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Purpose: Theoretically, a health system has been described in terms of integration being the coordination of health services and collaboration amongst provider organizations. The components of an integrated health system remain inconclusive. Although senior healthcare executives establish structures and designs which facilitate the delivery of integrated care, their perspectives of a health system have not been explored. The purpose of this paper is to present senior healthcare executives' perspectives of a health system which, when combined, form a model for developing an integrated health system. Design/methodology/approach: Using a qualitative methodology and a multi-case study design, 11 presidents and 4 senior vice presidents of major healthcare organizations or systems in Ontario Canada were selected from a target population of 246 senior healthcare executives to engage in 1 h interviews each. Critical case sampling was applied in the selection of the study sample. Interviews were conducted between December 2017 and February 2018. Findings: Senior healthcare executives expressed four distinct perspectives of a health system: systems, institutional, clinical and governance. When combined, the four perspectives form an original research-based concept or model for an integrated health system. Originality/value: This paper conveys results of personal interviews with senior healthcare executives and presents a proposed model for an integrated health system based on their four distinct perspectives of a health system. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to critically reflect on the global dementia prevention views of the Japanese leaders at both the Japanese Young Leaders in Dementia Event and the Japanese Global Legacy Against Dementia event, from a Canadian perspective.Design/methodology/approach This paper undertook a global comparison of the discussion and recommendations from both the Japanese Young Leader Event and the satellite Global Dementia Legacy Event.Findings The paper provides insights about the cultural and intergenerational differences in both the Japanese solutions compared to the Canadian solutions.Originality/value The authors encourage leaders involved in global prevention dementia discussions to remember the importance of context, in regards to both cultural and intergenerational collaborations, in the search for global dementia solutions. [ABSTRACT FROM AUTHOR]

Purpose – Of the approximate 18 million refugees worldwide, between 2 and 5 percent are estimated to be separated children, a figure which represents between 360,000 and 900,000 children. Place and placemaking represent vital components and realities during flight. The concept of place addresses the physical and social environments within which separated children move through and live in. Place and placemaking both include elements of physical setting, activity, and meaning, with placemaking specifically constituting the act of transforming the places one finds oneself into the places in which one lives. Originality/value – Uncertainty continues to surround the concept and meaning of place and placemaking in large part due to their contextual and subjective nature. Furthermore, the notion of place is often under-explored and under-theorized when considering separated children's experiences and realities. Design/methodology/approach – Drawing upon in-depth interviews and a focus group with 17 youth respondents living in Canada, this paper explores the realities of place and placemaking in the lives of separated children. Findings – The paper highlights the meaning and significance of place during flight. It examines the ways in which respondents "made place" in contexts of violence and insecurity through social networks, through reliance on language and cultural traditions, and through place attachment and identity. Practical implications – The paper concludes with a discussion of the implications of place and placemaking for policy and practice with separated children. [ABSTRACT FROM AUTHOR]

Purpose - Citizens' opinions of the police are important indicators of how well the police are performing their duties and can help to shape police practice as well as public policy. However, little research exists in Canada on people's opinions of the police. This paper aims to provide a more robust understanding of citizen attitudes toward the police in Canada by examining a variety of factors that have been deemed important in shaping people's attitudes in other countries (predominantly from research conducted in the USA). Design/methodology/approach - The paper utilizes path analysis to decompose and better understand the relationships between sociodemographic/non-sociodemographic variables and attitudes toward the police. Data were drawn from the 1999 General Social Survey conducted by Statistics Canada. A random sample of Canadians was surveyed regarding victimization, personal safety and attitudes toward the criminal justice system. Findings - Several distinct groups of people (i.e. young people, visible minorities, males, those who have experienced criminal victimization, those dissatisfied with their safety and those who perceive their neighborhoods as being high in crime) emerged as having negative views toward the police, which is consistent with much of the research conducted in the USA. Originality/value - Police practice should more closely resemble the principles inherent in community policing if certain groups' negative views of the police are to be improved. This can be partly accomplished by the police being more inclusive of diverse opinions in the community and actively seeking out this opinion in order to better inform policing practices and strategies. [ABSTRACT FROM AUTHOR]

