Search

As a registered psychotherapist and art therapist, my clinical training was primarily based on North American clinical approaches influenced by traditional Euro and western‐centric clinical theories of human behavior. I completed my training feeling certain that traditional clinical mental health practices were not an appropriate fit for racialized communities and could have negative implications for their healing and well‐being. As clinicians, it is our moral obligation to support and enhance the quality of life for marginalized groups. We can do this by challenging our values and knowledge that have been defined and influenced by structures (i.e., education, training, etc.) embedded in these colonial teachings. For this paper, I used a heuristic self‐inquiry research method to investigate these concerns. I interviewed other racialized psychotherapists practicing in Turtle Island (currently mostly occupied by the political entities of Canada and the United States) with the aim to learn how and if decolonization can be used in therapy practice. With this research, I (1) identified a gap in care for racialized communities, (2) questioned if or how a decolonizing approach to care should be considered, (3) explored my discomfort with practitioners in the field that claim their position on decolonizing therapy, practice, and approaches, and lastly (4) propose other ways of knowing that can inform new ways of practicing therapy. The results of this research helped to problematize the language and use of decolonizing therapeutic practices while learning about other concepts that may be relevant yet distinct, such as principles of coloniality/decoloniality. Those of us, therapists or researchers, wanting to disrupt the current practice of therapy need to work together, share knowledge, and challenge each other, so that we can transform the way we practice as psychotherapists. This paper is my contribution to this conversation. Highlights: I interviewed racialized psychotherapists to learn how and if decolonization can be used in therapy.Traditional psychology can lead to ineffective mental health care for racialized communities.I propose other ways of knowing that can inform new therapy practices for racialized communities. [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]

Canada has one of the most complex and rigorous drug approval and public reimbursement processes and is, unfortunately, one of the countries with the longest delays in drug access. To assess the overall impact of systemic delays in access to cancer therapy, a targeted literature review (TLR) was performed to identify studies associated with the clinical, economic, and quality of life impacts of delayed access to oncology drugs. Using MEDLINE/PubMed databases and snowballing, four unique records met the eligibility criteria. Results revealed that clinical outcomes were the most impacted by systemic delays in access to oncology drugs (e.g., life years lost, overall survival, and progression-free survival). The four articles retrieved by the TLR specifically illustrated that a substantial number of life years could potentially be saved by increasing systemic efficiency regarding the development, approval, and reimbursement processes of new drugs for advanced malignancies. It is imperative that initiatives are put in place to improve the performance and speed of Canadian drug regulatory and health technology assessment (HTA) processes, especially for new cancer therapeutics. The proposed solutions in this paper include better coordination between HTA and Canadian payers to harmonize coverage decisions, international collaborations, information sharing, and national standards for timeliness in oncology drug access. [ABSTRACT FROM AUTHOR]

Family members are essential contributors to the quality of life (QoL) of persons living in residential long-term care (RLTC). This paper analyzes how the system enables or inhibits family involvement with residents in RLTC. Our analysis of 21 policies that regulate long-term care in four Canadian Provinces reveal differences in their portrayal of residents' families. Family roles are characterized procedurally (task-oriented) or relationally (interactive). Operational standards linked to licensing of RLTC homes employ more formal terminology, while RLTC program guidelines, use facilitative language to engage families and build relationships. Examples of orientation procedures, care protocols, living at risk, and end-of-life care reveal inter-provincial variations. We argue that there are opportunities to further engage families within the current regulatory framework and improve their continued contributions in the post-pandemic era. [ABSTRACT FROM AUTHOR]

Background: Moral distress is recognized as an international problem that contributes to decreased work productivity, job dissatisfaction and intent to leave for adult Critical Care nurses. Aim: To explore Critical Care nurses moral distress levels using the Moral Distress Scale Revised (MDS‐R) and its relationship with intention to stay. The study reported in this paper was part of a larger study that also investigated Critical Care nurses' work environment in Canada and the Midlands region of the UK. Study design: During January to August 2017 a cross‐sectional survey was distributed to adult Critical Care nurses in the Midlands region of the UK. Methods: Surveys were distributed to adult Critical Care Registered Nurses in the Midlands region of the UK examining moral distress levels and intention to stay in Critical Care, the organization (NHS Trust) and in the nursing profession. Results: Two hundred sixty‐six number of a potential sample of 1066 Critical Care nurses completed the survey (25% response rate). Age and moral distress were significantly positively correlated with intention to stay on their current unit (r = 0.16, P =.05), indicating older nurses were more likely to stay in the critical care unit. Moral distress was negatively correlated with intent to stay scores, showing critical care nurses with higher levels of moral distress were less likely to stay on their unit (r = −0.20, P =.02). Moral distress was also significantly negatively correlated with intention to stay with their current employer (r = −0.28, P <.001). Nurses that stated they had high rates of moral distress were more likely to consider leaving their current employer. Conclusion: Moral distress appears to be an issue among adult Critical Care nurses requiring further exploration and development of effective strategies to reduce this phenomenon and stabilize the workforce by reducing turnover. Relevance to clinical practice: By identifying the top causes of moral distress, tools and strategies can be developed to allow the Critical Care nurse to work within an ethically safe clinical environment and reduce the turnover of experienced adult Critical Care nurses. [ABSTRACT FROM AUTHOR]

The compassionate community movement as both a public health approach and a social model of care for various life stages is gaining traction in Canada and elsewhere. One example is the Windsor-Essex Compassion Care Community (WECCC), an evidence-based model and set of tools to improve the quality of life, health and wellness of vulnerable and aging populations by identifying and addressing upstream and downstream social and other risks to physical and mental health. This paper presents findings from the WECCC pilot evaluation. The WECCC initiative provided one-on-one volunteer-supported quality of life assessment, resource navigation and goals support program (Catalyzing Community Connections). This was augmented with public education sessions on social connection and loneliness (Importance of Being Connected) for the broader population. The RE-AIM framework was used to frame evaluation of WECCC through the first 4 years. Questionnaires were used to evaluate participant outcomes related to implementation and effectiveness. Interviews and focus groups were completed to understand impacts. From 2017 to 2020, WECCC has engaged over 2,500 individuals, 65 organizations and 400 volunteers combined in both programs. Nearly all (82% to 95%) participants reported positive changes to health, quality of life and/or social connections. This developmental phase of a compassionate community initiative has allowed piloting of an evaluation framework focusing on reach, adoption, implementation and early signals of effectiveness and maintenance. This demonstration provides information on feasibility, acceptability and potential impacts of this type of over-arching community initiative. [ABSTRACT FROM AUTHOR]

