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Medical Assistance in Dying (MAID) legislation has evolved rapidly in Canada with significant impacts on nursing practice. The purpose of this paper is to describe evolving complexities in legislative context and practice standards that influence the experiences nurse practitioners and registered nurses have with MAID. Qualitative interviews were conducted with 25 registered nurses and 10 nurse practitioners from diverse contexts across Canada. Participants described their practices and considerations when discussing MAID as part of advance care planning; their use of, and challenges with, waivers of consent; their practice considerations in negotiating the complexities of clients for whom death is not reasonably foreseeable; and their moral wrestling with the inclusion of MAID for persons whose sole underlying medical condition is mental illness. Findings illustrate the moral complexities inherent in the evolving legislation and the importance of robust health and social care systems to the legal and ethical implementation of MAID in Canada. [ABSTRACT FROM AUTHOR]

Despite increased access to and improvements in contraceptives, unintended pregnancy continues to be a problem globally and is associated with adverse outcomes for mothers and infants. This paper seeks to unravel the mediators of intended versus unintended pregnancies among Black women living with HIV. The paper draws on survey data from a broader multi-country mixed methods study that used a community-based participatory research approach to investigate the psychosocial experiences of Black mothers living with HIV. The study participants were Black mothers living with HIV drawn through venue-based sampling from Ottawa, Canada (n = 89), Port Harcourt, Nigeria (n = 400), and Miami, Florida, United States (n = 201). We used Hierarchical Binary Logistic Regression Modelling (HBLM) to estimate the independent associations of pregnancy intention (intended versus unintended) with blocks of predictor variables (sociodemographic, sociocultural, and psychosocial predictors) at alpha level of 0.5. Specifically, 44.2%, 67.3%, and 17.7% of the women had unintended pregnancies in Ottawa, Miami, and Port Harcourt, respectively. There were important results from the HBLM. The odds of intended relative to unintended pregnancies were (i) reduced in larger households (OR = 0.56, 95% CI = 0.36/0.87), but increased with employment (OR = 7.84, 95% CI = 1.52/40.54) and HIV knowledge (OR = 3.13, 95% CI = 1.42/6.90) in Ottawa; (ii) reduced with age (OR = 0.93, 95% CI = 0.88/0.98), but increased with marriage (OR = 2.90, 95% CI = 1.43/5.88) and social support (pregnancy (OR = 3.77, 95% CI = 1.98/7.19) in Port Harcourt; (iii) reduced with social support (OR = 0.95, 95% CI = 0.91/1.00) but increased with HIV status disclosure (OR = 1.73, 95% CI = 1.01/2.97) and the influence of specific referent (OR = 1.68, 95% CI = 1.13/2.52) in Miami-FL. The incidence of unintended pregnancy is more prevalent among Black women living with HIV in the North American cities relative to the African city. Also, unique combinations of sociodemographic, sociocultural, and psychosocial factors influence pregnancy intention in each city. This implies that policy and practices to address reproductive health needs of WLHIV must consider these contextual issues. [ABSTRACT FROM AUTHOR]

Background: Virtual care quickly became of crucial importance to health systems around the world during the COVID-19 pandemic. Despite the potential of virtual care to enhance access for some communities, the scale and pace at which services were virtualized did not leave many organizations with sufficient time and resources to ensure optimal and equitable delivery of care for everyone. The objective of this paper is to outline the experiences of health care organizations rapidly implementing virtual care during the first wave of the COVID-19 pandemic and examine whether and how health equity was considered. Methods: We used an exploratory, multiple case study approach involving four health and social service organizations providing virtual care services to structurally marginalized communities in the province of Ontario, Canada. We conducted semi-structured qualitative interviews with providers, managers, and patients to understand the challenges experienced by organizations and the strategies put in place to support health equity during the rapid virtualization of care. Thirty-eight interviews were thematically analyzed using rapid analytic techniques. Results: Organizations experienced challenges related to infrastructure availability, digital health literacy, culturally appropriate approaches, capacity for health equity, and virtual care suitability. Strategies to support health equity included the provision of blended models of care, creation of volunteer and staff support teams, participation in community engagement and outreach, and securement of infrastructure for clients. We put our findings into the context of an existing framework conceptualizing access to health care and expand on what this means for equitable access to virtual care for structurally marginalized communities. Conclusion: This paper highlights the need to pay greater attention to the role of health equity in virtual care delivery and situate that conversation around existing inequitable structures in the health care system that are perpetuated when delivering care virtually. An equitable and sustainable approach to virtual care delivery will require applying an intersectionality lens on the strategies and solutions needed to address existing inequities in the system. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to assess the extent to which the LEADS Framework guided health-care leaders through organizational change and the COVID-19 pandemic in a western Canadian province. Design/methodology/approach: A qualitative exploratory inquiry assessed the extent to which health leaders applied competencies that aligned with the LEADS Framework. A purposeful sample of 22 health-care leaders participated in the study representing senior, mid-level and front-line health-care leaders in various health-care organizations to ensure diverse representation of leader competencies. The authors conducted semi-structured interviews to collect the data and used Braun and Clarke's (2006) six-phase approach to guide data analysis. Findings: The analysis suggests that health-care leaders found Engaging with Others and Developing Coalitions were the most critical themes of the LEADS Framework for change management and for navigating the COVID-19 pandemic. Findings reveal that during transformational change and a crisis context, leaders embrace relational approaches to adapt and improve performance in dynamic organizations. Practical implications: These findings have implications for a relational approach to improve teamwork and decrease emotional strain; a focus on mobilizing and sharing power with nurses; and educational programs to advance relational and self-management skills, shared leadership, communication, change management, human resource and talent development as critical learning components for current and future health-care leaders. Originality/value: The LEADS Framework is used to examine how health-care leaders responded to transformational change in the organization while situated in a pandemic context. [ABSTRACT FROM AUTHOR]

