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The COVID-19 pandemic brought about changes to the lives of families with young children. It has been associated with physical and psychological risk, yet the impact on younger children is poorly examined. The aim of this qualitative study was to examine how the COVID-19 pandemic impacted the day-to-day life of parents of young children living in a small northern city in British Columbia, Canada. Ten mothers with children aged 0–5 years participated in a six-week longitudinal study between November 2020 and March 2021. This article presents data from entry and exit interviews that were analysed using Todorov's narrative theory. Three key themes were identified: (1) gaps in health services; (2) gaps in early childhood education and programs; and (3) changes to/lost social interactions. Limited opportunities to engage with providers caused frustration and left parents feeling disempowered or dissatisfied. Family support and well-being were negatively impacted by a loss in social connectivity. Despite unpredictability and worries about child development, most of the mothers found ways to cherish the time to 'stop and refocus'. Overall, the families evidenced resilience, despite a loss in relational habits. [ABSTRACT FROM AUTHOR]

The transition to adulthood is a critical time for everyone to build independence, experience new things, and become self-sufficient. With medical advances, individuals with complex chronic conditions are surviving into adulthood. As such they withstand additional challenges during this stage of their life including; facing a discontinuity of care, loss of prior health-care networks and champions, and a shift toward increased responsibility and self-management of their conditions. Often this shift results in the need for primary care providers to act as care managers, coordinating care and supporting the young adult as they navigate adulthood. In exploring the role of primary care providers with this population we reviewed the literature to identify what strategies primary care providers can use to enhance the transition process for young adults ages 15 to 25 years with complex chronic conditions exiting pediatric services. An integrative literature review approach was used to systematically search the contemporary literature. Applying inclusion criteria and quality assessment of relevant research and gray literature we identified 12 studies that warranted detailed review and analysis. Analysis of the studies highlighted four key themes: relationships, fear and anxiety, preparedness, and communication and collaboration. It was evident that health-care transition for young adults with complex chronic conditions was complicated by their psychosocial development and extensive health and service needs. Health-care transition is a team effort influenced by local contexts, resources, and relational practices. Both groups of primary care providers and young adults must be prepared prior to transition if they are to become immersed and engaged in this work. The population of young adults with complex chronic conditions exiting pediatric care will continue to grow as access to care delivery and medical technology continue to expand. While health-care transition for this population is complicated by extensive needs and psychosocial development, primary care providers can act as key supports in employing strategies to enhance the transition process for these young adults. [ABSTRACT FROM AUTHOR]

Background: An enduring challenge remains about how to effectively implement programs, services, or practices. Too often, implementation does not achieve its intended effectiveness, fidelity, and sustainability, even when frameworks or theories determine implementation strategies and actions. A different approach is needed. This scoping review joined two markedly different bodies of literature: implementation and hermeneutics. Implementation is usually depicted as focused, direct, and somewhat linear, while hermeneutics attends to the messiness of everyday experience and human interaction. Both, however, are concerned with practical solutions to real-life problems. The purpose of the scoping review was to summarize existing knowledge on how a hermeneutic approach has informed the process of implementing health programs, services, or practices. Methods: We completed a scoping review by taking a Gadamerian hermeneutic approach to the JBI scoping review method. Following a pilot search, we searched eight health-related electronic databases using broadly stated terms such as implementation and hermeneutics. A diverse research team that included a patient and healthcare leader, working in pairs, independently screened titles/abstracts and full-text articles. Through the use of inclusion criteria and full-team dialogue, we selected the final articles and identified their characteristics, hermeneutic features, and implementation components. Results: Electronic searches resulted in 2871 unique studies. After full-text screening, we retained six articles that addressed both hermeneutics and implementing a program, service, or practice. The studies varied widely in location, topic, implementation strategies, and hermeneutic approach. All addressed assumptions underpinning implementation, the human dimensions of implementing, power differentials, and knowledge creation during implementation. All studies addressed issues foundational to implementing such as cross-cultural communication and surfacing and addressing tensions during processes of change. The studies showed how creating conceptual knowledge was a precursor to concrete, instrumental knowledge for action and behavioral change. Finally, each study demonstrated how the hermeneutic process of the fusion of horizons created new understandings needed for implementation. Conclusions: Hermeneutics and implementation have rarely been combined. The studies reveal important features that can contribute to implementation success. Implementers and implementation research may benefit from understanding, articulating, and communicating hermeneutic approaches that foster the relational and contextual foundations necessary for successful implementation. Trial registration: The protocol was registered at the Centre for Open Science on September 10, 2019. MacLeod M, Snadden D, McCaffrey G, Zimmer L, Wilson E, Graham I, et al. A hermeneutic approach to advancing implementation science: a scoping review protocol 2019. Accessed at osf.io/eac37. [ABSTRACT FROM AUTHOR]