Background: Emotional blunting—inability to feel positive or negative emotions, detachment, or reduced emotional responsiveness—is common in people with depression. However, there is a paucity of studies comprehensively investigating this symptom and its functional impact. This study investigated the experience of emotional blunting, and its impact on overall functioning and quality of life, in the acute and remission phases of depression from the perspective of patients and healthcare providers. This paper presents data on the clinical presentation of emotional blunting in depression from the patient perspective. Methods: Cross-sectional, observational study conducted in Brazil, Canada, and Spain between April 15 and May 18, 2021. Data were collected via a self-completed online survey. Respondents were adults with depression (acute or remission phase), who were currently using a prescribed antidepressant, and who reported emotional blunting during the past 6 weeks. Emotional blunting was assessed using the Oxford Depression Questionnaire (ODQ; total score range 26–130, higher scores indicate greater emotional blunting). Results: In all, 752 patients completed the survey (62% female; mean age, 45 years). Overall, 44% of patients rated their emotional blunting as extremely severe (acute phase [n = 300], 72%; remission phase [n = 452], 25%; difference, p < 0.01). In all, 56% of patients considered their emotional blunting to be caused by their depression (acute phase, 62%; remission phase, 52%). Mean ODQ total score was 94.8 for patients in the acute phase of depression and 85.7 for those in remission (difference, p < 0.01). Mean score for the ODQ 'antidepressant as cause' domain (maximum possible score, 30) was 18.0 in patients in the acute phase and 17.6 in those in remission. Overall, 45% of patients believed that their antidepressant medication was blunting their emotions and 39% were considering stopping or had already stopped their antidepressant because of perceived emotion-related side effects. Conclusions: Almost three-quarters of patients in the acute phase of depression and one-quarter of those in remission reported severe emotional blunting. Approximately 56% of patients considered their emotional blunting to be caused by their depression, while 45% believed that their antidepressant medication was negatively affecting their emotions. Just over one-third of patients were considering stopping or had stopped their antidepressant as a result. [ABSTRACT FROM AUTHOR]

There has been a growing focus on healthy aging in the political agenda. Discourses contained within policy documents have the potential to shape our notions of healthy aging and well-being. This comprehensive critical document analysis of provincial aging policies in Newfoundland and Labrador (2006–2015) contributes to a larger research study exploring aging women's notions of health and the body in relation to the aging process. The findings highlight how healthy aging discourses focus on the concept of productivity and how a certain type of health is required for ongoing contribution. The paper concludes by arguing that if healthy aging is framed around one's ability to remain productive, notions of health will remain limited to an externalized measure of output versus subjective experience of well-being. [ABSTRACT FROM AUTHOR]

Background: Obsessive–Compulsive Disorder (OCD) is a psychiatric illness that can result in debilitating symptoms and functional impairment. Until recently, individuals with severe OCD symptoms have not received appropriate services within the Canadian healthcare system. The Frederick W. Thompson Anxiety Disorders Centre launched an Intensive Services Residential treatment programme for OCD in July 2017 to meet the needs of the Canadian population. This paper sets out to demonstrate the effectiveness of this programme. Methods: This study incorporated quantitative and qualitative data collection. Quantitative data were analysed using paired sample t-tests while qualitative data was transcribed and coded for emerging themes. Results: Beneficial changes in symptomatology were found. Client narrative emphasised the importance of exposure response prevention (ERP), creation of an OCD community as well as enhanced functionality in clients' lives. Clients also commented on why they believed the treatment worked and points of potential improvement for discharge planning and programme organisation. Conclusions: This study adds to the growing body of evidence regarding the importance of intensive services for individuals experiencing severe symptoms of OCD. Enhancing accessibility to services and ensuring ongoing maintenance of gains will be important next steps in ensuring long-term recovery for individuals with severe symptoms of OCD. Intensive services treatment for OCD has been found to be beneficial for clients and this paper demonstrates the first time this has been seen within a Canadian programme. Treatment provided decreased OCD severity and increased functionality and quality of life. Clients cited exposure and response prevention work as a key ingredient in their recovery. Our programme is always in an ongoing state of quality improvement, ensuring client engagement and satisfaction. [ABSTRACT FROM AUTHOR]

Participatory action research can be a research methodology that seeks to offer relational processes that develop high touch research relationships, create coempowerment, while fostering resiliency and strength, within the HIV community. The Calgary HIV Social Society (CHSS) in Calgary, Alberta, Canada co-developed with peer-researchers at Mount Royal University, a progressive form of action-oriented research that allowed the HIV community to develop and provide social gatherings to reduce the impact of stigma and isolation. The research project was developed with the community of people living with HIV to reduce the impact of isolation and stigma. The focus of the research was to better understand how social gatherings could improve the quality of life for those living with HIV. The action-oriented methodology allowed for HIV peer-researchers to bring their expertise on what was needed to reduce stigma and isolation. The HIV social support community created participatory action research processes that successfully contributed to building an inclusive, community for people living with HIV. This paper will share the themes that acknowledge the significant impact that a HIV high touch relationship research community can have for those, who face the barriers of isolation and stigma by increasing community connection, reducing financial constraints that limit participation, while increasing mental health wellness. [ABSTRACT FROM AUTHOR]

Introduction: Chronic pelvic pain (CPP) is a significant issue, and approximately 14% of women experience CPP once in their lifetime. While interdisciplinary pain management is considered the gold standard of treatment, few programs offer this type of treatment in Canada. The aims of this paper were to: 1) describe the development of an interdisciplinary CPP program; and 2) demonstrate changes in patient-related outcomes after attending an interdisciplinary CPP program. Methods: Referrals were received from community urologists and obstetricians/gynecologists, and pain physicians at the Michael G. DeGroote Pain Clinic. Patients attended an orientation session, completed an interdisciplinary assessment, and if appropriate, attended an eight-day interdisciplinary CPP program. Each day consisted of group-based pelvic floor physiotherapy, psychoeducation, goal-setting, cognitive behavioral therapy, and mindfulness. Psychometric questionnaires were completed pre- and post-program by patients, and paired sample t-tests were used to evaluate the changes in patient-related outcomes after attending the program. Results: Thirty-seven female patients completed the program, and results demonstrate that the CPP program was associated with significant improvements in impact of pelvic pain on quality of life, readiness for change, and pain-related self-efficacy, as well as decreases in pain catastrophizing and fear of pain/re-injury. Conclusions: CPP is a complex condition that requires interdisciplinary management and care. The results of this study demonstrate the short-term benefits of an interdisciplinary CPP program, highlight the unique needs of women with CPP, and implicate multiple factors for programming and treatment. [ABSTRACT FROM AUTHOR]

• This study examines a diverse range of life circumstances and outcomes for youth accessing homelessness services who have a history of involvement with child protection services. • Data presented is drawn from the 2019 Without a Home: The National Youth Homelessness Survey—which is the largest study ever conducted in Canada on youth homelessness (n = 1375). • This study presents risk factors that are likely to be associated with the first experience of homelessness, including adverse childhood experiences and involvement with child protection services. Youth leaving or being discharged from child protection services (CPS) are a particularly vulnerable population in Canada that could be at an increased risk of homelessness, which has many adverse consequences including declining physical and mental health, school disengagement, involvement with the justice system, and substance use disorders. In this paper, we examine the extent to which youth accessing homelessness services with a history of involvement with CPS differ from their peers who have not interacted with CPS using the 2019 Without a Home: The National Youth Homelessness Survey—which is by far the largest study ever administered in Canada on youth homelessness (n = 1375). This examination includes a diverse range of life circumstances and outcomes, including quality of life, relationships with friends and family, criminal records, education, and adverse childhood experiences (ACEs). Furthermore, controlling for demographic characteristics, we present risk factors that are likely to be correlated with youth homelessness, including ACEs and the CPS history, and conclude by discussing policy implications and proposing future research avenues. [ABSTRACT FROM AUTHOR]