Rather than racism targeted toward service users, this paper adds to the sparse corpus of articles that reports on racism and microaggressions experienced by racialized social work practitioners. Based on two qualitative exploratory research studies in Canada, the findings suggest that racism continues to be a significant problem for racialized social workers. In addition to the oft-mentioned category of individual racism, four other "modern" forms of racism are explored: cultural racism, institutional racism, epistemological racism, and aversive racism. The importance of broadening the categories of racism is that these other forms are less familiar and thus are more likely to be unnoticed yet have profound effects on practitioners. [ABSTRACT FROM AUTHOR]

Background: Rigorously designed longitudinal studies can inform how best to reduce the widening health gap between Indigenous and non-Indigenous children.Methods: A systematic review was performed to identify and present the breadth and depth of longitudinal studies reporting the health and well-being of Indigenous children (aged 0-18 years) globally. Databases were searched up to 23 June 2020. Study characteristics were mapped according to domains of the life course model of health. Risk of bias was assessed using the National Institutes of Health (NIH) Study Quality Assessment Tools. Reported level of Indigenous involvement was also appraised; PROSPERO registration CRD42018089950.Results: From 5545 citations, 380 eligible papers were included for analysis, representing 210 individual studies. Of these, 41% were located in Australia (n = 88), 22.8% in the USA (n = 42), 11.9% in Canada (n = 25) and 10.9% in New Zealand (n = 23). Research tended to focus on either health outcomes (50.9%) or health-risk exposures (43.8%); 55% of studies were graded as 'good' quality; and 89% of studies made at least one reference to the involvement of Indigenous peoples over the course of their research.Conclusions: We identified gaps in the longitudinal assessment of cultural factors influencing Indigenous child health at the macrosocial level, including connection to culture and country, intergenerational trauma, and racism or discrimination. Future longitudinal research needs to be conducted with strong Indigenous leadership and participation including holistic concepts of health. This is critical if we are to better understand the systematic factors driving health inequities experienced by Indigenous children globally. [ABSTRACT FROM AUTHOR]

The development of a tool to track participation in activity-based therapy (ABT) for people with spinal cord injury or disease (SCI/D) was identified as a priority of the Canadian ABT Community of Practice. The objective of this study was to understand multi-stakeholder perspectives on tracking ABT participation across the continuum of care. Forty-eight individuals from six stakeholder groups (persons living with SCI/D; hospital therapists; community trainers; administrators; researchers; and funders, advocates and policy experts) were recruited to participate in focus group interviews. Participants were asked open-ended questions concerning the importance of and parameters around tracking ABT. Transcripts were analyzed using conventional content analysis. Themes reflected the Who, What, Where, When, Why and How of tracking ABT. Participants described the importance of involving hospital therapists, community trainers and individuals with SCI/D in tracking ABT to capture both subjective and objective parameters across the continuum of care and injury trajectory. Digital tracking tools were favoured, although paper-based versions were regarded as a necessity in some circumstances. Findings highlighted the importance of tracking ABT participation for individuals with SCI/D. The information may guide the development of ABT practice guidelines and support the implementation of ABT in Canada. Tracking the details of activity-based therapy (ABT) sessions and programs across the continuum of care and injury trajectory may provide important information to support the development of ABT practice guidelines and implementation strategies. Tracking objective and subjective parameters are needed to provide a comprehensive description of an ABT session and program. Clinicians and individuals with spinal cord injury or disease (SCI/D) should both be able to track ABT to accommodate all settings and types of data. Digital tracking tools, such as an app, may provide an accessible, versatile and efficient way of tracking ABT. [ABSTRACT FROM AUTHOR]