Background: Early childhood is a critical period of development for infants, young children, and their families. An array of services, programs, and interventions exist to support families during this life stage, often delivered by a diverse range of professionals. Overlap in early years services exists between healthcare, social care, childcare, education, and not-for-profit organizations. Such diversity in services has the potential to add a rich experience to early childhood development, or without collaboration, widen service gaps, risking providers' ability to meet the needs of families. Methods: In northern British Columbia (BC), Canada, a group of individuals came together to approach building relationships and engagement across sectors in early years services using compassionate systems leadership (CSL). A virtual summit was hosted with early childhood service providers including peer support workers and parents/caregivers using a hybrid model of pre-recorded asynchronous sessions combined with a live workshop. The purpose of the event was to find common ground, celebrate local success, and build understanding of how to work collaboratively across the region to identify and address early years priorities. Results: The event was successful in engaging 121 providers across early years services from a broad geographic region. Applying CSL principles for engagement allowed the team to examine how all partners could address silos in early years services across northern BC. Using a reflexive thematic approach, four key themes were identified at the Summit: (1) early years services are a patchwork but there are dreams of weaving a new blanket together, (2) an ideal model of service is family-centred and inclusive, (3) all sectors are needed at the table, and (4) compassion is the thread that weaves this work together. Conclusions: The application of CSL principles can be used to guide engagement and develop supportive spaces for open conversation about creating systems change. In facilitating a space that allowed for vulnerability and relational ways of engaging across sectors we discovered commitment and a willingness for those present to consider new ideas and partnerships that would allow for greater integration of early years services in northern BC. Plain English summary: For children aged zero to eight years old there are a wide range of community services geared to supporting health, pre-school education, and parenting skills and knowledge. Getting the right services at the right time in early childhood can make a major difference to a child's health and development and influence their physical and mental health outcomes into adulthood. We know there are individuals from a wide range of sectors working with families during early childhood. Sectors include the health system, education, government ministries, childcare centres, and community programs. Despite working with many of the same families, each sector's services are often seen as separate which means that the opportunity to develop shared, family centred goals can be missed. In northern British Columbia, Canada we hosted a virtual event with 121 people who work in roles that support children between the ages of zero to eight and their families living in smaller, more rural communities. Using a blend of pre-recorded videos and a live online workshop we drew together a community of providers to learn about the work they are doing. Specifically, we were interested in exploring ways in which we can improve working together to support positive early childhood experiences for children and their families. [ABSTRACT FROM AUTHOR]

Both healthcare providers and researchers in the health sciences are well rehearsed in asking the question 'What could be causing this'? and examining beyond the surface of observable symptoms or obvious factors to understand what is really occurring with patients and health services. Critical realism is a philosophical framework that can help in this inquiry as we attempt to make sense of the observable world. The aim of this article is to introduce critical realism and explore how it can help both healthcare providers and health science researchers to better understand causation through the mechanisms that generate events, despite those mechanisms often being unseen. The article reviews foundational concepts and examples framed in the healthcare setting to make the key principles, strengths and limitations of critical realism accessible for those who are just beginning their journey with this approach. [ABSTRACT FROM AUTHOR]

