 Ottawa Public Health – Physicians’ Update: Issue 99

Version française disponible La Mise à jour pour les médecins est aussi disponible en français. [ Top ]

Read previous issues: · October 2014 (98) · May 2014 (97) · February 2014 (96) · September 2013 (95) · June 2013 (94) · February 2013 (93) · September 2012 (92) · Special Issue on Mental Health, April 2012 (91) · Special Issue on Seniors, June 2011 (89) · January 2011 (88) · Fall 2010 (87) · Spring/Summer 2010 (86)

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