In the current article, we describe the development and validation of the Social Comparison Rumination Scale. This measured was developed as a supplement to existing social comparison measures and to enable us to determine its potential relevance to perfectionism and other personality constructs. The Social Comparison Rumination Scale (SCRS) is a six-item inventory assessing the extent to which an individual is cognitively preoccupied and thinking repetitively about social comparison outcomes and information. Three studies with five samples of university students are described. Psychometric analyses established the SCRS consists of one factor assessed with high internal consistency and the measure is reliable and valid. Analyses showed that elevated levels of social comparison rumination are associated with trait perfectionism, perfectionistic automatic thoughts, perfectionistic self-presentation, ruminative brooding, burnout, depression, and fear of negative evaluation. Links were also established between social comparison rumination and both narcissism and dispositional envy. Overall, our findings support the further use of the SCRS and highlight the tendency of many people to think in deleterious ways about social comparisons long after the actual comparisons have taken place. We discuss social comparison rumination within the context of concerns about excessive social media use and young people being exposed to seemingly perfect lives that became a vexing cognitive preoccupation. [ABSTRACT FROM AUTHOR]

Background: Individuals experiencing socioeconomic inequity have worse health outcomes and face barriers to palliative and end-of-life care. There is a need to develop palliative care programs tailored to this underserved population. Objectives: To understand the characteristics and symptom profiles of a group of urban patients experiencing socioeconomic inequity and receiving palliative care. Design: Descriptive exploratory analysis of a patient dataset. The patient dataset was generated through a pilot research study with patients experiencing socioeconomic inequity and life-limiting illness who received a community-based palliative care intervention. Methods: The intervention took place over 1 year in the Palliative Care Outreach and Advocacy Team, a community-based urban palliative care clinic in Edmonton, Alberta, Canada, serving persons experiencing socioeconomic inequity. Participants had to be at least 18 years of age, be able to communicate in English, require palliative care for a life-limiting illness, and be able to consent to inclusion in the study. Results: Twenty-five participants were enrolled. Participants predominantly identified as male and Indigenous, experienced poverty and housing instability, and had metastatic cancer. Our participants rated their pain, shortness of breath, and anxiety as more severe than the broader community-based palliative care population in the same city. Most patients died in inpatient hospices (73%). Conclusion: Our analysis provides an in-depth picture of an understudied, underserved population requiring palliative care. Given the higher symptom severity experienced by participants, our analysis highlights the importance of person-centered palliative care. We suggest that socioeconomic inequity should be considered in patients with life-limiting illnesses. Further research is needed to explore palliative care delivery to those facing socioeconomic inequity. [ABSTRACT FROM AUTHOR]

Aim: To explore clinician-perceived barriers to and facilitators for the provision of actionable processes of care important for patients with persistent or chronic critical illness. Design: Qualitative descriptive interview study. Methods: Secondary analysis of semi-structured telephone interviews (December 2018 – February 2019) with professionally diverse clinicians working with adults experiencing persistent or chronic critical illness in Canadian intensive care units. We used deductive content analysis informed by the Social-Ecological Model. Results: We recruited 31 participants from intensive care units across nine Canadian provinces. Reported intrapersonal level barriers to the provision of actionable processes of care included lack of training, negative emotions and challenges prioritizing these patients. Facilitators included establishment of positive relations and trust with patients and family. Interpersonal barriers included communication difficulties, limited access to physicians and conflict. Facilitators included communication support, time spent with the patient/family and conflict management. Institutional barriers comprised inappropriate care processes, inadequate resources and disruptive environmental conditions. Facilitators were regular team rounds, appropriate staffing and employment of a primary care (nurse and/or physician) model. Communitylevel barriers included inappropriate care location and insufficient transition support. Facilitators were accessed to alternate care sites/teams and to formalized transition support. Public policy-level barriers included inadequacy of formal education programs for the care of these patients; knowledge implementation for patient management was identified as a facilitator. Conclusion: Our results highlighted multilevel barriers and facilitators to the delivery of actionable processes important for quality care for patient/family experiencing persistent or chronic critical illness. Impact: Using the Social-Ecological Model, the results of this study provide intra and interpersonal, institutional, community and policy-level barriers to address and facilitators to harness to improve the care of patients/family experiencing persistent or chronic critical illness. Reporting Method: Consolidated criteria for reporting qualitative studies. [ABSTRACT FROM AUTHOR]