Objectives: Due to accelerating wildland fire activity, there is mounting urgency to understand, prevent, and mitigate the occupational health impacts associated with wildland fire suppression. The objectives of this review of academic and grey literature were to: Identify the impact of occupational exposure to wildland fires on physical, mental, and emotional health; and Examine the characteristics and effectiveness of prevention, mitigation, or management strategies studied to reduce negative health outcomes associated with occupational exposure to wildland fire. Methods: Following established scoping review methods, academic literature as well as government and industry reports were identified by searching seven academic databases and through a targeted grey literature search. 4679 articles were screened using pre-determined eligibility criteria. Data on study characteristics, health outcomes assessed, prevention or mitigation strategies studied, and main findings were extracted from each included document. The results of this scoping review are presented using descriptive tables and a narrative summary to organize key findings. Results: The final sample was comprised of 100 articles: 76 research articles and 24 grey literature reports. Grey literature focused on acute injuries and fatalities. Health outcomes reported in academic studies focused on respiratory health (n = 14), mental health (n = 16), and inflammation and oxidative stress (n = 12). The identified studies evaluated short-term outcomes measuring changes across a single shift or wildland fire season. Most research was conducted with wildland firefighters and excluded personnel such as aviation crews, contract crews, and incident management teams. Five articles reported direct study of mitigation strategies, focusing on the potential usage of masks, advanced hygiene protocols to reduce exposure, fluid intake to manage hydration and core temperature, and glutamine supplementation to reduce fatigue. Conclusions: While broad in scope, the evidence base linking wildland fire exposure to any one health outcome is limited. The lack of long-term evidence on changes in health status or morbidity is a clear evidence gap and there is a need to prioritize research on the mental and physical health impact of occupational exposure to wildland fire. [ABSTRACT FROM AUTHOR]

Congenital adrenal hyperplasia (CAH) encompasses a range of autosomal recessive inherited enzyme deficiencies that impact cortisol biosynthesis pathways. Although reported as a rare and lifelong disorder, it holds chronic health risks for individuals that can influence menstruation. The purpose of this environmental scan and integrative literature review was to identify health information pertinent to CAH and menstruation in order to inform health providers, increase patient education, and promote menstrual wellbeing. Analysis identified that while information about menses is reported, information about menstrual irregularities and their management in adolescents and women with CAH is uncertain. Furthermore, there is insufficient good quality research and knowledge on CAH and menstruation to inform health providers in their practice with this population. The need for individuals with CAH to access evidence-informed information is constrained by the state of current understanding and limitations in knowledge translation. The importance of having trustworthy and safe spaces in which to ask questions and draw on ethically sound, language appropriate, and evidence-informed material is paramount in supporting women's confidence and wellbeing across their lifetime. We encourage the building of stronger relationships between researchers, health providers, support groups and individuals to improve knowledge translation and dissemination regarding CAH and menstruation. [ABSTRACT FROM AUTHOR]

Background: Physical literacy is a multidimensional concept that describes a holistic foundation for physical activity engagement. Understanding the utilization and effectiveness of physical literacy in the context of health and the health care setting will support clinical and population health programming. The purpose of this rapid scoping review was to: 1) map the conceptualization of physical literacy as it relates to health; 2) identify and describe the utilization of physical literacy in the context of health and engagement of health care providers; and 3) better understand the relationship between physical literacy, physical activity, and health.Methods: Following established scoping review methods adapted for a rapid review approach, we searched electronic databases Medline OVID, CINAHL Ebsco, PsycInfo Ebsco, Web of Science ISI, and ERIC Ebsco from conception until September 2019. Tabulation coding was used to identify the key themes across included articles and synthesize findings. The review follows an integrated knowledge translation approach based on a partnership between the health system, community organizations, and researchers.Results: Following removal of duplicates, our search identified 475 articles for title and abstract screening. After full text review, 17 articles were included (12 original research papers and five conceptual or review papers). There was near consensus among included papers with 16 of 17 using the Whiteheadian definition of physical literacy. There was limited involvement of health care providers in the concept of physical literacy. Physical literacy was connected to the following health indicators: BMI and body weight, waist circumference, cardiorespiratory fitness, physical activity, and sedentary behaviour. The primary demographic focus of included studies was children and there was a conceptual focus on the physical domain of physical literacy.Conclusions: Despite growing popularity, the empirical evidence base linking physical literacy and health outcomes is limited and the relationship remains theoretical. Physical literacy may present a novel and holistic framework for health-enhancing physical activity interventions that consider factors vital to sustained participation in physical activity across the life course. Future work should continue to explore the nature and direction of the relationship between physical activity and physical literacy to identify appropriate focused approaches for health promotion. [ABSTRACT FROM AUTHOR]