Homelessness has negative implications for mental well-being and quality of life. This paper identifies the quality of life variables that contribute to positive or negative wellbeing, reporting on a regression analysis from 343 individuals experiencing homelessness in Canada. Results indicate that a lack of sleep duration and quality reduced mental well-being for both genders, not having access to food and/or hygiene facilities decreased men's well-being, and engaging in illegal subsistence strategies, such as selling drugs, negatively impacted women's mental well-being. For persons experiencing homelessness, mental well-being and quality-of-life are gendered outcomes of their limited access to social determinants of health. [ABSTRACT FROM AUTHOR]

Dental pain reduces a person's quality of life and constrains the ability to perform routine day-to-day activities, yet its distribution in society is inequitable and significantly shaped by the social determinants of health. This paper explores this social phenomenon of dental pain using John Rawls' conception of justice as fairness. Several key concepts in Rawls' framework are examined, including the implications for: a person's right to fair equality of opportunity; a person's sense of self-respect; and, the dental profession's social contract. We conclude that the current distribution of dental pain in Canada and the United States breaks with the principles set out in Rawls' conception of a just society. [ABSTRACT FROM AUTHOR]

Background: Since the early 90s, patient navigation programs were introduced in the United States to address inequitable access to cancer care. Programs have since expanded internationally and in scope. The goals of patient navigation programs are to: a) link patients and families to primary care services, specialist care, and community-based health and social services (CBHSS); b) provide more holistic patient-centred care; and, c) identify and resolve patient barriers to care. This paper fills a gap in knowledge to reveal what is known about motivators and factors influencing implementation and maintenance of patient navigation programs in primary care that link patients to CBHSS. It also reports on outcomes from these studies to help identify gaps in research that can inform future studies.Methods: This scoping literature review involved: i) electronic database searches; ii) a web site search; iii) a search of reference lists from literature reviews; and, iv) author follow up. It included papers from Canada, the United States, the United Kingdom, Australia, New Zealand, and/or Western Europe published between January 1990 and June 2013 if they discussed navigators or navigation programs in primary care settings that linked patients to CBHSS.Results: Of 34 papers, most originated in the United States (n = 29) while the remainder were from the United Kingdom, Canada and Australia. Motivators for initiating navigation programs were to: a) improve delivery of health and social care services; b) support and manage specific health needs or specific population needs, and; c) improve quality of life and wellbeing of patients. Eleven factors were found to influence implementation and maintenance of these patient navigation programs. These factors closely aligned with the Diffusion of Innovation in Service Organizations model, thus providing a theoretical foundation to support them. Various positive outcomes were reported for patients, providers and navigators, as well as the health and social care system, although they need to be considered with caution since the majority of studies were descriptive.Conclusions: This study contributes new knowledge that can inform the initiation and maintenance of primary care patient navigation programs that link patients with CBHSS. It also provides directions for future research. [ABSTRACT FROM AUTHOR]

Objective: To examine the impact and cost associated with mental illness. Methods: A rapid review of the literature from Australia, New Zealand, UK and Canada was undertaken. The review included literature pertaining to the cost-of-illness and impact of mental illness as well as any modelling studies. Included studies were categorised according to impact on education, labour force engagement, earlier retirement or welfare dependency. The well-accepted Drummond 10-point economic appraisal checklist was used to assess the quality of the studies. Results: A total of 45 methodologically diverse studies were included. The studies highlight the significant burden mental illness places on all facets of society, including individuals, families, workplaces and the wider economy. Mental illness results in a greater chance of leaving school early, a lower probability of gaining full-time employment and a reduced quality of life. Research from Canada suggests that the total economic costs associated with mental illness will increase six-fold over the next 30 years with costs likely to exceed A$2.8 trillion (based on 2015 Australian dollars). Conclusions: Mental illness is associated with a high economic burden. Further research is required to develop a better understanding of the trajectory and burden of mental illness so that resources can be directed towards cost-effective interventions. What is known about the topic?: Although mental illness continues to be one of the leading contributors to the burden of disease, there is limited information on the economic impact that mental illness imposes on individuals, families, workplaces and the wider economy. What does this paper add?: This review provides a summary of the economic impact and cost of mental illness. The included literature highlights the significant burden mental illness places on individuals, families, workplaces, society and the economy in general. The review identified several areas for improvement. For example, only limited information is available on the impact of attention deficit hyperactivity disorder, anxiety, cognitive function, conduct disorder, eating disorder and psychological distress. There was also a dearth of evidence on the intangible elements of pain and suffering of people and their families with depressive disorders. More research is required to better understand the full extent of the impact of mental illness and strategies that may be implemented to minimise this harm. What are the implications for practitioners?: Knowing the current and future impact of mental illness highlights the imperative to develop an effective policy response. [ABSTRACT FROM AUTHOR]

This is the second in a series of papers that deal with care-giving in Canada, as based on data available from the Canadian General Social Survey (2007). Building on the first paper, which reviewed the differences between short-term, long-term and end-of-life ( EOL) caregivers, this paper uniquely examines the caregiver supports employed by EOL caregivers when compared to non- EOL caregivers (short-term and long-term caregivers combined). Both papers employ data from Statistics Canada's General Social Survey ( GSS Cycle 21: 2007). The GSS includes three modules, where respondents were asked questions about the unpaid home care assistance that they had provided in the last 12 months to someone at EOL or with either a long-term health condition or a physical limitation. The objective of this research paper was to investigate the link between the impact of the care-giving experience and the caregiver supports received, while also examining the differences in these across EOL and non- EOL caregivers. By way of factor analysis and regression modelling, we examine differences between two types of caregivers: (i) EOL and (ii) non- EOL caregivers. The study revealed that with respect to socio-demographic characteristics, health outcomes and caregiver supports, EOL caregivers were consistently worse off. This suggests that although all non- EOL caregivers are experiencing negative impacts from their care-giving role, comparatively greater supports are needed for EOL caregivers. [ABSTRACT FROM AUTHOR]