Background: Vaccine hesitancy exists on a continuum ranging between complete adherence and complete refusal due to doubts or concerns within a heterogeneous group of individuals. Despite widespread acknowledgement of the contextual factors influencing attitudes and beliefs shaping COVID-19 vaccine hesitancy, qualitative research with equity-deserving groups, accounting for unique lived experiences, remains a gap in the literature. We aim to identify and begin to understand and document the unique contextual factors shaping hesitancy by equity-deserving groups as it relates to relationships with government and health authorities. Methods: Participants were recruited and interviewed between Aug-Dec 2021. Semi-structured interviews using a convergent interviewing technique were conducted with individuals from the general population, as well as individuals who identify as First Nations, Métis, or Inuit, members of the LGBT2SQ + community, low-income Canadians, Black Canadians, and newcomers. Interviews were audio recorded and transcribed by a team of researchers. Memos were written following interviews and used to complement the thematic analysis of the interview data. Themes are presented in the results section. Results: The rationale for hesitancy among equity-deserving groups is consistent with literature documenting hesitancy in the general population. Contextual factors surrounding equity-deserving groups' attitudes and beliefs, however, are unique and relate to a history of oppression, discrimination, and genocide. We identified factors unique to subgroups; for example, religious or fatalistic beliefs among participant who identify as FNMI, fear associated with lack of testing and speed of vaccines' production among participants who identify as FNMI, Black, and LGBT2SQ + , distrust of the healthcare system for LGBT2SQ + and Black Canadians, and distrust of the government and opposition to vaccine mandates for participating who identify as LGBT2SQ + , low-income, FNMI, or Black Canadian. Newcomers stood out as very trusting of the government and accepting of COVID-19 vaccination. Conclusions: While our data on vaccine hesitancy largely mirror concerns reported in the vast body of literature citing rationale for COVID-19 hesitancy in high-income countries, the contextual factors identified in our work point to the need for wider systemic change. Our results may be used to support efforts, beyond tailored promotion campaigns, to support the confident acceptance of vaccines for COVID-19 and the acceptance of novel vaccines as future infectious diseases emerge. [ABSTRACT FROM AUTHOR]

This study aimed to describe how occupational therapists evaluate older adults with cognitive impairments. A descriptive qualitative study design was used. Four focus groups were conducted with 16 occupational therapists working with cognitively impaired older adults in institutional and community care settings. An inductive thematic analysis of the content of the interviews was applied. Occupational therapists described a three-stage assessment process that was predominantly occupation-based, linear and iterative: (a) gathering information from the older adult, their care network and family members to plan the assessment, (b) assessing cognitive impairment and occupational performance using non-standardized observations and standardized tests, and (c) applying clinical reasoning to predict further performance issues and safety. Despite using a predominantly occupation-based assessment process, occupational therapists reported a lack confidence to predict safety. Occupational therapists may require additional knowledge, skills and tools to support them in assessing older adults with cognitive impairments. [ABSTRACT FROM AUTHOR]

Summary: Increasingly, school districts are looking for insights on how to embed a well-being focus across school communities. Well-being in K-12 education is proven to support positive mental health, improve academic performance and contribute to positive outcomes for students and staff. How districts transition to deeply integrate well-being into existing priorities and practices is not well understood. Insights on such shifts can help inform widespread change in education. In 2020, six Canadian school districts participated in case study research to examine how and why districts were able to shift their culture to one that prioritizes well-being. Fifty-five school community members participated in individual semi-structured interviews to explore their perception of well-being in their school communities. Analysis identified six themes: well-being is wholistic and requires balance, student and staff well-being are interconnected, organizational leadership sustains implementation, connection and voice as a catalyst to well-being, building capacity to support well-being action, and charting and re-charting a course. Findings increase our understanding of system-level change, and provide insights to support well-being in education. Lay Summary: Well-being in K-12 education is proven to support positive mental health, improve academic performance and contribute to positive outcomes for students and staff. How school districts can deeply integrate well-being into existing priorities and practices is not well understood. Many districts are looking for insights on how to embed a well-being focus across school communities. These insights can help inform change in K-12 education. In 2020, six Canadian school districts participated in case study research to examine how and why districts were able to shift their culture to one that prioritizes well-being. Fifty-five participants from six districts took part in interviews on the topic of district well-being prioritization. Supporting documents were also reviewed. Qualitative analysis identified six common themes: well-being is wholistic and requires balance, student and staff well-being are interconnected, organizational leadership sustains implementation, connection and voice as a catalyst to well-being, building capacity to support well-being action, and charting and re-charting a course. Study findings increase our understanding of system-level change in K-12 education. Findings provide valuable 'entry points' for school and district leaders to consider when making well-being a priority in their own contexts. [ABSTRACT FROM AUTHOR]

The objective of the study was to validate adapted versions of the Glasgow Anxiety Scale for people with Intellectual Disabilities (GAS-ID) simultaneously developed in English and French. A sample of 361 youth with mild to moderate intellectual disability (ID) (M = 15.78 years) from Australia (English-speaking) and Canada (French-speaking) participated in this study. The results supported the factor validity and reliability, measurement invariance (between English and French versions), a lack of differential items functioning (as a function of youth's age and ID level, but not sex in the English-Australian sample), temporal stability (over one year interval), and convergent validity (with global self-esteem and school loneliness) of a bi-factor exploratory structural equation modeling representation of the GAS-ID. The present study supports the psychometric properties of the English-Australian and French-Canadian versions of the adapted GAS-ID. [ABSTRACT FROM AUTHOR]