Background: With an increase in wildfire activity across the globe and growing numbers of personnel involved each year, it is necessary to explore the health impacts of occupational exposure to wildfires and the practices and policies that can be implemented to mitigate these effects. The aim of this work is to (1) identify the impact occupational exposure to wildfires has on health outcomes including physical, mental, and social wellbeing; (2) examine the characteristics and effectiveness of mitigation strategies or policies to reduce negative health impacts as reported by current literature and reports; and (3) develop a program of research to address and understand the health impacts of occupational exposure to wildfires based on gaps in the literature and stakeholder priorities. Methods: This scoping study will be conducted in two phases: (1) scoping literature review and (2) modified Delphi process. The literature review will follow a methodologically rigorous scoping review approach that includes (a) identifying the research question (and protocol development), (b) identifying literature (an iterative process), (c) selecting relevant studies, (d) extracting data into tables, and (e) synthesizing, summarizing, and reporting results. Alongside this, a modified Delphi process will be conducted to define priorities for wildland fire occupational health research. A partnership with the British Columbia (BC) Wildfire Service will enable exploring the appropriateness of identified mitigation strategies and health risks for the BC context. Discussion: This two-phase approach will provide an in-depth review of the literature of the health impacts of occupational exposure to wildfires and identify mitigation strategies or policies implemented to protect workers and reduce negative health impacts. It is anticipated that these findings may provide recommendations for "quick wins" or initial action that can be implemented within the BC context to reduce negative health outcomes, and inform gaps in context-specific research that needs to be addressed through a strategic, collaborative research program over the next 5 years. Systematic review registration: Open Science Framework osf.io/ugz4 [ABSTRACT FROM AUTHOR]

Background This article describes the provincial dissemination of HEARTSMAP, an evidence-based emergency department (ED) psychosocial assessment and disposition decision tool for clinician use with children and youth. Methods HEARTSMAP was disseminated in partnership with local, child and youth mental health teams, as part of a quality improvement initiative implemented in British Columbia EDs. The target audience of education sessions were clinicians working in ED settings responsible for paediatric psychosocial assessments. We used the RE-AIM framework to evaluate the reach, effectiveness, adoption, implementation, and maintenance of HEARTSMAP dissemination, analyzing data from session evaluation forms and online tool data. Results Education sessions reached 475 attendees, in 52 of 95 British Columbia EDs. HEARTSMAP training was well received by clinicians with 96% describing effective content including increased comfort in conducting paediatric psychosocial assessments and confidence in disposition planning after training. Clinicians identified unclear processes and lack of local resources as the main barriers to implementation. One-third of the attendees expressed willingness to use the tool, and 27% of registered clinicians have used the tool postimplementation. Conclusions Our approach reached and effectively trained clinicians from over half of the province's EDs to use HEARTSMAP for emergency paediatric psychosocial assessments. For some, this provided greater comfort and confidence for these assessments and the following disposition decisions. This evaluation provides valuable insights on training clinicians to use a paediatric mental health tool within diverse ED settings and emphasized the need for ongoing support and institutional engagement to facilitate local, infrastructural, and operational processes for adoption and maintenance, postdissemination. [ABSTRACT FROM AUTHOR]

Background: Long-term care facilities (LTCFs) are often places where persons with complex health needs that cannot be met in a community setting, reside and are cared for until death. However, not all persons experience continuous declines in health and functioning. For some residents who experience improvement in personal abilities and increased independence, transition from the LTCF to the community may be an option. This scoping review aimed to synthetize the existing evidence regarding the transition process from discharge planning to intervention and evaluation of outcomes for residents transitioning from LTCFs to the community.Methods: This review followed a five-stage scoping review framework to describe the current knowledge base related to transition from LTCFs to community based private dwellings as the location of the discharge (example: Person's own home or shared private home with a family member, friend, or neighbour). Of the 4221 articles retrieved in the search of 6 databases, 36 articles met the criteria for inclusion in this review.Results: The majority of studies focussed on an older adult population (aged 65 years or greater), were conducted in the USA, and were limited to small geographic regions. There was a lack of consistency in terminology used to describe both the facilities as well as the transition process. Literature consisted of a broad array of study designs; sample sizes ranged from less than 10 to more than 500,000. Persons who were younger, married, female, received intense therapy, and who expressed a desire to transition to a community setting were more likely to transition out of a LTCF while those who exhibited cognitive impairment were less likely to transition out of a LTCF to the community.Conclusions: Findings highlight the heterogeneity and paucity of research examining transition of persons from LTCFs to the community. Overall, it remains unclear what best practices support the discharge planning and transition process and whether or not discharge from a LTCF to the community promotes the health, wellbeing, and quality of life of the persons. More research is needed in this area before we can start to confidently answer the research questions. [ABSTRACT FROM AUTHOR]