Introduction: Quality of life is included in the economic evaluation of health services by measuring the preference for health states, i.e. health state utilities. However, most intervention studies include a disease-specific, not a utility, instrument. Consequently, there has been increasing use of statistical mapping algorithms which permit utilities to be estimated from a disease-specific instrument. The present paper provides such algorithms between the MacNew Heart Disease Quality of Life Questionnaire (MacNew) instrument and six multi-attribute utility (MAU) instruments, the Euroqol (EQ-5D), the Short Form 6D (SF-6D), the Health Utilities Index (HUI) 3, the Quality of Wellbeing (QWB), the 15D (15 Dimension) and the Assessment of Quality of Life (AQoL-8D). Methods: Heart disease patients and members of the healthy public were recruited from six countries. Non-parametric rank tests were used to compare subgroup utilities and MacNew scores. Mapping algorithms were estimated using three separate statistical techniques. Results: Mapping algorithms achieved a high degree of precision. Based on the mean absolute error and the intra class correlation the preferred mapping is MacNew into SF-6D or 15D. Using the R squared statistic the preferred mapping is MacNew into AQoL-8D. Implications for research: The algorithms reported in this paper enable MacNew data to be mapped into utilities predicted from any of six instruments. This permits studies which have included the MacNew to be used in cost utility analyses which, in turn, allows the comparison of services with interventions across the health system. [ABSTRACT FROM AUTHOR]

Background: Stroke survivors might perceive their quality of life (QoL) as being affected even years after onset. The purpose of this review was to go through the literature to identify factors related to QoL for persons with stroke in China and Western countries for possible similarities and differences in their respective cultural views. Method: A narrative literature review was conducted on the papers identified by searching PubMed, EBSCO/CINAHL, EMBASE, PsycINFO, China National Knowledge Infrastructure and Wanfang Data that published up to November 2016. Factors predicting QoL after stroke were extracted, and comparisons were made between Chinese and Western studies respecting cultural aspects. Results: A total of 43 articles were included in this review, with 31 conducted in Western countries and 12 in China. Predictors of QoL included Demographic factors: age, gender, marital status, education level, socioeconomic status; Clinically related factors: severity of stroke, physical function, depression/anxiety, cognitive impairment, incontinence and other comorbidities; Environmental factors: residential status, social support, social participation; and Individual factors: coping strategies and self‐perception. Being married and resident at home might be associated with the perception of QoL differently between Chinese and Western survivors. Conclusions: Most predictors of QoL in stroke survivors were the same in China and the Western countries. However, their QoL might be predicted differently regarding to the individualistic and collectivistic cultural differences. [ABSTRACT FROM AUTHOR]

Relatively little is yet known about employment readiness and elements that promote access to, and the retention of, employment for adults with autism spectrum disorder (ASD). This paper posits elements within the ecosystem of employment and ASD. The ecosystem approach locates employment among persons with ASD as inextricably linked with broader community resources, family support, workplace capacity building (e.g., employer, co-workers) and policy. Application of the approach is offered through process evaluation data yielded from an ecosystem-informed job readiness program entitled, 'Employment Works Canada'. Findings illustrate job readiness in the context of the broader ecosystem that envelopes salient components in the aim of community engagement and quality of life. Recommendations are offered for community-based applications and for program and research development. [ABSTRACT FROM AUTHOR]

Given that 'home' is the major physical-spatial environment of many older adults and that home, social and neighbourhood environments are well-recognised to impact both the ability to age in place and quality of life in this population, a better understanding of the nature of social interactions within seniors' communal living environments is critical for health promotion. This paper describes a two-phase participatory research study examining peer bullying by older adults conducted in April and May, 2016. Responding to needs expressed by tenants, the objectives of this study were to identify the nature, prevalence and consequences of peer bullying for tenants of two low-income senior apartment communities. In collaboration with the local Older Adult Abuse Task Force, a screening survey on bullying was distributed to all tenants. Findings (n = 49) indicated that 39% of tenants had witnessed peer bullying and 29% had experienced bullying by peers. An adapted version of a youth bullying survey was administered in follow-up face-toface interviews with 13 tenants. The most common forms of peer bullying were deliberate social exclusion and hurtful comments. The majority of respondents indicated that bullying was a problem for seniors and that bullies hurt other people. Outcomes of bullying included feelings of dejection and difficulties conducting everyday activities. [ABSTRACT FROM AUTHOR]

Background: Increased immigration requires successful interaction of different cultures in various life domains, such as health. This study investigates acculturation orientation (AO) of immigrant patients and doctors native to the country, as a potential factor related to perceived medical advice adherence.Data and Methods: N = 171 immigrant patients (M = 54.38 years, SD = 17.94, range = 23-96, 74.3 % female) and their N = 12 doctors (M = 38.88 years, SD = 13.42, range = 27-66, 83 % female) from a hospital in Montreal, Canada, participated in a paper-based survey to assess AOs, patients' perceived expectations of their doctor (regarding adopting the new culture or keeping their previous culture), doctors' actual expectations, perceived quality of care and perceived adherence.Results: AO of patients significantly related to perceived adherence, via a path model involving perceptions of doctors' expectations and perceived quality of care. Integration was positively related to perceived adherence, while Marginalization was negatively related to it. Doctors' AOs were not significant.Conclusion: Patient perceptions seem to be a significant factor to be considered when striving to improve immigrant medical advice adherence. [ABSTRACT FROM AUTHOR]

As modern technologies leverage medical sciences, life expectancy is on the rise in Canada, and indeed globally, with a remarkable increase in the elderly population in need of health care. The same is true of the diversity of cultural groups who are now patrons and stakeholders in Canada’s health care landscape. An emergent feature of this landscape is the complexity of contexts for negotiating and mediating medical care delivery at the end of life. This paper examines the gaps in regulatory and legal interventions as well as the gaps and opportunities to negotiate the transition to palliative care in cross-cultural contexts that have the potential to escalate as Canada’s domestic health care system increasingly engages with non-dominant segments of Canada’s cultural mosaic at the endof- life spectrum. It calls attention to the increased relevance of palliative care, identifying cross-cultural elements required for continuing and future elaboration of that care regime fully into the Canadian health care system. [ABSTRACT FROM AUTHOR]

Background: Increasing immigration in the world today leads to more intercultural interactions. This is a particularly crucial fact in doctor-patient relationships, which often become more complex and suboptimal within an intercultural context. Since acculturation is a particularly important factor in this process, and the doctor-patient relationship is a key component in patient health outcomes, this study investigates the interrelation of individual immigrant acculturation orientations with the quality of the doctor-immigrant patient relationship, the patients' perceived quality of care, and how this relates to immigrant health behaviours and quality of life of the patients.Methods: 171 immigrant patients of various backgrounds participated in a paper and pencil questionnaire to assess the role of acculturation orientations (AO) on patients' perceived expectations of their doctor, perceived quality of care (PQOC), health behaviours and quality of life. Data were analyzed using ANOVA, regression and correlation procedures with SPSS statistical software.Results: Significant correlations were found between all AOs and measures of the participant feeling connected to the host or home culture, thereby verifying the measure of AO. All four AOs were significantly interrelated directly with the patient's perception of what the doctor expects of him/her, and the patients' quality of life. Patients' perceived expectations of their doctors were significantly related to the patients' PQOC, and PQOC was associated with improved health behaviours (adherence to doctor recommendations, physical activity maintenance self-efficacy).Conclusions: AO may be an important factor in the doctor-immigrant patient relationship, via a complex process involving the patients' perceptions of doctors' expectations and perceived quality of care. This has important implications, since such an understanding can be used to create interventions for both doctors and immigrant patients to learn about their own AO, how it can relate to the quality of their relationship, and ultimately, the quality of care, health and quality of life of the patient. [ABSTRACT FROM AUTHOR]

