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Objectives Due to their medical and technology dependence, families of children with medical complexity (CMC) have significant costs associated with care. Financial impact on families in general have been described, but detailed exploration of expenses in specific categories has not been systematically explored. Our objective was to describe out-of-pocket (OOP) expenses incurred by caregivers of CMC and to determine factors associated with increased expenditures. Methods This is a secondary observational analysis of data primary caregiver-reported OOP expenses as part of a randomized control trial conducted in Ontario, Canada. Caregivers completed questionnaires reporting OOP costs. Descriptive statistics were utilized to report OOP expenses and a linear regression model was conducted. Results 107 primary caregivers of CMC were included. The median (IQR) age of participants was 34.5 years (30.5 to 40.5) and 83.2% identified as the mother. The majority were married or common-law (86.9%) and 50.5% were employed. The participant's children [median (IQR) age 4.5 (2.2 to 9.7); 57.9% male] most commonly had a neurological/neuromuscular primary diagnosis (46.1%) and 88% utilized medical technology. Total OOP expenses were $8,639 CDN annually (IQR = $4,661 to $31,326) with substantial expenses related to childcare/homemaking, travel to appointments, hospitalizations, and device costs. No factors associated with greater likelihood of OOP expenses were identified. A P-value of <0.05 was considered significant. Conclusion Caregivers of CMC incur significant OOP expenses related to the care of their children resulting in financial burden. Future exploration of the financial impact on caregiver productivity, employment, and identification of resources to mitigate OOP expenses will be important for this patient population. [ABSTRACT FROM AUTHOR]

Objectives Pain affects all children and youth, yet acute and procedural pain remains undertreated in Canadian hospitals. To improve pain management practices in paediatric hospitals, it is necessary to understand how healthcare professionals (HCPs) wish for educational interventions to be designed to improve their pain management practice. Methods Semi-structured interviews were conducted with 18 HCPs between October and December 2020. Snowball sampling was used to first recruit interested members from the hospital's Pediatric Pain Management Committee. Interviews were conducted per participant preference and included Zoom, telephone, and in-person interviews. Recruitment ceased when data were determined sufficiently rich. A thematic analysis of verbatim transcripts and reflexive field notes were used to create a data set focused on knowledge mobilization and clinical education. Results Three core themes were identified: (a) the necessity for just-in-time education for HCPs; (b) the availability of clinical pain champions to educate staff; and (c) the provision of resources to educate children and their families about available pain management interventions. Just-in-time education included suggestions for in-service training, hands-on training, and regular updates on the latest research. Pain champions, including clinical nurse educators, were stressed as being important in motivating staff to improve their pain management practices. Participants noted the lack of resources for patient and family education on pain management and suggested providing more multimodal resources and educational opportunities. Conclusion Having local champions introduce pain management initiatives and just-in-time education positively impacts the implementation climate, which also helps HCPs provide evidence-based education and resources to patients and families. [ABSTRACT FROM AUTHOR]

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This study examined the relationship between having a child with a disability or developmental delay and early impacts of the COVID-19 pandemic on family environments that influenced early childhood development and health in the Maritime provinces of Canada. This was a mixed method cross-sectional survey involving 256 primary caregivers of children with disabilities or developmental delays and 1720 primary caregivers of typically developing children aged 0–8 years. A Family access to resources and social support, parenting Abilities and self-care, and home Routines and Environments change scale (FARE Change Scale) was produced from the survey to assess the early impacts of the pandemic on family environments that influenced early childhood development and health. Open-ended questions provided in-depth description of the early impacts of the pandemic on family environments. Pooled bivariate and multivariate regression coefficients revealed that having a child with a disability or developmental delay significantly decreased a caregiver's score on the FARE Change Scale by 1.95. The open-ended questions were thematically analyzed. Caregivers of children with disabilities or developmental delays discussed positive and negative impacts of the pandemic on their family environments. Overall, the study findings indicate that the early impacts of the pandemic on family environments that influenced early childhood development and health of children with disabilities or developmental delays were mixed and context-specific. The study findings inform the development of context-specific policies and programs to adequately support families of children with disabilities or developmental delays in public health crises similar to the pandemic. Highlights: Early impacts of the pandemic on families of children with disabilities or developmental delays in the Maritime provinces of Canada were mixed and context-specific. Measures to mitigate public health crises similar to the pandemic should take into consideration the needs of families of children with disabilities or developmental delays. Positive experiences associated with the pandemic discussed by some families in our study offer important directions to adequately address some unmet needs that families experienced before the pandemic into the future. [ABSTRACT FROM AUTHOR]