Essential family caregivers (EFCs) of relatives living in long-term care homes (LTCHs) experienced restricted access to their relatives due to COVID-19 visitation policies. Residents' experiences of separation have been widely documented; yet, few have focused on EFCs' traumatic experiences during the pandemic. Objective: This study aims to explore the EFCs' trauma of being locked out of LTCHs and unable to visit their loved ones in-person during COVID-19. Seven online focus groups with a total of 30 EFCs from Ontario and British Columbia, Canada were conducted as part of a larger mixed-method study. We used an inductive approach to thematic analysis to understand the lived experiences of trauma. Four trauma-related themes emerged: 1) trauma from prolonged separation from loved ones; 2) trauma from uncompassionate interactions with the LTCH's staff and administrators; 3) trauma from the inability to provide care to loved ones, and 4) trauma from experiencing prolonged powerlessness and helplessness. The EFCs experienced a collective trauma that deeply impacted their relationships with their relatives as well as their perception of the LTC system. Experiences endured by EFCs highlighted policy and practice changes, including the need for trauma-centred approaches to repair relational damage and post-pandemic decision-making that collaborates with EFCs. [ABSTRACT FROM AUTHOR]

Due to cultural influences, people from some ethnic minority groups expect to provide caregiving for their family members who suffer from illness. Little is known about the expectations about caregiving and the help‐seeking process among the Korean population in Canada. Thus, the purpose of this study is to examine perceptions of caregiving for people living with dementia and help‐seeking patterns among prospective Korean caregivers who anticipate becoming primary caregivers of their older relatives with dementia. An exploratory qualitative study was conducted in Montreal, Canada. In‐depth semi‐structured interviews were conducted with nine prospective Korean caregivers. The interviews were analysed using a qualitative thematic analysis. This study found four emerging themes: (1) the importance of family care; (2) the ability to find resources outside of the family; (3) the roles of Korean churches as a support system and; (4) the perceptions of service providers and health care settings. The findings of this study suggest that linguistic support services enable family caregivers to access more health and social services. Resources may be more easily accessed by Korean communities when provided through churches. [ABSTRACT FROM AUTHOR]

Emergency shelters are a core component of homeless service systems that address immediate basic needs. Service bans, which refer to temporary or permanent disallowances from a program or organization, are an underresearched phenomenon that can leave people experiencing homelessness without needed supports. This exploratory study examined the factors associated with shelter bans among people experiencing homelessness using secondary data from two Canadian studies: (1) a multisite randomized controlled trial of Housing First (At Home/Chez Soi Demonstration Project) and (2) a cross-sectional survey of youth experiencing homelessness across Canada (2019 Without a Home-National Youth Homelessness Survey). The two datasets were analyzed separately using logistic regression models with similar predictors to maximize the comparability of the results. Participants who experienced homelessness at an earlier age and had recent criminal justice system involvement were more likely to have shelter bans in both datasets. Impaired impulse control, more chronic medical conditions and living in Toronto were associated with increased likelihood of shelter bans in the At Home/Chez Soi dataset, whereas more adverse childhood experiences, physical violence victimization, engagement in survival sex behaviours and longer current episodes of homelessness were significant predictors of bans in the Without A Home dataset. Overall, the findings suggest that victimization and criminalization during homelessness may increase the risk of shelter loss from bans and further exclusion. The observed regional differences also highlight the potential limits of individual-level predictors. Further research is needed on shelter ban outcomes, as well as how capacity limits and organizational policies affect banning decisions. [ABSTRACT FROM AUTHOR]

Objective: It is essential that the embedded process of rural case selection be highlighted and documented to provide reassurance of rigour across rural surgical services supported by generalist surgeons, general practitioners with enhanced surgical skills and general practitioner anaesthetists. This enables feedback and improves the triage and case selection process to ensure the highest quality outcomes. Therefore, this research aims to explore participants' rational criteria for decision making around rural case selection. Design: Participants participated in a series of semi‐structured in‐depth interviews which were coded and underwent thematic analysis. Setting: Six community hospitals in British Columbia, Canada. Participants: General practitioners with enhanced surgical skills, general practitioner anaesthetists, local maternity care providers, and specialists. Results: Based on participant accounts, rural surgical and obstetrical decision‐making processes for local patient selection or regional referral had five major components: (1) Clinical Factors, (2) Physician Factors, (3) Patient Factors, (4) Consensus Between Providers and (5) the Availability of Local Resources. Conclusion: Decision‐making processes around rural surgical and obstetrical patient selection are complex and require comprehensive understanding of local capacity and resources. Current policies and guidelines fail to consider the varying capacities of each rural site and should be hospital specific. [ABSTRACT FROM AUTHOR]