Background: Aboriginal children experience challenges to their health and well-being, yet also have unique strengths. It has been difficult to accurately assess their health outcomes due to the lack of culturally relevant measures. The Aboriginal Children's Health and Well-Being Measure (ACHWM) was developed to address this gap. This paper describes the validity of the new measure.Methods: We recruited First Nations children from one First Nation reserve in Canada. Participants were asked to complete the ACHWM independently using a computer tablet. Participants also completed the PedsQL. The ACHWM total score and 4 Quadrant scores were expected to have a moderate correlation of between 0.4 and 0.6 with the parallel PedsQL total score, domains (scale scores), and summary scores.Results: Paired ACHWM and PedsQL scores were available for 48 participants. They had a mean age of 14.6 (range of 7 to 19) years and 60.4 % were girls. The Pearson's correlation between the total ACHWM score and a total PedsQL aggregate score was 0.52 (p = 0.0001). The correlations with the Physical Health Summary Scores and the Psychosocial Health Summary Scores were slightly lower range (r = 0.35 p = 0.016; and r = 0.51 p = 0.0002 respectively) and approached the expected range. The ACHWM Quadrant scores were moderately correlated with the parallel PedsQL domains ranging from r = 0.45 to r = 0.64 (p ≤ 0.001). The Spiritual Quadrant of the ACHWM did not have a parallel domain in the PedsQL.Conclusions: These results establish the validity of the ACHWM. The children gave this measure an Ojibway name, Aaniish Naa Gegii, meaning "how are you?". This measure is now ready for implementation, and will contribute to a better understanding of the health of Aboriginal children. [ABSTRACT FROM AUTHOR]

Background: Speech and language therapists can improve the quality of life of people receiving palliative care through the management of communication and swallowing difficulties (dysphagia). However, their role in this domain is poorly defined and little is understood about the current international professional practice in this field. Aims: To examine how speech and language therapists perceive their role in the delivery of palliative care to clients, to discover current international speech and language therapist practices and to explore the similarities and differences in speech and language therapists’ practice in palliative care internationally. This will inform professional clinical guidelines and practice in this area.Design:Anonymous, non-experimental, cross-sectional survey design.Participants:Speech and language therapists working with adult and paediatric palliative care populations in Republic of Ireland, United Kingdom, United States, Canada, Australia and New Zealand where the speech and language therapist profession is well established. Method: Purposive and snowball sampling were used to recruit participants internationally using gatekeepers. An online survey was disseminated using Survey Monkey (http://www.surveymonkey.com). Results: A total of 322 speech and language therapists responded to the survey. Speech and language therapist practices in palliative care were similar across continents. Current speech and language therapist practices along with barriers and facilitators to practice were identified. The need for a speech and language therapist professional position paper on this topic was emphasised by respondents. Conclusion: Internationally, speech and language therapists believe they have a role in palliative care. The speech and language therapist respondents highlighted that this area of practice is under-resourced, under-acknowledged and poorly developed. They highlighted the need for additional research as well as specialist training and education for speech and language therapists and other multidisciplinary team members in the area of palliative care. [ABSTRACT FROM AUTHOR]

Aims A discussion of the extent to which people with dementia's perspectives on quality of life have been included in quantitative research. Background Capturing the perspective of people with dementia may improve understanding of their quality of life. Quantitative tools to assess quality of life exist, but the extent to which these reflect the perspective of people with dementia has not been evaluated. Design A discussion paper. Data sources Ten tools (designed between 1992-2012) to measure quality of life from the perspective of people with dementia were located from existing reviews. Discussion Each tool was rated according to the extent to which the developers included the perspectives of people with dementia at three different points of quality of life conceptualization: during quality of life assessment, to identify quality of life domains and to define an overall conceptual framework. This analysis demonstrates that tool developers were inconsistent in their approach to including the perspectives of people with dementia to understand quality of life. The perspective of people with dementia was included primarily to assess, but not to select domains or define overall quality of life. Implications for nursing Nurses should consider not only who assesses quality of life, but also whose understanding of quality of life is being assessed. Conclusion It is unclear whether the quantitative quality of life literature reflects the perspective of people with dementia. Debate is needed regarding the impact of this issue on the lives of people with dementia. [ABSTRACT FROM AUTHOR]

Objectives: The reported prevalence of vestibular dysfunction after cochlear implantation (CI) is varies between different scientific papers. The aim of this study is to determine the reported postimplantation outcome in terms of dizziness, and to measure its impact on quality of life using the Dizziness handicap inventory (DHI). Methods: This was a prospective questionnaire based study of postoperative cochlear implant patients. The questionnaire assessed the type and onset of dizziness in addition to the DHI. Results: 122 patients were recruited in this study, which is the largest sample size in the literature reported so far. Dizziness was evident in 45.9% of the population post-CI and in 27% pre-CI. The commonest subtype of the dizziness was unsteadiness followed by lightheadedness. The dizziness was mild in most of the patients. Conclusion: Although mild, dizziness is a common complaint post-cochlear implantation. An understanding of symptoms helps counsel patients preoperatively. [ABSTRACT FROM AUTHOR]

Assisted suicide and euthanasia have long been contentious issues worldwide. Views vary depending on a number of considerations including autonomy, the "vulnerability" of the population in question, and sanctity vs. quality of life. The groundbreaking 2012 Supreme Court of British Columbia case Carter v. Canada struck down Section 241 (b) of the Criminal Code of Canada that makes assisted suicide illegal. This decision is currently under appeal by the defence, which fears that "vulnerable populations" will be in danger of being coerced into using the right to request physician-assisted suicide. This paper examines one approach to the moral and legal justifications for the decision of the Supreme Court of B.C. and provides a model for the implementation of legally assisted suicide that Canada could follow. The model examined is the model used in the Netherlands, which has stringent procedures in place to ensure that those requesting physician-assisted suicide are not coerced into or in the wrong mental state when making their decision. [ABSTRACT FROM AUTHOR]

This paper addresses the gap in research on the social dimensions of refugee resettlement. This is accomplished by examining refugee belonging and definitions of "integration" through a case study of Acehnese refugees resettled in Vancouver, British Columbia, between 2004 and 2006. We analyze findings based on a survey and in-depth interviews conducted five years after resettlement. Our findings suggest that recently resettled groups like the Acehnese, who are "new and few," face specific integration challenges. Importantly, the lengthy timelines to enact sponsorship of a spouse and/or family reunification from Aceh unwittingly inhibit the social integration of the sponsors waiting in Canada. [ABSTRACT FROM AUTHOR]

