Search

Although women's representation in STEM fields and occupations has increased, science and math continue to be stereotyped as male domains. This paper links psychological and sociological explanations for gendered disparities in STEM by examining the relationship between the local "micro-situational" female learning environment and the gender gap in academic self-concept in math and science. We applied hybrid models to TIMSS 2015 data comprised of a pseudo-panel of repeated measures for individual student and peer achievement, academic self-concept, utility value, and interest-enjoyment value in math/science (at age 14). We analyzed data from three countries, including a subsample of students who were taught by the same teacher in both math and science, thus eliminating unobserved teacher heterogeneity. Results indicate that female peer climate in the classroom is important for understanding how girls' self-concept in math/science is formed, even though it was unrelated to the gender gap. [ABSTRACT FROM AUTHOR]

Background: The gender disparity in surgical disciplines, specifically in speakers across North American medical and surgical specialty conferences, has been highlighted in recent literature. Improving gender diversity at society meetings and panels may provide many benefits. Our aim was to determine the state of gender diversity amongst presenters and speakers at the annual Canadian Society of Otolaryngology-Head and Neck Surgery (CSO) meetings. Methods: Scientific programs for the CSO annual meetings from 2008 to 2020 were obtained from the national society website. Participant name, role, gender, location, and subspecialty topic were recorded for all roles other than poster presenter. Gender (male or female) was determined using an online search. The total number of opportunity spots and proportion of women was then calculated. Gender differences were analyzed using chi-square test and logistic regression with odds ratios. Four categories were analyzed: Society Leadership, Invited Speaker Opportunities, Workshop Composition (male-only panels or "manels", female-only panels, or with at least one female speaker), and Oral Paper Presenters (first authors). Results: There were 1874 leadership opportunity spots from 2008 to 2020, of which 18.6% were filled by women. Among elected leadership positions in the society, only 92 unique women filled 738 leadership opportunity spots. 13.2% of workshop chairs, 20.8% of panelists and 22.7% of paper session chairs were female. There was an overall increase in the proportion of leadership positions held by women, from 13.9% of leadership spots in 2008 to 30.1% in 2020. Of the 368 workshops, 61.1% were led by men only, 36.4% by at least 1 female surgeon, and 2.5% by women only. "Manels" have comprised at least 37.5% of workshops each year. Conclusions: The proportion of women in speaking roles at the annual CSO meetings has generally increased over time, particularly among panelists, leading to fewer male-only speaking panels. However, there has been a slower rate of growth in the proportion of unique women in speaker roles. There remains an opportunity to increase gender/sex diversity at the major Canadian otolaryngology meeting. [ABSTRACT FROM AUTHOR]

Background: Chronic rhinosinusitis with nasal polyposis (CRSwNP) often coexists with lower airway disease. With the overlap between upper and lower airway disease, optimal management of the upper airways is undertaken in conjunction with that of the lower airways. Biologic therapy with targeted activity within the Type 2 inflammatory pathway can improve the clinical signs and symptoms of both upper and lower airway diseases. Knowledge gaps nevertheless exist in how best to approach patient care as a whole. There have been sixteen randomized, double-blind, placebo-controlled trails performed for CRSwNP targeted components of the Type 2 inflammatory pathway, notably interleukin (IL)-4, IL-5 and IL-13, IL- 5R, IL-33, and immunoglobulin (Ig)E. This white paper considers the perspectives of experts in various disciplines such as rhinology, allergy, and respirology across Canada, all of whom have unique and valuable insights to contribute on how to best approach patients with upper airway disease from a multidisciplinary perspective. Methods: A Delphi Method process was utilized involving three rounds of questionnaires in which the first two were completed individually online and the third was discussed on a virtual platform with all the panelists. A national multidisciplinary expert panel of 34 certified specialists was created, composed of 16 rhinologists, 7 allergists, and 11 respirologists who evaluated the 20 original statements on a scale of 1–9 and provided comments. All ratings were quantitively reviewed by mean, median, mode, range, standard deviation and inter-rater reliability. Consensus was defined by relative interrater reliability measures—kappa coefficient (κ ) value > 0.61. Results: After three rounds, a total of 22 statements achieved consensus. This white paper only contains the final agreed upon statements and clear rationale and support for the statements regarding the use of biologics in patients with upper airway disease. Conclusion: This white paper provides guidance to Canadian physicians on the use of biologic therapy for the management of upper airway disease from a multidisciplinary perspective, but the medical and surgical regimen should ultimately be individualized to the patient. As more biologics become available and additional trials are published we will provide updated versions of this white paper every few years. [ABSTRACT FROM AUTHOR]