This literature review sought to examine the extant literature on the relationship between emergency response services (ERS) personnel and suicide in Canada. The purpose was to determine what research has been conducted on suicide and suicide ideation among ERS, to contribute to knowledge in the area, and also to identify potential research gaps. Through a search of multiple databases (PubMed, Web of Science, Medline, Psyc Articles, Psyc Info, Science Direct, CINAHL) and additional hand searching, 40 articles were identified to meet search criteria and provide relevant information on this topic. The articles revealed that research has primarily focused on the traumatic stress and critical incidents encountered by emergency responders, while little research has been conducted specifically on suicide within these professions. The minimal research that has focused on suicide generally discusses ERS encounters with suicide victims and patients, rather than suicide in the context of their personal mental health. The limited research that does discuss ERS suicide is largely restricted to law enforcement and military personnel. Finally, the literature search identified a particular lack of research relevant to the Canadian context. A research agenda is recommended to further investigate suicide among ERS within Canada, and the impact these suicides have on colleagues, families and friends. [ABSTRACT FROM AUTHOR]

Introduction: The early years (ages 0-8) is a critical stage of childhood development, supporting families during this time requires collective efforts across sectors. Siloed streams limit our ability to meet families' needs thereby missing opportunities to positively influence childhood outcomes. In northern British Columbia a small group of professionals completed training in Compassionate Systems Leadership (CSL). The CSL approach focuses on developing shared knowledge and cultural awareness to strengthen capacity to effectively progress systems change initiatives. Applying CSL with a wider community across northern BC allowed the team to examine how all partners could address silos in early years services. Aims Objectives Theory or Methods: A first step in applying CSL is to be culturally sensitive and actively relational with professionals working within early years services. In February 2021 we hosted a summit in northern BC, bringing together professionals across child and family serving sectors. The objectives were to find common ground, celebrate local work supporting children, and build on understanding priorities in the early years. Our five day event wove together Indigenous and western pedagogies, highlighting northern First Nation voices and cultural practices. The event used a hybrid model of pre-recorded asynchronous sessions with a concluding full day virtual workshop. Highlights or Results or Key Findings: Early years services were described as patchy and inconsistent. Critically, the burden of weaving together supports falls to primary caregivers, and across sectors it was acknowledged this created gaps in comprehensive early years services. Many communities worked hard to lessen fragmentation and participants described how relational ways of being helped co-create partnered supports. Participants acknowledged that working compassionately facilitated local initiatives which positively impacted the early years, yet gaps remained including the absence of health's engagement in work across the region. There was consensus that a holistic, culturally respectful, multidisciplinary team, which includes primary health care was needed to support the health and development needs of young children. Discussion focused on expanding hub models of care which exist in select northern communities. A clear message from the summit was a willingness for crosssector collaboration, and the development of an integrated approach to support families in the early years is required. Conclusions: In facilitating a safe space that allowed for vulnerability and relational ways of engaging across sectors we discovered commitment, interest, and a willingness for those present to consider new ideas and partnerships that would allow for greater integration of early years services in northern BC's rural contexts. Implications for applicability/transferability sustainability and limitations: Shifting from siloed work to integration across services is complex. Relational ways of being helped providers with this complexity, creating space to learn from each other, begin co-creation, and enhance partnerships. This was evident in early years services but is likely to apply in other service areas seeking integration. [ABSTRACT FROM AUTHOR]

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