• Highlights diverse lived experiences of smart city planning and redevelopment. • Responds to calls to enhance inclusion & accessible dialogue in smart city discourse. • One of few papers to use CAP & research vignettes in urban planning research. • Contributes novel approach to representing diverse lived experiences of urban change. • Focuses on the needs of local people in the pursuit of knowledge-based development. The "smart city" is a set of policies and programs that aim to increase the efficiency and effectiveness of municipal services, encourage urban (re)development, facilitate private investment, and improve quality of life through investing in information and communication technologies. Yet critics contend that the benefits of investment and (re)development programs are not shared equally and there is need for better understanding diverse lived experiences of community members. This paper highlights local voices and lived experiences amid physical and social change in downtown Kitchener, Ontario, Canada, a city that is actively pursuing a smart city agenda. Drawing on data collected from a community workshop that included representatives from local government, technology and start-up sectors, community service providers, and community activists, we adopt a Creative Analytic Practice (CAP) approach and present a set of hybrid vignettes centered on the experiences of these stakeholder groups. The vignettes highlight differing expectations for the role of technology in promoting quality of life and illustrate a struggle to translate aspirations for collaboration and equity into on-the-ground action. We argue that CAP is an effective tool for presenting and enhancing the inclusiveness and accessibility of smart city discussions and debates. [ABSTRACT FROM AUTHOR]

The social and cultural dimensions of arctic environmental change were explored through Canada's International Polar Year (IPY) research program. Drawing on concepts of vulnerability, resilience and human security, we discuss preliminary results of 15 IPY research projects (of 52) which dealt with the effects and responses of northern communities to issues of ecological variability, natural resource development and climate change. This paper attempts to determine whether the preliminary results of these projects have contributed to the IPY program goal of building knowledge about well-being in the arctic. The projects were diverse in focus and approach but together offer a valuable pan-northern perspective on many themes including land and resource use, food security, poverty and best practices of northern engagement. Case study research using self-reported measures suggests individual views of their own well-being differ from regional and territorial standardized statistics on quality of life. A large body of work was developed around changes in land and resource use. A decline in land and resource use in some areas and consequent concerns for food security, are directly linked to the effects of climate change, particularly in coastal areas where melting sea ice, erratic weather events and changes in the stability of landscapes (e.g., erosion, slumping) are leading to increased risks for land users. Natural resource development, while creating some new economic opportunities, may be compounding rather than offsetting such stresses of environmental change for vulnerable populations. While the IPY program has contributed to our understanding of some aspects of well-being in the arctic, many other issues of social, economic, cultural and political significance, including those unrelated to environmental change, remain poorly understood. [ABSTRACT FROM AUTHOR]

Recognizing that older adults are among the biggest consumers of medication, and the demographic group most likely to suffer an adverse drug reaction (ADR), this paper details the findings from a recent study on how older adults come to understand medication and its related use. Using a qualitative content analysis method, semi-structured interviews were conducted with 21 individuals from British Columbia, Canada. Study participants ranged in age from 65 to 89 years (male=9, female=11). Using NVIVO† 7 software, data were subjected to comparative thematic content analysis in an effort to capture the role of medication use in the context of everyday living as understood by older adults. While there was variability in how older adults come to understand their medication use, an overarching theme was revealed whereby most participants identified their prescription medications as being life-sustaining and prolonging. Deeper thematic content analysis of participant narratives drew attention to three key areas: (A) medications are viewed as a necessary, often unquestioned, aspect of day-to-day life (B) a relationship is perceived to exist between the amount of medications taken and ones current state of health (C) the overall medication experience is positively or negatively influenced by the doctor patient relationship and the assumption that it is the physicians role to communicate medication information that will support everyday living. The article concludes that medical authority and the complexities surrounding medication use need to undergo significant revision if community dwelling older adults are to experience greater success in safely managing their health and medication-related needs. [ABSTRACT FROM AUTHOR]

This study describes predictors of secondary traumatic stress and burnout in a national sample of helping professionals, with a specific focus on the unique responses of child welfare (CW) workers. Specific worker and exposure characteristics are examined as possible predictors of these forms of occupational distress in a sample of 669 professionals from across the country who responded to mailed (e-mail and post) invitations to participate in an online survey. Email and home mailing addresses were secured from licensure boards and professional membership organizations in six states from across the country that had high rates of child related deaths in 2009. Respondents completed the Professional Quality of Life IV (Stamm, 2005) to ascertain compassion fatigue (CF) and burnout symptoms. Being male, young, Hispanic, holding rural residence, and endorsing a lack of religious participation were significant predictors of secondary traumatic stress. Similarly, being male and young predicted high burnout rates, while actively participating in religious services predicted lower burnout. CW worker job status as a professional was significantly more likely to predict CF and burnout compared to all other types of behavioral healthcare professionals. Based on the findings from this study, this paper proposes strategies for enhancing self-care for CW workers, and describes the essential elements of a trauma-informed CW agency that addresses secondary traumatic stress and burnout. [ABSTRACT FROM AUTHOR]

The purpose of this paper was to report the physical activity and health outcomes results from the Physical Activity Counselling (PAC) trial. Patients ( n = 120, mean age 47.3 ± 11.1 years, 69.2% female) who reported less than 150 min of physical activity per week were recruited from a large community-based Canadian primary care practice. After receiving brief physical activity counselling from their provider, they were randomized to receive 6 additional patient-centered counselling sessions over 3 months from a physical activity counsellor (intensive-counselling group; n = 61), or no further intervention (brief-counselling group; n = 59). Physical activity (self-reported and accelerometer) was measured every 6 weeks up to 25 weeks (12 weeks postintervention). Quality of life was also assessed, and physical and metabolic outcomes were evaluated in a randomly selected subset of patients (33%). In the intent-to-treat analyses of covariance, the intensive-counselling group self-reported significantly higher levels of physical activity at 6 weeks ( p = 0.009) and 13 weeks ( p = 0.01). There were no differences in self-reported physical activity between the groups after the intervention in the follow-up period, nor was there any increase in accelerometer-measured physical activity. Finally, the intensive-counselling patients showed greater decreases in percent body fat and total fat mass from 13 weeks to 25 weeks. Results for physical activity depended on the method used, with positive short-term results with self-report and no effects with the accelerometers. Between-group differences were found for body composition in that the intensive-counselling patients decreased more. A multisite randomized controlled trial with a longer intensive intervention and follow-up is warranted. [ABSTRACT FROM AUTHOR]

This paper presents a study of prenatal screening educational materials that uses metaphoric textual analysis to critically examine implicit messages in the educational resources. In Canada, the Clinical Practice Guideline on prenatal screening explicitly states that counselling about prenatal screening should be non-directive, promote choice, and be respectful of the needs and quality of life of people with disabilities. This study examines whether the written public education materials available to Canadian women are consistent with these aims. Findings from the prenatal screening patient education pamphlets are presented, and prominent figurative and metaphoric language identified in the educational resources is highlighted. The discussion considers the ways in which the education pamphlets may communicate subtle messages to women, and offers considerations for the design of non-directive prenatal screening educational materials. In addition, the discussion considers the ways in which metaphor analysis can foster critical reflection and reveal insights important for the design of educational materials in health care. [ABSTRACT FROM AUTHOR]