Background: The purpose of this paper is to provide a preliminary evaluation of treatment outcomes, retention and client satisfaction following a 12-week combined cognitive behavioural therapy (CBT) and motivational enhancement therapy (MET) group treatment for cannabis use disorder (CUD) delivered in an outpatient setting. Implementation of the program is also described. Methods: A retrospective observational cohort study was conducted using data collected from medical records and self-report assessments. Participants were treatment-seeking cannabis users at the Centre for Addiction and Mental Health, Toronto. Cannabis use, cannabis-related problems, craving, withdrawal symptoms, self-efficacy for remaining abstinent, depression and anxiety were assessed pre- and post-treatment. Treatment retention was calculated by inspecting clinic attendance records, and client satisfaction was evaluated using an anonymous feedback survey. Potential predictors of treatment outcomes and retention were investigated in exploratory analyses. Results: Cannabis use was lower and days of abstinence higher post-treatment (vs pre-treatment). Post-treatment improvements in cannabis-related problems, craving, withdrawal symptoms, self-efficacy and mood were also observed. Completion of group treatment (⩾75% of sessions attended) was 57% and moderate levels of treatment satisfaction were reported. Conclusions: This study provides preliminary evidence that a 12-week combined CBT and MET treatment for cannabis use disorder delivered in a novel group setting improves cannabis use outcomes. Potential predictors of reduced cannabis use and retention were identified. Future controlled studies are warranted, and strategies for increasing retention should be explored. [ABSTRACT FROM AUTHOR]

Background: Recent evidence suggests that biologic therapy with targeted activity within the Type 2 inflammatory pathway can improve the clinical signs and symptoms of chronic rhinosinusitis with nasal polyposis (CRSwNP). There remains a population in CRSwNP that despite medical therapy and endoscopic sinus surgery have persistent signs and symptoms of disease. Therefore, biologics, monoclonal antibody agents, could be beneficial therapeutic treatments for these patients. There have been eight randomized, double-blind, placebo-controlled trails performed for CRSwNP targeted components of the Type 2 inflammatory pathway, notably interleukin (IL)-4, IL-5 and IL-13, IL-5R, IL-33, and immunoglobulin (Ig)E. However, there are no formal recommendations for the optimal use of biologics in managing Chronic Rhinosinusitis (CRS) within the Canadian health care environment. Methods: A Delphi Method process was utilized involving three rounds of questionnaires in which the first two were completed individually online and the third was discussed on a virtual platform with all the panelists. 17 fellowship trained rhinologists across Canada evaluated the 28 original statements on a scale of 1–10 and provided comments. A rating within 1–3 indicated disagreement, 8–10 demonstrated agreement and 4–7 represented being neutral towards a statement. All ratings were quantitively reviewed by mean, median, mode, range and standard deviation. Consensus was defined by removing the highest and lowest of the scores and using the "3 point relaxed system". Results: After three rounds, a total of 11 statements achieved consensus. This white paper only contains the final agreed upon statements and clear rationale and support for the statements regarding the use of biologics in patients with CRS. Conclusion: This white paper provides guidance to Canadian physicians on the use of biologic therapy for the management of patients with CRS, but the medical and surgical regimen should ultimately be individualized to the patient. As more biologics become available and additional trials are published we will provide updated versions of this white paper every few years. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Occupational Therapy is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Annual turnover of home care workers represents a huge loss of revenue and is a key source of inefficiency in the home health care industry. In this article, we propose a data-driven approach to monitor employee churn and to capture the evolution of employee intent to leave. Unlike most papers in the literature, we use machine learning techniques to analyze over 2 million visits in the US, Canada, and Australia between 2016 and 2019. Results show that the gap between the number of hours worked and in the contract is the most important factor to predict employee intent to leave, which means an employee should be given as many hours as requested in the contract to improve retention. Secondary results show that having diverse shift lengths and continuity in services and patients seem to be associated with less turnover. [ABSTRACT FROM AUTHOR]

Patterns of linguistic and interactional behavior by people at the very end of their lives are not well described, partly because data is difficult to obtain. This paper analyzes descriptions of 486 deaths gathered from 1900 to 1904 in the first-ever clinical study of dying by noted Canadian physician, Sir William Osler. Only 16 patients were noted speaking, and only four canonical last words were reported. The most frequent observation by medical staff was that the deaths were quiet (n = 30), though range of other behaviors were noted (e.g., moaning, delirium, seeming intention to speak). Osler's problematic study left behind data whose analysis is a small step toward empirically characterizing the linguistic and interactional details of a previously under-described phenomena as well as the importance of the social context in which they occur. [ABSTRACT FROM AUTHOR]