Objective: Acute agitation in pediatrics is commonly encountered in hospital settings, can contribute to significant physical and psychological distress, and management is highly varied in practice. As such, the development of a standardized pharmacologic guideline is paramount. We aimed to develop a novel clinical pathway (CP) for management of acute agitation for all hospitalized pediatric patients in Canada. Methods: Healthcare professionals in Canada with expertise in treating and managing pediatric agitation formed a working group and developed a CP through conducting a literature review, engaging key partners, and obtaining interdisciplinary consensus (iterative real-time discussions with content experts). Once developed, the preliminary CP was presented to additional internal and external partners via multiple grand rounds and a webinar; feedback from participants guided final CP revisions. Results: The working group created a pediatric inpatient CP to guide pharmacologic management of agitation and serve as an easy-to-use clinical and educational resource with three complementary sections including: 1) a treatment algorithm, 2) a quick reference medication chart, and 3) two supporting documents, which provide a general overview of non-pharmacologic strategies prior to CP implementation and an illustrative scenario to accompany the medication chart to ensure effective utilization. Conclusions: This is the first CP to standardize pharmacological treatment and management of acute agitation in children in inpatient settings in Canada. Although further research is warranted to assess implementation and support process improvement, the CP can be adapted by individual institutions to assist in prompt pharmacological management of pediatric agitation to potentially improve outcomes for patients, families, and healthcare professionals. [ABSTRACT FROM AUTHOR]

Objective: This study explores the perspectives of parents in open or polyamorous relationships with regards to challenges and benefits of practicing consensual non‐monogamy (CNM). Background: Studies show that about one in five people, both in Canada and the United States, have been involved in a CNM relationship in their lifetime, a proportion that is even higher among today's young adults. While we know that many of those people have children, little research has focused on the experiences of parents practicing CNM. Method: This article begins to fill this gap, drawing on 34 individual semi‐structured interviews with Canadian parents involved in CNM relationships and their partners. The author explores the benefits and challenges associated with raising children in the context of CNM, as experienced by the participants. Results: The vast majority of participants argued that the benefits of being polyamorous or in an open relationship considerably outweighed the difficulties they encountered. Six overarching themes emerged from the participants' discourses, namely: (1) social acceptance and legal protection, (2) coming out to children, (3) time management, (4) reconciling family obligations and personal needs, (5) it takes a village to raise children, and (6) teaching important values to children. Conclusion: Ultimately, this study shows that parents practicing CNM perceive their relationship model as mostly beneficial for themselves, as parents, and for their family. [ABSTRACT FROM AUTHOR]

Numerous studies have examined associations between sociodemographic characteristics and attitudes toward premarital sex and, more recently, toward casual sex. However, no recent study has examined these associations in Canada's general population. The present exploratory study consists of a secondary analysis of the World Values Survey's seventh wave of data collected in 2020 from a sample of 4,018 Canadian adults. Results indicate moderately positive attitudes toward premarital sex and lower levels of approval for casual sex, on average. Religion-related variables yielded moderate to strong effect sizes, with identifying as religious, higher frequencies of religious service attendance, and greater attributed importance to religion being associated with lower levels of approval for premarital and casual sex. Small to moderate effects were found for politics-related, family-related, and ethnocultural variables. On average, participants who considered premarital and casual sex as justifiable tended to be more left-leaning, have fewer children, live together as married, have been born in Canada, identify as White, report French as the language they normally speak at home, and live in Quebec. While age and generation were weakly associated with premarital sex attitudes, they were more strongly associated with casual sex attitudes, with younger participants being somewhat more accepting of casual sex than older participants. Small gender differences were found for casual but not premarital sex attitudes. Attitudinal differences based on socioeconomic variables were overall statistically insignificant or negligible. The findings are consistent with and expand on the existing literature. They also shed light on Canada's ethnocultural and provincial particularities. [ABSTRACT FROM AUTHOR]

Resettlement to a new country is a period of adjustment for all youth refugees, especially for highly traumatized groups of refugees, such as the Yazidi population. This study explores adjustment challenges faced by Yazidi youth refugees in Canada using group concept mapping. 12 Yazidi youth participated. Seven concepts represent the statements, including family stress and adjustment, the experience of instability and fear, navigating the differences between countries, starting over, getting used to school, the impact of war and my discomfort. The findings from this study were compared and contrasted with the existing literature. [ABSTRACT FROM AUTHOR]