Social capital has been a key framework in conceptualizing the place of social ties in quality of life. Families have not been among groups of interest in social capital research. Yet within the context of research and public policy on aging, the contemporary discourse on families and care is congruent with social capital assumptions. In this paper, we draw on social capital literature to frame our understanding of the social capital inherent in families of frail older adults, and hypothesize their abilities to benefit family members. Data are drawn from Statistics Canada 2002 General Social Survey on Aging and Social Support. [ABSTRACT FROM AUTHOR]

Study aims were to develop and assess the measurement properties of a four-part treatment satisfaction measure for patients with asthma. The Asthma Treatment Satisfaction Measure (ATSM) incorporates specific attributes representing patient expectations, treatment preferences, self-reported treatment outcomes, and overall treatment satisfaction. This paper describes patients' ability to detect change in their satisfaction with asthma therapies using the ATSM. Adult patients with chronic asthma requiring a change in their asthma controller medications were recruited from sites in the US and Canada. Interviews were conducted with 22 patients to elicit areas important to patients in asthma treatment for measurement of satisfaction, providing the basis for the four-part questionnaire that was then tested for clarity. An additional 105 patients participated in the validation study and completed the first two parts of the ATSM (expectations and importance of treatment) at their initial visit (baseline) prior to a change in treatment. Parts 3 and 4 (treatment outcomes and treatment satisfaction) were completed after 4 weeks on the new treatment. A daily diary was completed by patients at home between visits. During clinical visits, patients also completed the Asthma Specific Quality of Life Questionnaire Standardized version assessing HRQL (AQLQ(S)), the Asthma Control Questionnaire 6-item version (ACQ-6), a 9-item asthma symptom checklist, items assessing symptom severity, and a single item overall rating of satisfaction (numerical analog scale between 0 and 10). Derived total satisfaction scores were compared to scores produced by the single global treatment satisfaction item using score variation and distribution plots. Qualitative results identified 11 key attributes of asthma treatment. Internal consistency for the expectations, outcomes, and satisfaction parts of the measures (11 items each) were 0.73, 0.82 and 0.95, respectively. ATSM scores were able to discriminate between control and lack of control measured by ACQ-6 scores (F = 30.09; p < 0.001); between improvement, no change, or worsening of symptoms using the 4-week diary (F = 7.05; p < 0.001); between mild, moderate and severe levels of self-reported severity of asthma (F = 2.07; p < 0.001); and levels of self-reported health status (F = 5.96; p < 0.001). Compared to the single overall satisfaction item, the ATSM satisfaction score demonstrated a broader and more normal distribution. Irrespective of the variety of treatment regimens being changed from and changed to in the normal care setting, 4 of the 11 attributes still detected statistically significant differences in (p < 0.05) levels of patient satisfaction related to their new asthma treatment regimen. By augmenting a satisfaction rating with the constructs that help define satisfaction with treatment (expectation, importance and actual treatment experience), the ATSM scores demonstrated greater ability to detect changes in treatment and provide a potentially useful measurement system for pharmacologic evaluation. This study was conducted using a normal care setting to identify patients undergoing a change in treatment. Therefore, the main limitations were the inability to control for efficacy of treatment, and a relatively small sample. Several individual ATSM satisfaction scores were able to detect significant levels of patient satisfaction related to their treatment, while the global satisfaction scores were unable to detect any significant differences. [ABSTRACT FROM AUTHOR]

Objectives. The objectives of the current paper are to address the timing of declines in health after arrival in the host country, and to document differences in health status by immigrant arrival group (economic immigrants, family reunification, and refugees). Design. Statistics Canada's Longitudinal Survey of Immigrants to Canada captures health and other attributes of a cohort of immigrant arrivals to Canada at six months, two years, and four years after arrival. Descriptive and multivariate methods are applied to this data file in order to ascertain changes in health status in the period immediately after arrival. Results. Significant declines in health status are noted within as little as two years post-arrival. In addition, refugees are observed to have lower levels of health and are more likely to transition to a state of poor health, while economic immigrants report the highest levels of self-assessed health. Conclusion. The health status of new arrivals, measured by self-assessed health, physical health, and mental health, declines quickly after arrival. Refugees generally experience the lowest levels of health. [ABSTRACT FROM AUTHOR]

Abstract: Information-rich environments in Canada, Australia, and the United Kingdom have been built using record linkage techniques with population-based health insurance systems and longitudinal administrative data. This paper discusses the issues in extending population-based administrative data from health to additional topics more generally connected with well being. The scope of work associated with a multi-faceted American survey, the Panel Study in Income Dynamics (PSID), is compared with that of the administrative data in Manitoba, Canada. Both the PSID and the Manitoba database go back over 30 years, include families, and have good information on residential location. The PSID has emphasized research design to maximize the opportunities associated with expensive primary data collection. Information-rich environments such as that in Manitoba depend on registries and record linkage to increase the range of variables available for analysis. Using new databases on education and income assistance to provide information on the whole Manitoba population has involved linking files while preserving privacy, scaling educational achievement, assessing exposure to a given neighborhood, and measuring family circumstances. Questions being studied concern the role of the socioeconomic gradient and infant health in child development, the comparative influence of family and neighborhood in later well being, and the long-term effects of poverty reduction. Issues of organization of research, gaps in the data, and productivity are discussed. [Copyright &y& Elsevier]

The literature suggests that the foreign-born, and especially recent arrivals, enjoy better health than their Canadian-born counterparts, as measured by a number of health outcomes including self-assessed health and chronic conditions. Using data drawn from Statistics Canada's longitudinal National Population Health Survey (NPHS), the paper evaluates the so-called ‘healthy immigrant effect’ with respect to chronic conditions. Specifically, it evaluates the presence, number and type of chronic conditions (heart disease, asthma, arthritis, diabetes) within the immigrant population, with comparisons made to the native-born population. Native- and foreign-born prevalence rates for chronic conditions are also age–sex standardised to aid comparison. Evidence from both descriptive and multivariate analysis supports the healthy immigrant effect with respect to chronic conditions. Strong evidence of health disparities across arrival cohorts is also found. [ABSTRACT FROM AUTHOR]

This paper argues that the well-being of all Canadians will be increased by policies that make it easier for individuals to smooth their labour supply more evenly over the life cycle. However, if working longer is to represent an improvement in individual well-being, it must be due to choice, not necessity. The past decade has seen a substantial increase in the lifetime risk exposure of Canadian workers. Since one must expect that this will increase the fraction of future cohorts who arrive at 65 without a private pension or appreciable retirement savings, welfare improving policies to even out labour supply over the life cycle should be complemented by reforms to Employment Insurance to help individuals even out income fluctuations during their working years. [ABSTRACT FROM AUTHOR]