As uses of plasma-derived medical products increase globally, so does the demand to collect plasma from donors. There is evidence that positive interactions with center staff motivate plasma donors to return. This paper reports on a focused ethnography investigating experiences of nurses and phlebotomists in one of Canadian Blood Services’ first source plasma collection center during the COVID-19 pandemic. Participants found the transition from whole blood collection to source plasma amid a global pandemic challenging, but they adapted by coming together as a team, and then worked to put the donor experience first. Their experience resonates with scholarship on emotional labor. As blood services worldwide attempt to increase source plasma collection, there is a need to understand care work that nurses and phlebotomists perform on the front-line. This study offers insight into how blood services can support staff in plasma operations by recognizing emotional labor. [ABSTRACT FROM AUTHOR]

Background. Persons experiencing or at risk of homelessness have occupational needs that are seldom addressed in the Canadian system of care. The lack of documented evidence on occupational therapy practices in this field hinders the development of the profession. Purpose. This article identifies current and potential practices that aim to enable or support the occupations of persons experiencing or at risk of homelessness. Method. A scoping review was conducted, including evidence from both occupational therapy and non–occupational therapy sources. Findings. One hundred and seventy-eight papers were selected in the areas of occupational performance skills training, enrichment of occupational repertoire, employment/education, physical rehabilitation services, child/family services, community building, occupational transition from homeless to housed, literacy, and disaster relief. Implications. Occupational therapists can build environments and create opportunities that facilitate occupational engagement of individuals experiencing homelessness. Gaps in knowledge include the evaluation of occupational therapy practices, the Canadian context of family homelessness, and the cultural safety of occupational therapy interventions. [ABSTRACT FROM AUTHOR]

The aim of this paper is to illuminate findings of disclosure experiences for youth living with chronic illness using a non-categorical approach. The findings were derived from a larger qualitative study framed by social constructivist grounded theory that sought to understand youth's involvement in healthcare decision-making in the context of chronic illness. Fifty-four youth participated in the study, ranging from 9 to 24 years. Three main themes representing the youth's perspectives and experiences of disclosing chronic illness were identified: (1) disclosure is central to the illness experience; (2) spectrum of disclosure; and (3) navigating others' reactions to disclosure. The findings reinforce that more emphasis on decisions related to disclosing illness in research and clinical care for youth with chronic conditions is warranted. [ABSTRACT FROM AUTHOR]

Vaginal cleansing products such as douches, sprays, wipes, powders, washes, and deodorants are part of a growing $2 billion industry in North America. Part of the appeal of these products is supposedly attaining vaginal cleanliness, which is marketed in association with product use. Although these products are promoted as healthy, medical research indicates potential health risks for some of these products (e.g. yeast infections, bacterial vaginosis, and disruption of the vaginal microbiota). Despite these risks, many women use these products. In this paper, we draw on interviews with women who use vaginal cleansing products to examine the ways in which particular portrayals of the vagina are connected with broader societal messages about female genitalia and with motivations to use vaginal cleansing practices. These portrayals include the healthy vagina, the clean vagina, and the dirty vagina. We show that although participants in our study valued both a clean vagina and a healthy vagina, when tension occurred between these two portrayals, participants prioritized vaginal cleanliness over vaginal health. We argue that this prioritization of the idealized clean vagina is connected to societal pressures of needing to attain unrealistic standards of vaginal cleanliness. [ABSTRACT FROM AUTHOR]

Background: Patient "engagement" in health research broadly refers to including people with lived experience in the research process. Although previous reviews have systematically summarized approaches to engaging older adults and their caregivers in health research, there is currently little guidance on how to meaningfully engage older adults with multimorbidity as research partners. Objectives: This paper describes the lessons learned from a patient-oriented research program, the Aging, Community and Health Research Unit (ACHRU), on how to engage older adults with multimorbidity as research partners. Over the past 7-years, over 40 older adults from across Canada have been involved in 17 ACHRU projects as patient research partners. Methods: We developed this list of lessons learned through iterative consensus building with ACHRU researchers and patient partners. We then met to collectively identify and summarize the reported successes, challenges and lessons learned from the experience of engaging older adults with multimorbidity as research partners. Results: ACHRU researchers reported engaging older adult partners across many phases of the research process. Five challenges and lessons learned were identified: 1) actively finding patient partners who reflect the diversity of older adults with multimorbidity, 2) developing strong working relationships with patient partners, 3) providing education and support for both patient partners and researchers, 4) using flexible approaches for engaging patients, and 5) securing adequate resources to enable meaningful engagement. Conclusion: The lessons learned through this work may provide guidance to researchers on how to facilitate meaningful engagement of this vulnerable and understudied subgroup in the patient engagement literature. [ABSTRACT FROM AUTHOR]