Rural homelessness in Canada has only recently been acknowledged, and several gaps remain in our understanding of the phenomenon and how it is influenced by the rural context. This qualitative exploratory study aimed to help understand the experience of housing insecurity, factors that lead to rural homelessness, and potential solutions to the housing crisis in a rural Ontario community. Interviews were conducted with 27 participants: 16 individuals who were housing insecure and 11 key informants who had knowledge of the local homelessness situation. Data collection took place between August 2020 and May 2021 and inductive analysis was concurrent. Findings revealed competing perspectives on the magnitude of the crisis, its root causes, and potential solutions to rural homelessness. The invisible nature of rural homelessness and values of individualism that assign responsibility for homelessness to poor choices rather than structural factors may account for these different perspectives. Stigma also played an important role in how homelessness was understood, particularly for individuals who were homeless and perceived to be using substances. The lack of privacy, limited services, and low housing stock in the rural environment contributed to challenges with overcoming homelessness. Strategies to help improve supports for individuals facing homelessness include anti‐stigma education, capacity building, and inclusion of people with lived experience of homelessness in decision and policymaking. Prevention should also be incorporated into the response to rural homelessness through intersectoral collaboration and upstream policies that target the structural drivers of homelessness. [ABSTRACT FROM AUTHOR]

Validate the factor structure and establish internal consistency reliability of the French-Canadian version of the Mayo-Portland Adaptability Inventory (MPAI-4), using a Canadian sample of adults with traumatic brain injury (TBI) receiving post-acute rehabilitation services. Psychometric analysis of French-Canadian MPAI-4 data from TBI adults (N = 1012) who received rehabilitation interventions and for whom a first French-Canadian MPAI-4 measure was completed between 2016 and 2020. Exploratory factor analysis was used to evaluate the factor structure of the French-Canadian MPAI-4. The final and best solution revealed three factors, which accounted for 48.68% of the variance. Using Cronbach's alpha, all subscales showed good internal consistency (all 0.70 ≤ α ≤ 0.89). Reference norms for the TBI sample are provided, as well as descriptive raw data according to sex, age, TBI severity and rehabilitation setting. The French-Canadian MPAI-4 factor structure is validated. The three factors extracted are similar to the three subscales of the original MPAI-4. The questionnaire shows good psychometric properties and represents a suitable tool for TBI adults receiving rehabilitation services in a French-Canadian context. The provided reference norms will also help guide the clinical use of the MPAI-4 in French-Canadian TBI populations. The MPAI-4 questionnaire measures functional abilities, global outcome and community integration following traumatic brain injury (TBI). The questionnaire can be used in inpatient, outpatient and vocational rehabilitation settings to assess TBI patients' progress and outcomes, plan interventions and evaluate the effect of rehabilitation. The French-Canadian version of the MPAI-4 is validated and suitable to be used in French-Canadian post-acute TBI rehabilitation settings. [ABSTRACT FROM AUTHOR]

Objective: To translate and validate the Child Three-Factor Eating Questionnaire (CTFEQr17), assessing cognitive restraint (CR), uncontrolled eating (UE) and emotional eating (EE), among French-speaking Canadian young individuals.Design: Phase 1 comprised a translation and the evaluation of the comprehension of the questionnaire. Phase 2 comprised a confirmatory factor analysis (CFA), the evaluation of internal consistency (Cronbach's α), test-retest reliability (intra-class correlation coefficients (ICC)) and construct validity, including correlations among the CTFEQr17 and Eating Attitudes Test (EAT-26), anthropometrics, dietary intake and diet quality.Setting: Primary and secondary schools, Québec City, Canada.Participants: Phases 1 and 2 included 20 (40 % boys, mean age 11·5 (sd 2·4) years) and 145 (48 % boys, mean age 11·0 (sd 1·9) years) participants, respectively.Results: Phase 1 resulted in the questionnaire to be used in Phase 2. In Phase 2, the CFA revealed that the seventeen item, three-factor model (CTFEQr17) provided an excellent fit. Internal consistency was good (Cronbach's α: 0·81-0·90). Test-retest reliability was moderate to good (ICC = 0·59, (95 % CI 0·48, 0·70), ICC = 0·78, (95 % CI 0·70, 0·84), ICC = 0·50, (95 % CI 0·38, 0·62) for CR, UE and EE, respectively). CR correlated with EAT-26 score (r = 0·43, P < 0·0001). UE and EE correlated negatively with BMI Z-scores (r = -0;·26, P = 0·003; r = -0;·19, P = 0·03, respectively). CR correlated with the proportion of energy intake from protein and diet quality (r = 0·18, P = 0·04; r = 0·20, P = 0·02, respectively).Conclusion: The CTFEQr17 is suitable to use among French-speaking Canadian young individuals. [ABSTRACT FROM AUTHOR]