Purpose: The life expectancy for persons with intellectual disabilities (ID) has increased significantly, resulting in an increasing number of aging persons with ID. To promote healthy and active aging of persons with ID, discussions on new initiatives to design age-friendly communities have begun at local and international levels. The purpose of this paper, a qualitative research study, is to identify features of an age-friendly community, and facilitators and barriers from the perspectives of older adults with mild ID and their caregivers who live in the city of Winnipeg in Canada. Design/methodology/approach: Seven older persons with mild ID were interviewed, and 15 caregivers participated in focus group discussions. All participants were asked questions about features of community living and their experiences in eight broad topic areas (i.e. transportation, housing, social participation, respect and social inclusion, opportunities for community involvement, communication and information, community support and healthcare services, and outdoor spaces and buildings). Findings: The results indicated that many of the current features of the city of Winnipeg do not adequately address the needs of aging persons with ID; specifically, participants revealed that issues related to accessibility, social participation, social disrespect and inclusion, and lack of resources were important barriers to independence. Originality/value: The findings will increase awareness of the needs of aging persons with ID and inform programme planning, service delivery, coordination of community-based services and policies to support healthy and active aging for this vulnerable population. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to examine how formal navigators interpret their roles supporting families of older adults.Design/methodology/approach This study was an interpretive inquiry informed by critical gerontology and discourse analytic methods. Interview data were collected and analyzed from 22 formal service providers who helped older adults and their families navigate health and social care resources in one Western Canadian city.Findings Although acknowledging structural barriers to service access, participants emphasized individual empowerment as their dominant strategy, interpreting their roles as providing information and education about services. In part, these interpretations may reflect the limited nature of their ability to help broker access or advocate; in part, they may also reflect the broader political and economic discourses surrounding care in Canada.Research limitations/implications When providers position navigation and access to care as individual problems, this can obscure structural burden as well as potential inequities among older adults. Future research should examine whether navigational role interpretations are similar or different to those of navigators in other regions. Navigators in other health and social care contexts may enact differing meanings in their work.Practical implications Although formal public navigators can play an important role, approaches that go beyond providing information may better meet families' needs for support.Originality/value This is one of the first studies focused specifically on providers' interpretations of the meaning of navigational work in health and social care for older adults, and to extend a critical gerontological gaze toward the issue of system navigation. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to identify the training needs of the next generation of psychiatrists, and barriers in prescribing first-generation antipsychotics (FGAs), long-acting injectable (LAIs) antipsychotics and clozapine.Design/methodology/approach An electronic survey was sent to psychiatry residents (N= 75/288, 26 percent) at four Canadian residency programs in late December 2017. The survey was based on an instrument originally developed at the University of Cambridge and consisted of 31 questions in 10 content domains.Findings Nearly 80 percent of residents were aware that FGAs and second-generation antipsychotics (SGAs) have similar efficacy. However, extra-pyramidal symptoms and lack of training experience were the leading concerns associated with the prescribing of FGAs. Although over 90 percent of residents felt confident about initiating an oral SGA as a regular medication, only 40 percent did so with FGAs. Confidence with initiating LAIs and clozapine was 60 and 61 percent, respectively.Practical implications The survey highlights the need for better training in the use of FGAs, clozapine and LAIs. These medications can be effectively used in providing patients with the most appropriate evidence-based treatment options to improve treatment outcomes, while ensuring that these resources are not lost to the future generations of psychiatrists.Originality/value The survey may be the first of its kind to assess antipsychotic prescribing attitudes in Canadian psychiatry residents in multiple sites. [ABSTRACT FROM AUTHOR]