Background: Evaluating gender differences in publication rates after conference presentations is an avenue to assess women's contributions to academic medicine. The objective of this study was to assess gender differences in publication rates, time to publication, and subspeciality of publication of abstracts presented at Canadian otolaryngology conferences over an 11-year period. Methods: Cross-sectional data was obtained from online conference schedules of annual Canadian Society of Otolaryngology–Head and Neck Surgery national meetings between 2009 and 2020. A total of 2111 abstract titles were searched in MedLine via PubMed. Gender of the first and senior author, publication status of presented work, and subspeciality of publication were extracted. Results: Of 2111 scientific abstracts presented between 2009 and 2020, female first and senior authors accounted for 29.0% and 12.8% of published abstracts, respectively. There was a significant difference in the publication rate of senior authors by gender (p < 0.01). Male senior authors had a 9.70% higher rate of publication compared to female senior authors. Posters with a female first author were 33.0% (OR: 0.67; 95% CI 0.49–0.91) less likely to be published compared to posters with a male first author. Similarly, posters with a female senior author were 34.0% (OR: 0.66; 95% CI 0.45–0.96) less likely to be published. There was a significant difference in discipline of publication by gender of the senior author (p < 0.001). Male senior authors were more likely to supervise projects in otology while female senior authors were more likely to supervise projects in education and pediatrics. The time to publication and impact factor of the journal of publication did not differ by gender. Conclusion: Gender disparities exist in the publication rates of first and senior authors at Canadian otolaryngology meetings. Female senior authors have significantly lower publication rates compared to their male colleagues and differences exist in publication rates after poster presentations. Investigation of gender gaps in academic medicine, research productivity, and publications is essential for development of a diverse, equitable, and inclusive workforce in otolaryngology. [ABSTRACT FROM AUTHOR]

Background: Knowledge dissemination is paramount so physicians may practice the most up-to-date, evidence-based medicine to best serve their patients. Medical conferences are a commonly employed method of facilitating this. By determining the publication rate of research presented at a conference, the quality of the conference is indirectly assessed. Therefore, this study aimed to determine the publication rate, along with other conference metrics, of abstracts presented at the Canadian Society of Otolaryngology-Head and Neck Surgery (CSOHNS) meetings from 2008 to 2018. Methods: All abstracts presented at the CSOHNS Annual Meetings from 2008 to 2018 were reviewed from publicly available records. Presentation year, presentation type (i.e. oral or poster), whether each abstract was presented in the Poliquin Resident Research Competition, and the country in which the lead author's institution was located, were collected. Publication status of each abstract was then determined using a six-tiered search strategy in PubMed and Google Scholar. All data were then analyzed using SPSS Version 27.0. Results: From 2008 to 2018, 1947 abstracts were analyzed, yielding an overall publication rate of 58.7%. There was a significantly increasing trend in publication rate over the 11 years (p = 0.015). The rate of publication differed based on type of presentation (oral 65.1%, poster 50.2%; p = 0.001). Most presentations were presented by a first author associated with a Canadian institution (94.4%). The top journal in which research was published was Journal of Otolaryngology- Head and Neck Surgery (37.3%). The mean impact factor of the journals in which presentations were published was 2.92. Finally, the median time to publication was 14 months (IQR: 9.0–25.0). Conclusions: Research presented at 2008–2018 CSOHNS annual meetings was published in academic journals at higher rates than research at comparable conferences. Oral presentations have a significantly greater publication rate, compared to poster presentations. Additionally, the upward trend in publication rate over the 11 meetings suggests a steady increase in the quality of research being presented. [ABSTRACT FROM AUTHOR]

Introduction: Individuals experiencing housing instability face significant health inequities. Addressing housing instability requires an understanding of the factors that contribute to these inequities—a responsibility that has been assumed by community-based organizations. Interviewing individuals from 3 Canadian provinces, the present study aimed to examine the perspectives of individuals from front-line services of the social determinants of health (SDoH) needs of individuals experiencing housing instability. Methods: As part of a larger knowledge translation study, we conducted 8 semi-structured interviews with individuals from front-line services (eg, shelter workers and shelter mental health nurses) in Canada (Nova Scotia, Saskatchewan, and Alberta) and used thematic analysis to identify predominant unmet SDoH needs. Results: Individuals from front-line services discussed the roles of many SDoH that may perpetuate housing instability in their clients. These included: (1) limited social supports; (2) poor access to health services; (3) poor opportunities for income and employment; (4) lack of transportation; (5) gender-based discrimination; (6) race-based discrimination; and (7) limited access to education and limited literacy skills. Conclusion: This study reveals how front-line service providers observe SDoH factors contributing to housing instability and create barriers to accessing support services. They advocate for a multi-system approach to addressing intersecting SDoH factors to validate clients' experiences and help them achieve stable housing. Additionally, more research and consultation with front-line providers are necessary to understand and overcome systemic barriers to stable housing. [ABSTRACT FROM AUTHOR]