Background: We studied the impact of fine particulate matter (PM2.5) exposure due to a remote wildfire event in the Pacific Northwest on daily outpatient respiratory and cardiovascular physician visits during wildfire (24-31 August, 2015) and post-wildfire period (1-30 September, 2015) relative to the pre-wildfire period (1-23 August, 2015) in the city of Calgary, Canada.Methods: A quasi-Poisson regression model was used for modelling daily counts of physician visits due to PM2.5 while adjusting for day of the week (weekday versus weekend or public holiday), wildfire exposure period (before, during, after), methane, relative humidity, and wind direction. A subgroup analysis of those with pre-existing diabetes or hypertension was performed.Results: An elevated risk of respiratory disease morbidity of 33% (relative risk: RR) [95% confidence interval (CI): 10%-59%] and 55% (95% CI: 42%-69%) was observed per 10µg/m3 increase in PM2.5 level during and after wildfire, respectively, relative to the pre-wildfire time period. Increased risk was observed for children aged 0-9 years during (RR = 1.57, 95% CI: 1.21-2.02) and after the wildfire (RR = 2.11, 95% CI: 1.86-2.40) especially for asthma, acute bronchitis and acute respiratory infection. The risk of physician visits among seniors increased by 11% (95% CI: 3%-21%), and 19% (95% CI: 7%-33%) post-wildfire for congestive heart failure and ischaemic heart disease, respectively. Individuals with pre-existing diabetes had an increased risk of both respiratory and cardiovascular morbidity in the post-wildfire period (RR = 1.35, 95% CI: 1.09-1.67; RR = 1.22, 95% CI: 1.01-1.46, respectively).Conclusions: Wildfire-related PM2.5 exposure led to increased respiratory condition-related outpatient physician visits during and after wildfires, particularly for children. An increased risk of physician visits for congestive heart failure and ischaemic heart disease among seniors in the post-wildfire period was also observed. [ABSTRACT FROM AUTHOR]

Background: Dementia is an increasing concern in many countries, especially in those experiencing rapid growth in the proportion of older adults in their population.Objective: This study aims to describe trends and demographic characteristics of incident dementia cases in community-dwelling older adults managed by primary care physicians.Methods: We used electronic medical records from the Canadian Primary Care Sentinel Surveillance Network database to conduct a retrospective analysis to determine the number of, and trends for, incident diagnoses of dementia. Age-standardized annual incidence rates were calculated. Participants in our cohort are Canadian community dwelling seniors aged 65+ years who were not diagnosed with dementia before baseline with at least six years of record at their primary care clinics.Results: The cohort consisted of 39 067 patients of whom 57% were females; the mean (SD) follow-up was 8.4 (1.5) years. During follow-up, 4935 patients were diagnosed with dementia. The risk for dementia diagnosis increased with increasing age but decreased in the last four years among people aged 80 and older at baseline (P < 0.001). People with dementia were more likely to be females (P = 0.001) and urban residents (P < 0.001), they are less likely to be classified into the least deprived group (P = 0.012).Conclusions: The incidence of dementia diagnosis increased with age except in the oldest old in both sexes. This may be attributed to the effect of mortality competing risk. Future research on the association between risk factors and dementia should consider studying dementia among the oldest old separately to minimize bias. [ABSTRACT FROM AUTHOR]

Rationale: Bronchopulmonary dysplasia increases the risk of disability in extremely preterm infants. Although the pathophysiology remains uncertain, prior exposure to intermittent hypoxemia may play a role in this relationship. Objectives: To determine the association between prolonged episodes of intermittent hypoxemia and severe bronchopulmonary dysplasia. Methods: A post hoc analysis of extremely preterm infants in the Canadian Oxygen Trial who survived to 36 weeks' postmenstrual age was performed. Oxygen saturations <80% for ⩾1 minute and the proportion of time per day with hypoxemia were quantified using continuous pulse oximetry data that had been sampled every 10 seconds from within 24 hours of birth until 36 weeks' postmenstrual age. The study outcome was severe bronchopulmonary dysplasia as defined in the 2001 NIH Workshop Summary. Measurements and Main Results: Of 1,018 infants, 332 (32.6%) developed severe bronchopulmonary dysplasia. The median number of hypoxemic episodes ranged from 0.8/day (interquartile range, 0.2-1.1) to 60.2/day (interquartile range, 51.4-70.3) among the least and most affected 10% of infants. Compared with the lowest decile of exposure to hypoxemic episodes, the adjusted relative risk of severe bronchopulmonary dysplasia increased progressively from 1.72 (95% confidence interval, 1.55-1.90) at the 2nd decile to 20.40 (95% confidence interval, 12.88-32.32) at the 10th decile. Similar risk gradients were observed for time in hypoxemia. Significant differences in the rates of hypoxemia between infants with and without severe bronchopulmonary dysplasia emerged within the first week after birth. Conclusions: Prolonged intermittent hypoxemia beginning in the first week after birth was associated with an increased risk of developing severe bronchopulmonary dysplasia among extremely preterm infants. Clinical trial registered with www.isrctn.com (ISRCTN62491227) and www.clinicaltrials.gov (NCT00637169). [ABSTRACT FROM AUTHOR]