This paper presents an account of the experience of South Asian women of Pakistani descent who have immigrated to Canada within the last year. The purpose of the study was to explore the quality of life and personal stresses and strains that follow immigration to a different culture. Seven immigrant women from the Greater Toronto Area (GTA) were interviewed about their experiences of immigrating with their families to Toronto. The interviews were then subjected to a qualitative analysis based on the principles of grounded theory. The findings outline the goals and expectations these immigrants hoped to achieve and highlight the losses, pains and hardships they went through in the pursuit of these goals. A four-stage model of the women's experience of immigration to Canada is presented. [ABSTRACT FROM AUTHOR]

Although there is a large body of research dedicated to exploring public attributions for poverty, considerably less attention has been directed to public understandings about the effects of poverty. In this paper, we describe lay understandings of the effects of poverty and the factors that potentially influence these perceptions, using data from a telephone survey conducted in 2002 on a random sample ( n = 1671) of adults from eight neighbourhoods in two large Canadian cities (Edmonton and Toronto). These data were supplemented with interview data obtained from 153 people living in these same neighbourhoods. Multivariate linear and logistic regressions were used to determine the effects of basic demographic variables, exposure to poverty and attribution for poverty on three dependent variables relating to the effects of poverty: participation in community life, the relationship between poverty and health and challenges facing low-income people. Ninety-one per cent of survey respondents agreed that poverty is linked to health, while 68% agreed that low-income people are less likely to participate in community life. Affordable housing was deemed especially difficult to obtain by 96%, but other resources (obtaining healthy food, giving children a good start in life, and engaging in healthy behaviours) were also viewed as challenging by at least 70% of respondents. The regression models revealed that when controlling for demographics, exposure to poverty explained some of the variance in recognising the effects of poverty. Media exposure positively influenced recognition of the poverty–health link, and attending formal talks was strongly related to understanding challenges of poverty. Attributions for poverty accounted for slightly more of the variance in the dependent variables. Specifically, structural and sociocultural attributions predicted greater recognition of the effects of poverty, in particular the challenges of poverty, while individualistic attributions predicted less recognition. Older and female respondents were more likely to acknowledge the effects of poverty. Income was positively associated with recognition of the poverty–health link, negatively associated with understanding the challenges of low-income people, and unrelated to perceptions of the negative effect of poverty on participation in community life. [ABSTRACT FROM AUTHOR]

In this paper we connect existing work on rooming houses to literature dealing with the meaningful nature of ‘home’ and its impact on individuals' health and social well-being. We then examine the extent to which rooming houses provide low-income tenants with ‘homes’, drawing from in-depth interviews with rooming-house tenants living in Hamilton, a city of 450000 people in southern Ontario, Canada. Our analysis raises concerns about the capacity of rooming houses to provide affordable and stable accommodation. Poor living conditions and poor relations with rooming-house landlords worked directly against the capacity of rooms to offer private, controllable spaces and a degree of ontological security. Analysis also raised concerns about rooming houses as sites for social relations. Many respondents saw rooming houses as unpredictable and sometimes unhealthy social spaces, forcing them to seek other environments to cultivate and sustain relationships with friends and family. In general, respondents' experiences point to the shortcomings of rooming houses as ‘home’ environments, with implications for the health and social lives of the tenant population. Conceptual and policy implications are discussed in conclusion. [ABSTRACT FROM AUTHOR]

The well-being of residents of resource dependent communities is a question of traditional interest to rural sociologists. The label "resource dependent" obscures how this relationship may vary between particular resource industries, regions, or indicators of well-being. Few analyses have compared the relationship between well-being and resource dependence across different industries, nor tested competing theories about the relationship between resource dependence and well-being. Our paper presents an overview of the relationship between resource dependence— agriculture, fisheries, mining, energy, forestry—and human well-being in Canada. Analysis of 1996 Statistics Canada data revealed a great deal of variation in the effect of "resource" dependence on indicators of well-being (e.g., human capital, unemployment, income): some industries exhibit fairly positive outcomes (e.g., agriculture), others more negative outcomes (e.g., fishing). Consistent with analyses conducted in the United States, these relationships vary by region, suggesting the need for models that incorporate the particulars of place and industry. [ABSTRACT FROM AUTHOR]

During early 1997, after focus groups, interviews and a mail survey were administered to a random sample of Grand River watershed dairy farmer in the Grand River watershed of southwestern Ontario. This paper summarizes the main results of the study. We concluded that these farmers have achieved a very good average quality of life. Their farming systems display good productivity, excellent viability and stability and moderate average environmental protection-all important elements of sustainability. This is mainly because they have steady incomes as a result of their supply managed system, excellent cattle genetics, strong family relationships and spirituality. If they had to leave their dairy farms they would miss the open space and country living more than anything else. There is some concern that international free trade agreements may threaten supply management to which the majority attribute their stable and reasonably good incomes. Environmental protection may also be at risk for many dairy farmers. For instance, their present manure management system is a limiting factor preventing as many as a third of them from expanding their herds in addition to such other barriers as the high price that they must pay for the milk quota that they must purchase. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to examine the utilisation of HR-QOL information by US and Canadian federal regulatory bodies, with a focus on pre- and postmarket product review processes. There are a number of challenges facing regulators in using HR-QOL data derived from clinical trials and/or pharmacoeconomic analyses. Some of these challenges are inherent to HR-QOL tools and methodologies, while others relate to their inappropriate application in clinical studies. Regulators also need to take some responsibility for the chasm that exists between the potential and the reality of the contribution of HR-QOL information in decision making. Federal regulators need to develop and promulgate clear guidances that will help improve the quality and validity of studies submitted for review, and greater transparency is needed in terms of how such information is used in the product review process. Advances in technology are sure to increase the volume and complexity of HR-QOL information collected within clinical trials, and regulators need to prepare themselves to address this influx of data. Key actions are proposed to improve both the credibility as well as the uptake of HR-QOL information within the regulatory process so that this important source of information can be used appropriately and to its full potential. [ABSTRACT FROM AUTHOR]

The Health Utilities Index Mark 3 (HUI3) is a multi-dimensional, preference-based measure of health status and health-related quality of life (HRQoL). HUI3 scores correlate strongly with self-ratings of health status and functional disability and vary according to age, gender and occupation. In comparative studies relating to HRQoL, it is necessary to carry out adjusted comparison of the health status of the different groups. taking into account unbalanced distribution of confounding variables. This paper describes a stratification method to adjust the distributions of HUI3 scores. This method provides a graphical representation of adjusted distribution of HUI3, which can also be used to adjust other HRQoL scores. Cross-sectional data from the 1998/1999 National Population Health Survey (NPHS) in Canada were used to verify the proposed method. Male agriculture workers and male construction workers in Canada had quite different age distributions but similar HUI3 distributions. After adjusting the age distribution of the construction group to match the distribution of agriculture group, the mean HUI3 score of the former significantly decreased. [ABSTRACT FROM AUTHOR]