There is a wide gap between what research evidence identifies as effective reading intervention and what is currently offered in schools. This effectiveness study reports the results of a long-term research/school system partnership that is implementing reading intervention for children with reading difficulties in Canadian community schools. In Study 1, growth-curve analyses revealed significant long-term shifts in the reading trajectories of children (n = 731) from Kindergarten to Grade 5 as a function of receiving the Empower™ Reading: Decoding and Spelling intervention. Long-term outcomes were higher in children who received intervention in Grade 2 than in Grade 3, supporting the benefit of earlier intervention. In Study 2, we compare reading outcomes before and after children participated in school system-led intervention (Empower™ Reading, n = 341) to results from previously reported researcher-led intervention and business-as-usual controls. Children in both school system-led and researcher-led interventions showed greater improvement than controls on standardized measures of decoding and reading comprehension. Among school system participants, greater gains were seen for those with stronger reading skills at pre-test. Findings demonstrate successful school system implementation of research-originated and validated reading intervention. Researcher/school system partnerships may be integral in closing the research–practice gap. [ABSTRACT FROM AUTHOR]

Objective: Quantify the cost benefits of otoplasty under local as opposed to general anaesthesia. Design: A cost analysis of all components of otoplasty surgery under local anaesthesia (LA) in a minor operating room (OR) and general anaesthesia in a main OR was performed. Setting: Our institution, compared to provincial/federal data, with costs converted into 2022 Canadian dollars. Patients, Participants: Patients undergoing otoplasty under LA in the last year. Interventions: An efficiency analysis was performed by means of an opportunity cost, and the cost of failure was added to the overall LA costs. Main Outcome Measure: Expenses for infrastructure, surgical and anaesthetic material, salaries, and personnel costs were derived from the literature, our hospital OR catalog and federal/provincial salary data, respectively. The cost of failure to tolerate local anaesthesia for such cases was also tabulated. Results: The true cost of LA otoplasty was computed as the absolute cost ($611.73) added to the cost of failure ($10.80), resulting in a total of $622.53/procedure. The true cost of GA otoplasty was calculated as the absolute cost ($2033.05) added to the opportunity cost ($1108.94), representing 3141.99$/procedure. The total savings when performing LA otoplasty to GA otoplasty are thus 2519.44$/case, with 1 GA otoplasty costing 5.05 LA otoplasties. Conclusion: Otoplasty under local anaesthesia offers significant cost savings when compared with the same procedure under general anaesthesia. Economic considerations must be given particular attention given the elective nature of this procedure, which is often publicly funded. [ABSTRACT FROM AUTHOR]

Importance: Chronic rhinosinusitis (CRS) is a common inflammatory disease of the paranasal sinuses with significant quality of life impairments. There is a need to implement outcome-based metrics to evaluate the outcomes of CRS treatment with endoscopic sinus surgery or biologics. Objective: We aimed to understand Canadian otolaryngologists' opinions on patient-related outcome measures (PROM) for CRS and identify potential barriers to implementation. Design: Qualitative research. Setting and Participants: A cross-sectional survey was distributed via the Canadian Society of Otolaryngology-Head and Neck Surgery and direct emailing. Measures: Participants' demographics, practice information, and opinions on PROM were collected. Results: Of 346 (23%) Canadian otolaryngologists, 78 responded to the survey (26 rhinology fellowship–trained, 51 non-fellowship-trained, and 1 missing data). Thirty-eight responded that they collect PROM (69% with fellowship-trained, 39% non-fellowship-trained, P =.029). Regarding opinions on PROM, 74% of respondents agreed that it helps patients report their symptoms, 42% agreed that it improves the efficiency of the patient encounter, 54% agreed that it is easy for patients to understand, 62% agreed that it improves management and monitoring of clinical outcomes, and 71% disagreed that PROM is not helpful. Fellowship-trained otolaryngologists were 4 times more likely to agree that PROM improves management and monitoring of clinical outcomes (P =.014), and no other differences in opinions were significant. The most-frequently-identified barriers to PROM usage were lack of time for 67% of respondents, difficulty integrating into clinical workflow for 64%, and lack of integration into the electronic medical record for 47%. If these barriers were addressed, 86% of respondents said they would use PROM in their practice. Conclusions and Relevance: Despite the low uptake of PROM among otolaryngologists without rhinology fellowship, opinions were generally favorable. We identified barriers that, if addressed, may increase their use in clinical practice. As resource-limited therapies such as biologics become more prevalent in CRS management, PROM may find more applications in shared clinical decision making. [ABSTRACT FROM AUTHOR]