Objectives: To determine whether the genotypic resistance profile inferred from WGS could accurately predict phenotypic resistance for ESBL-producing Escherichia coli isolated from patient samples in Canadian hospital laboratories.Methods: As part of the ongoing CANWARD study, 671 E. coli were collected and phenotypically confirmed as ESBL producers using CLSI M100 disc testing criteria. Isolates were sequenced using the Illumina MiSeq platform, resulting in 636 high-quality genomes for comparison. Using a rules-based approach, the genotypic resistance profile was compared with the phenotypic resistance interpretation generated using the CLSI broth microdilution method for ceftriaxone, ciprofloxacin, gentamicin and trimethoprim/sulfamethoxazole.Results: The most common genes associated with non-susceptibility to ceftriaxone, gentamicin and trimethoprim/sulfamethoxazole were CTX-M-15 (n = 391), aac(3)-IIa + aac(6')-Ib-cr (n = 121) and dfrA17 + sul1 (n = 169), respectively. Ciprofloxacin non-susceptibility was most commonly attributed to alterations in both gyrA (S83L + D87N) and parC (S80I + E84V), with (n = 187) or without (n = 197) aac(6')-Ib-cr. Categorical agreement (susceptible or non-susceptible) between actual and predicted phenotype was 95.6%, 98.9%, 97.6% and 88.8% for ceftriaxone, ciprofloxacin, gentamicin and trimethoprim/sulfamethoxazole, respectively. Only ciprofloxacin results (susceptible or non-susceptible) were predicted with major error (ME) and very major error (VME) rates of <3%: ciprofloxacin (ME, 1.5%; VME, 1.1%); gentamicin (ME, 0.8%-31.7%; VME, 4.8%); ceftriaxone (ME, 81.8%; VME, 3.0%); and trimethoprim/sulfamethoxazole (ME, 0.9%-23.0%; VME, 5.2%-8.5%).Conclusions: Our rules-based approach for predicting a resistance phenotype from WGS performed well for ciprofloxacin, with categorical agreement of 98.9%, an ME rate of 1.5% and a VME rate of 1.1%. Although high categorical agreements were also obtained for gentamicin, ceftriaxone and trimethoprim/sulfamethoxazole, ME and/or VME rates were ≥3%. [ABSTRACT FROM AUTHOR]

Aim: To investigate the role stressors, and how coping strategies cultivated nurse managers' resilience in rural workplaces. Background: A stressful workplace can impair the mental and physical health of nurse managers leading to poor performance. Building and sustaining manager resilience in complex and stressful practice environments is necessary to attract and maintain competent and skilled managers. Method: In this qualitative exploratory inquiry, a purposive sampling method was used to recruit 16 nurse managers in rural western Canada. Results: Coping strategies fostered manager's resilience that made their work meaningful, and included putting out fires, psychologically reframing a situation, serving others and receiving support. Conclusions: Managers brought expertise, knowledge and skill to make their work meaningful and central to ongoing health service delivery in these rural communities. Nurse manager resilience can be strengthened by using evidence‐based strategies in an increasingly complex health care environment. Implications for Nursing Management: Managers need to be supported and encouraged to develop awareness of their own protective factors as they cope with challenging situations. Building resilience through formal education, social support and meaningful recognition is an important focus for nurse leaders in establishing a healthy work environment and maintaining a stable nursing workforce. [ABSTRACT FROM AUTHOR]

Background: Compared with those with a higher socio-economic position (SEP), individuals with a lower SEP have higher cancer morbidity and mortality. However, the contribution of modifiable risk factors to these inequities is not known. This study aimed to quantify the mediating effects of modifiable risk factors to associations between SEP and cancer morbidity and mortality.Methods: This study used a prospective observational cohort design. We combined eight cycles of the Canadian Community Health Survey (2000/2001-2011) as baseline data to identify a cohort of adults (≥35 years) without cancer at the time of survey administration (n = 309 800). The cohort was linked to the Discharge Abstract Database and the Canadian Mortality Database for cancer morbidity and mortality ascertainment. Individuals were followed from the date they completed the Canadian Community Health Survey until 31 March 2013. Dates of individual first hospitalizations for cancer and deaths due to cancer were captured during this time period. SEP was operationalized using a latent variable combining measures of education and household income. Self-reported modifiable risk factors, including smoking, excess alcohol consumption, low fruit-and-vegetable intake, physical inactivity and obesity, were considered as potential mediators. Generalized structural equation modelling was used to estimate the mediating effects of modifiable risk factors in associations between low SEP and cancer morbidity and mortality in the total population and stratified by sex.Results: Modifiable risk factors together explained 45.6% of associations between low SEP and overall cancer morbidity and mortality. Smoking was the most important mediator in the total population and for males, accounting for 15.5% and 40.2% of the total effect, respectively. For females, obesity was the most important mediator.Conclusions: Modifiable risk factors are important mediators of socio-economic inequities in cancer morbidity and mortality. Nevertheless, more than half of the variance in these associations remained unexplained. Midstream interventions that target modifiable risk factors may help to alleviate inequities in cancer risk in the short term. However, ultimately, upstream interventions that target structural determinants of health are needed to reduce overall socio-economic inequities in cancer morbidity and mortality. [ABSTRACT FROM AUTHOR]