One of the first ways some trans youth narrate their gender is through the process of choosing a name. Trans youth's negotiation of naming is particularly complex as they juggle family affinities and independence, as well as try on new identities and build relationships with peers. In the midst of transitioning, and often while still materially and emotionally dependent on their families, trans youth re-write their birth stories through, in part, the process of choosing a new name. Drawing on in-depth interviews with 10 racially and gender diverse trans youth in Canada, I explore how trans youth choose a name in relation to their family. I analyze these stories using Cavarero's theory of the formation of the self to think about what the work of names and naming exposes about how trans youth navigate their relationships with their family and their identity development. In their naming practices, trans youth discussed the relationship they have with their family and their negotiation of family reactions to the disclosure of their trans identity. Their narratives about naming and family challenge the binary discourse about family reactions as acceptance or rejection and provide stories about the complex ways trans youth navigate their relationship with their family in their daily lives. [ABSTRACT FROM AUTHOR]

Introduction: Patients with higher-risk myelodysplastic syndromes (MDS) face considerable challenges in disease management and often require caregiver support. Reports on the burden of caring for patients with advanced cancer suggest that caregivers receive insufficient support. Our research aimed to identify key challenges for caregivers of patients with higher-risk MDS. Methods: Online bulletin board is a qualitative research methodology which enables data collection via a web-based platform. A mix of moderator-led discussion guide and interparticipant discussion provides the caregiver insights as online dialogue, which then undergo content analysis to extract key findings. Results: Sixteen caregivers participated from the USA (n = 5), UK (n = 6) and Canada (n = 5). Content analysis identified the caregiver experience in higher-risk MDS as multifactorial, with seven key categories of caregiver burden: caregiver role and burden, mental health, family dynamics, disease experience, treatment experience, healthcare professional (HCP) interactions and information and education. Conclusion: There is significant impact and burden on caregivers of patients with higher-risk MDS, which varies depending on disease stage, choice (or lack of choice) of treatments, and the personal situation of the caregiver. Emotional stress occurs mostly at diagnosis/prognosis stage and when told to 'watch and wait', which is amplified when HCPs are perceived to lack knowledge/expertise about MDS. There is a need for better education about MDS for HCPs, patients, caregivers and the general community; a need for improved communication between patients/caregivers and HCPs; and a high unmet need for better mental health and emotional support for both patient and caregiver. [ABSTRACT FROM AUTHOR]

Medical assistance in dying (MAiD) is an evolving practice in Canada, with requests and outcomes increasing each year, and yet controversy is present—with a vast spectrum of ethical positions on its permissibility. International research indicates that family members who experience disagreement over their loved one's decision to have MAiD are less likely to be actively involved in supporting patients through the practical aspects of the dying process. Family members with passive involvement in the assisted dying process may also experience more significant moral dilemmas and challenging grief experiences than those who supported the decision. Given these previous findings, we designed this study to explore the factors complicating family members' experiences with MAiD in Canada and to understand how these complicating factors impact family members' bereavement in the months and years following MAiD. We conducted narrative interviews with 12 MAiD-bereaved family members who experienced disagreements, family conflicts, or differences in understanding about MAiD. Documenting and analyzing participants' experiences through storytelling allowed us to appreciate the complexity of family members' experiences and understand their values. The analysis generated five factors that can complicate the MAiD process and bereavement for family members: family discordance, internal conflict, legislative and eligibility concerns, logistical challenges, and managing disclosure and negative reactions. To our knowledge, this is the first Canadian study that explores how family discordance can impact bereavement following MAiD. Future bereavement services and resources should consider how these complicating factors may impact bereavement and ensure that Canadians with diverse MAiD experiences can access appropriate support. [ABSTRACT FROM AUTHOR]

This document is a correction to an article titled "Labour, social reproduction, and refugee politics: 'women's work' amongst Hungarian Romani families in Canada" published in the journal Dialectical Anthropology. The correction states that an earlier version of the article omitted nine sources from the reference list that are cited in the body of the article. The correction provides the missing references, which include books, articles, and news sources related to the topic. The original article can be found online, and the correction has been made by the author. [Extracted from the article]