Background: The bedside head impulse test (bHIT) is a clinical method of assessing the vestibulo-ocular reflex. It is a critical component of the bedside assessment of dizzy patients and helps differentiate acute stroke from vestibular neuritis. A previous study on senior Otolaryngology residents showed poor competence in performing and interpreting the bHIT and called for specific evaluations in the Competency By Design (CBD) curriculum to remedy this. This study aimed to assess whether those competencies have improved after full implementation of CBD in residency programs. Methods: Thirty post-graduate year 4 Otolaryngology residents in Canada were evaluated on the use of the bHIT using a written multiple-choice question (MCQ) examination, interpretation of bHIT videos, and performance of a bHIT. Ratings of bHIT performance were completed by 2 expert examiners (DT, DL) using the Ottawa Clinic Assessment Tool. Results: Only 6.7% (rater DT) and 20% (rater DL) of residents were found able to perform the bHIT independently. Inter-rater reliability was moderate (0.55, intraclass correlation). Mean scores were 70% (13.4% standard deviation) for video interpretation and 59% (20.6% standard deviation) for multiple-choice questions. Video interpretation scores did not correlate with bHIT ratings (Pearson r = 0.11), but MCQs and bHIT ratings did correlate moderately (Pearson r = 0.52). Comparing to the prior study, residents performed worse on the bHIT (3.14 average score vs 3.64, P <.01) and fewer residents performed the bHIT independently (6.7% vs 22%—rater DT, 20% vs 39%—rater DL). Residents also performed worse on MCQs (58.7% vs 70.9%, P = 0.038), though similarly on video interpretation (70% vs 65%, P =.198). Conclusion: Fourth year OTL-HNS residents in Canada are not competent in performing the bHIT. These findings have implications for refining competency-based curricula in the evaluation of critical physical exam skills. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has killed millions across the world in only two years. Government health restrictions aimed at preventing transmission have impacted typical mourning practices such as funeral gatherings and in-person grief support services. This research examines the potential impacts that the pandemic may have had on people's ability to grieve. We employed a mixed methods study design to ask those who have lost a loved one during this time to reflect on their mourning practices with an anonymous survey. Our results present themes of complicated grief, the uncertainty of who to blame for frustrations, and common needs requested by the bereaved to help them mourn during these unprecedented times. These findings may help inform grief support and bereavement services during current and future mass death and pandemic health concerns. [ABSTRACT FROM AUTHOR]

In this study, we applied an intersectional framework to explore service providers' perspectives on the mental health needs of newcomer young men. We conducted focus groups and interviews with 26 service providers in Edmonton, Calgary, and Vancouver, Canada. Findings show that service providers made sense of young men's mental health needs and service access in the context of systems. We identified three interconnected themes: newcomer young men's senses of self in relation to macro-systems, including racism and economic marginalization; settling well as a determinant of mental health; and systems capacities and interdependent resilience. While service providers are engaged in cross-sectoral work in support of newcomer young men's mental health, this work is not being sufficiently supported. Further work is needed around cross-sector capacity bridging and advocacy, as well as the tailoring of services to young men without the assumption and reinforcement of gender stereotypes. [ABSTRACT FROM AUTHOR]

Although healthcare managers make increasingly difficult decisions about health innovations, the way they may interact with innovators to foster health system sustainability remains underexplored. Drawing on the Responsible Innovation in Health (RIH) framework, this paper analyses interviews (n =37) with Canadian and Brazilian innovators to identify: how they operationalize inclusive design processes; what influences the responsiveness of their innovation to system-level challenges; and how they consider the level and intensity of care required by their innovation. Our qualitative findings indicate that innovators seek to: 1) engage stakeholders at an early ideation stage through context-specific methods combining both formal and informal strategies; 2) address specific system-level benefits but often struggle with the positioning of their solution within the health system; and 3) mitigate staff shortages in specialized care, increase general practitioners' capacity or patients and informal caregivers' autonomy. These findings provide empirical insights on how healthcare managers can promote and organize collaborative processes that harness innovation towards more sustainable health systems. By adopting a RIH-oriented managerial role, they can set in place more inclusive design processes, articulate key system-level challenges, and help innovators adjust the level and intensity of care required by their innovation. [ABSTRACT FROM AUTHOR]

Health Canada has developed its Notice of Compliance with conditions (NOC/c) policy to get promising new drugs for serious diseases to market faster than would be possible through its standard approval process. Companies can receive an NOC/c for a new drug or a new indication based on incomplete evidence in return for agreeing to conduct post-market studies. This paper investigates the additional therapeutic gain from drugs approved under this policy, the percent of drugs that have fulfilled their conditions, and the length of time for fulfillment. From the inception of the policy in 1998 to the end of 2017, 89 new drugs and new indications for existing drugs received an NOC/c. Therapeutic evaluations were available for 78 of the drugs, and 54 offered only minimal or no gains over existing products. Fifty NOC/c were fulfilled, 31 were not fulfilled, and 8 were withdrawn. The median time to fulfillment was 1,040 days. Twelve NOC/c took more than 5 years to fulfill their conditions. The unfulfilled NOC/c had been issued for a median of 1,161 days, and 10 had been issued more than 5 years. The value of the NOC/c policy to patients is uncertain. [ABSTRACT FROM AUTHOR]