Purpose - The purpose of this paper is to assess empirically Chinese immigrants' perceptions of the police in Toronto, Canada. Design/methodology/approach - Data were analyzed based on 293 surveys conducted with Chinese immigrants who participated in various community service organizations in Toronto, Canada, between March and May 2005. Ordinary least squares and ordered logit regressions are used for the analysis. Findings - The paper shows that individuals who had previous contact with police rated police less favorably than those who had not had contact with police in the past. In general, people who rated police as helpful when they called them for assistance expressed a higher degree of respect for police. In addition, poor communication was a significant predictor of Chinese immigrants' perception of police prejudice. Finally, a majority of respondents expressed the concern that more bilingual police were needed in the city. Research limitations/implications - As with any study utilizing a non-probability sample, care must be taken to avoid generalizing the findings to all Chinese immigrants in Toronto. Since the sample was taken from participants of various community service organizations in Toronto, the findings may not be appropriate to generalize to the other constituencies in the Chinese community, such as young people. Practical implications - The paper highlights the need for improving the quality of police services, recruiting more bilingual officers (or officers from their communities), strengthening police training in racial and cultural diversity, and reducing communication barriers to improve Chinese immigrants' evaluations of the police. Originality/value - This research is the first to specifically examine Chinese communities' perceptions of law enforcement in Canada. Law enforcement can utilize these findings to improve their services and address the Chinese community's concerns; not only can this promote the police-citizens relationship, but it can also encourage the Chinese community's participation in a crime reduction partnership. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to discuss the experiences of multiple forced migrations and resettlement among two refugee families in a mid-sized Canadian city. Design/methodology/approach -- Case studies are located within the contingencies of the participants' lives and the meanings they provide to the events. A postcolonial feminist perspective guided the data analysis to explore the micro-level of individual experiences that unfold within a raced, gendered, and classed reality. Open-ended interviews, participant observation, and field notes were used to collect participants' perspectives. Data were collected until saturation occurred. Findings -- An in-depth analysis of these two case studies revealed that lack of choice and lack of access to health and social services affect health through constant revival of traumatic past experiences prior to arrival to Canada. Three themes emerged from the data analysis: first, shared experiences of forced migrations; second, the past and present: construction of new identities; and third, resettlement challenges and opportunities. These themes overlap and intersect to shape the experiences of double forced migration. Research limitations/implications -- This research has limitations related to the sample size but provides data on a topic that deserves more attention in the field of immigrant and health studies. The authors argue that health and social professionals must resist "finalizing" refugees into disempowered identities that undermine human agency. Originality/value -- Research on resettlement experiences after forced migration is a burgeoning field in refugee studies. The originality lies in drawing on Bahktin to develop practical implications to guide health and social practice in this area marked by racialization and fundamentalism. [ABSTRACT FROM AUTHOR]

Purpose -- This paper seeks to present findings from a study soliciting the perspectives of child and youth mental health clinicians practising in rural/remote settings in British Columbia, Canada. Satisfaction is assessed in four areas: lifestyle, practice, preparation for practice, and fit of organizational standards. Design/methodology/approach -- An online survey using a variety of closed and open-ended questions was administered to clinicians practising in four distinct settings: small rural, large rural, small remote, and large remote. Closed questions were analyzed using SPSS 17.0 while open ended questions were analyzed using manual open and axial coding. Findings -- Findings indicate moderate to high levels of satisfaction in all areas. Satisfaction with rural lifestyle and professional practice was strongest for clinicians recruited from within the community. However, clinicians from small remote communities indicated much lower levels of satisfaction in all four areas. Originality/value -- The study underscores the importance of understanding the diversity of rural practice settings in mental health workforce development. In particular it highlights the need for greater attention to evidence based approaches to support mental health practitioners in small remote settings. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to describe divergent recent developments in provision of reproductive health services to North Americans. Design/methodology/approach – Narrative review. Findings – Two North American countries with very different histories present similar governance challenges today. The challenge is to provide all women with the full range of reproductive health options to which they are legally entitled now. In Canada, those contraception and abortion options are covered under the medical service plan insurance but not always available in convenient locations. In USA, those options are not uniformly covered under health insurance plans due to statutory limitations. In Canada, where federal law limiting abortion was struck down as unconstitutional, the leader of one of its three major federal political parties sees the way forward being to limit his party to pro-choice candidates. In USA, where new laws limiting abortion have been introduced at an unprecedented rate, the judiciary is being asked to define the way forward. Originality/value – Clinical governance needs to balance the moral beliefs of individual providers against the rights of patients to have their lawful choices available within reasonable convenience. Progress has been made but needs are still not adequately met, in these North American examples. [ABSTRACT FROM AUTHOR]