Objective: To describe the application of a new, objective diagnostic test for Meniere’s disease. Introduction: Electrovestibulography (EVestG) is a complex, newly-developed test paradigm that searches for neural firing patterns that may be diagnostic for particular neural disorders. EVestG system was previously “trained” to distinguish Meniere’s disease from other patients on a set of training data. In this paper we illustrate its diagnostic application in a new group of unknown subjects. Setting: Collaborative Academic Bioengineering Research Centre. Study design Prospective, blinded human Clinical Trial. Methods: In an attempt to understand the specific neural firing patterns that may objectively characterize latent Meniere’s disease, two hundred fifty-six consecutive patients who presented for electronystagmography testing were asked to undergo EVestG testing. Ten subjects actually completed testing but data were too noisy to permit analysis for one patient. Complete data were available for nine patients with either a clinical diagnosis of either Meniere’s disease (4 patients) or some other vestibular disorder (2 vestibular neuritis, 2 benign positional vertigo and 1 non-specific dizziness). None of the patients were experiencing attacks of vertigo within a week of EVestG testing. Ten normal control subjects with no history or symptoms of ear disease were also tested. EVestG was performed in a separate engineering research facility by investigators who were unaware of their clinical diagnosis. If EVestG suggested that the probability of Meniere’s disease was 0.5 or greater Meniere’s disease was considered present by the objective testing. The objective and clinical diagnoses were compared. Results: EVestG testing correctly identified three of four Meniere’s disease patients and rejected the diagnosis in 9 of the 10 controls. Two of the 5 dizzy, non-Meniere’s patients were incorrectly identified as Meniere’s disease. The sensitivity and specificity of EvestG testing were 75% and 80%, respectively. EVestG results were statistically significantly different for Meniere’s patients versus the other dizzy patients and controls (Univariate ANOVA difference contrasts p = 0.0340) even in this small sample. Conclusion: The EVestG protocol appeared to show promise as an objective, diagnostic test for Meniere’s disease, but our sample size is too small to generalize widely. Level of evidence N.A. Prospective Human clinical trial. [ABSTRACT FROM AUTHOR]

Objectives: Involuntary exit from the labor force can lead to poor health and well-being outcomes. Therefore, the purpose of this research is to better understand the factors that contribute to perceived retirement voluntariness. Methods: We conducted descriptive and multivariable logistic regression analyses using a sample of recent retirees (n = 2080) from the Canadian Longitudinal Study on Aging (CLSA). Results: More than one-quarter (28%) of older workers perceived their retirement to be involuntary. Among 37 possible predictors, 14 directly predicted retirement voluntariness and many more indirectly predicted retirement voluntariness. Only four direct predictors were common to both women and men, retiring because of organizational restructuring/job elimination; disability, health, or stress; financial possibility; and having wanted to stop working. Discussion: Findings suggest the need for employment support, health promotion, work disability prevention, financial education, and support that is sensitive to the differences between women and men to prevent involuntary retirement. [ABSTRACT FROM AUTHOR]

The study explores whether physical activity (PA) in early adolescence limits the risk of internalizing and externalizing problems in youth with difficult temperaments, from low-income families, or exposed to impaired family functioning. Participants (N = 1312; 53% girls) were drawn from the Quebec Longitudinal Study of Child Development (QLSCD). Results revealed that difficult temperament was associated with subsequent symptoms of anxiety among youth with low PA levels. Impaired family functioning was associated with higher levels of subsequent physical aggressivity among youth with high levels of PA. These results highlight the complex role of PA in different aspects of adjustment and the importance of the quality of PA contexts in young adolescents exposed to family adversity. [ABSTRACT FROM AUTHOR]

Understanding the heterogeneity of women who engage in violence is critical to provide effective treatment and reduce the likelihood of recidivism. Existing typologies of women who engage in violence have been created using mixed methodological approaches; the field would benefit from replication using a quantitative clustering method—latent class analysis (LCA)—as it is arguably more objective than methods used to date. A LCA was conducted using archival data involving 3,773 justice-impacted women in Western Canada to identify unique subgroups of women who perpetrate violence. Three distinct profiles emerged: (a) intimate partner violence (IPV)-only (40.5%), wherein almost all women reported only perpetrating domestic violence and had zero or only one previous violent conviction, (b) patterned (19.1%), wherein violence was perpetrated toward domestic partners and unknown victims, and the majority had two or more previous violent convictions, and (c) isolated (40.4%), wherein very few perpetrated domestic violence, some perpetrated violence toward unknowns, and the majority had either zero or only one previous conviction for a violent offense. Need profiles and recidivism outcomes were further analyzed as a function of group membership. As hypothesized, the group with the greatest criminal history and use of violence reported the greatest needs. Recidivism also increased as the number of dynamic needs increased. Notably, 80.9% of the sample was predominantly low risk/low need and were identified as IPV-only or isolated women. Implications of these findings may be used to inform risk classification, treatment targets, and treatment intensity required to reduce the likelihood of recidivism among women who perpetrate violence. [ABSTRACT FROM AUTHOR]