Purpose: A global pandemic, non-occupational noise-induced hearing loss (NIHL) is a completely preventable public health problem, which receives limited air time. This study has dual purposes: to contribute to scholarly literature that puts non-occupational NIHL on the global priority map and to effect change in the City of Vancouver's policies toward noise. Design/methodology/approach: Experts in public health and hearing health were contacted in addition to a scoping literature search on PubMed. Information pertaining to both developed and developing countries was obtained, and comparison was made to Canada where possible. The authors met with elected officials at the City of Vancouver to inform them of the win–win aspects of policies that promoted better hearing. Findings: Non-occupational NIHL is an underappreciated issue in Canada and many other countries, as seen by the lack of epidemiological data and public health initiatives. Other countries, such as Australia, have more robust research and public health programs, but most of the world lags behind. Better hearing health is possible through targeted campaigns addressing root causes of non-occupational, recreational noise – positive associations with loud noise. By redefining social norms so that soft to moderate sounds are associated with positive values and loud sounds are negatively attributed, the societies will prevent leisure NIHL. The authors recommend widespread national all-age campaigns that benefit from successful public health campaigns of the past, such as smoking cessation, safety belts and others. Soft Sounds are Healthy (SSH) is a suggested name for a campaign that would take many years, ample resources and sophisticated understanding of behavior change to be effective. Research limitations/implications: A gap exists in the collection of non-occupational NIHL data. Creating indicators and regularly collecting data is a high priority for most nations. Beyond data collection, prevention of non-occupational NIHL ought to be a high priority. Studies in each region would propel understanding, partly to discern the cultural factors that would predispose the general population to change favorable attitudes toward loud sounds to associations of moderate sounds with positivity. Evaluations of these campaigns would then follow. Practical implications: Everyday life for many people around the world, particularly in cities, is loud. Traffic, construction, loudspeakers, music and other loud sounds abound. Many people have adapted to these loud soundscapes, and others suffer from the lack of peace and quiet. Changing cultural attitudes toward loud sound will improve human and animal health, lessen the burden on healthcare systems and positively impact the economy. Social implications: Industries that create loud technologies and machinery ought to be required to find ways to soften noise. Regulatory mechanisms that are enforced by law and fines ought to be in place. When governments take up the banner of hearing health, they will help to set a new tone toward loud sounds as undesirable, and this will partially address the root causes of the problem of non-occupational NIHL. Originality/value: Very little public health literature addresses NIHL. It is a relatively ignored health problem. This project aims to spurn public health campaigns, offering our own infographic with a possible title of Soft Sounds are Healthy (SSH) or Soft Sounds are Sexy (SSS). The study also aimed to influence city officials in the authors' home, Vancouver, and they were able to do this. [ABSTRACT FROM AUTHOR]

Purpose The Edmonton Zone, one of five Zones in Alberta Health Services (the health system in the province of Alberta, Canada), established a quality management framework (QMF) as a means to improve the delivery of high quality health care in the spring of 2014. The purpose of this research study was to understand the factors that facilitated or hindered the implementation of a quality improvement (QI) initiative for hand hygiene led by a newly formed frontline unit quality council (UQC), a part of the QMF, based out of the pediatric intensive care unit (PICU) at the Stollery Children’s Hospital in the Edmonton Zone. This research will provide an understanding of the newly established QMF in the Edmonton Zone and the factors needed to foster the ongoing development of frontline UQC that do improvement work as part of their daily routine.Design/methodology/approach Using a qualitative case study research design data were collected using semi-structured open-ended interviews with six key stakeholders (one registered nurse, one physician, one patient case manager, medical director for QI, clinical QI consultant and director of clinical QI) involved in UQC at the PICU.Findings Individual, unit and organizational level factors were identified as influencing the function of the UQC. Leadership and work culture were the key facilitating factors to success and lack of QI training and personnel/dedicated time were perceived barriers to completing the QI initiative.Originality/value The findings from this research illustrate that frontline UQC are able to impact positive sustained change early in their establishment as part of a larger QMF. It is important, however, for the system to foster ongoing development of capacity and capability of these frontline UQC to ensure sustained success of the larger systems change. [ABSTRACT FROM AUTHOR]