Introduction and Objectives: Canadians rely on their primary care providers to address their mental health needs, but there are longstanding system gaps that must be addressed to enhance their ability to deliver mental health care. The present study addressed the gap in pediatric mental health care through the development, delivery, and evaluation of a mental health literacy training among non-physician primary care providers. Methods: We delivered the training among 97 participants, with all completed the pre-test survey, and 74 completed the post-test survey on knowledge, attitudes toward mental health, and help-seeking intentions. Additionally, participants explained why they attended the training and shared how they would apply the knowledge learned into their practice (behaviors). Results: Participants improved their knowledge significantly from pre-test to post-test, P <.001, d = 2.51. We didn't find any statistical significance between pre-test and post-test on attitudes, P =.067, nor on help-seeking intentions, P =.274. However, participants' scores were exceedingly high on both outcomes, indicating positive attitudes and intentions at 2 time points and implying a ceiling effect of both outcomes. We did not find outcome differences by demographics, practice year, practice zone, or professional role. While knowledge, years of practice and prior mental health training predicted participants attitudes at pre-test, they didn't at post-test. Attitudes toward mental health predicted help-seeking intentions. Participants indicated this training will change their practice behaviors. Conclusion: This mental health literacy training for primary care providers demonstrated strong evidence of the need to integrate mental health and addiction support into primary care practice. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Occupational Therapy is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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

The study aimed to evaluate the feasibility of implementing lifestyle interventions in primary care settings with hypertensive patients and their effect on blood pressure, body composition, cardiometabolic markers, and antihypertensive drug use. Sixty participants diagnosed with stage 1 hypertension were randomly assigned to 4 groups: (1) Standard medical care (control), (2) Physical activity protocol, (3) Dietary Approach to Stop Hypertension (DASH) diet, and (4) Combination of physical activity protocol and DASH diet. Participants received counseling from family physicians, nurses, kinesiologists, and registered dietitians. Various assessments were conducted before (T0) and after (T6) the interventions, including 24-h ambulatory blood pressure monitoring, blood and urine tests, anthropometric measurements, computed tomography to measure adipose tissue, submaximal exercise test to estimate maximal oxygen consumption and health questionnaires. Fifty-one (51) participants (51/57, 89%) completed the program. All interventions reduced blood pressure indices between T0 and T6, except the combined interventions group. Body composition and cardiometabolic parameters were improved in all groups, except for the control group. In total, 28% of participants (7/23) reduced or stopped their antihypertensive medications at T6. The results suggest that structured lifestyle interventions are feasible in primary care and improve blood pressure and cardiometabolic parameters in patients with stage 1 hypertension. [ABSTRACT FROM AUTHOR]

Policing domestic violence (DV) poses significant challenges in China due to cultural, legal, and organizational complexities. Policing DV in China favors mediation over assertive interventions, complicating law enforcement's role. While previous research has focused on coercive interventions by Chinese police, there is limited information on non-coercive, supportive approaches. This study investigates the relationship between police officers' knowledge and training regarding the Anti-DV law and their willingness to provide supportive services to DV victims in China. It also considers various individual and organizational factors. The data used in this study are derived from the Policing DV in China project, with a sample of 1,353 respondents who had experience dealing with DV cases within the past 3 years. The study focuses on three dependent variables representing supportive approaches to DV cases: Referral, Counseling, and Protection orders. Independent variables include officers' knowledge of the Anti-DV law and agency training. Control variables include the use of body-worn cameras (BWC) and attitudes toward Violence Tolerance, Male Dominance, and Gender Equality. Additionally, demographic variables, working environment, length of service, and police rank are considered. The analytical approach involves a three-step strategy, incorporating descriptive, bivariate analyses, and regression analyses. The results are interpreted using odds ratios and average marginal effects, and statistical software such as SPSS by IBM and R by Open-Source Model is utilized for data analysis. Key findings indicate that more than half of the officers referred intimate partner violence survivors to shelters and assisted victims in filing protection orders. Counseling practices varied across provinces and between male and female officers. Agency training and the use of BWC were positively associated with non-coercive and supportive approaches, while knowledge of the DV Act, male dominance score, and gender equality score did not predict the use of such approaches. Demographic characteristics, including police rank, length of service, and province of employment, influenced the utilization of non-coercive and supportive approaches. This study examines the challenges faced by Chinese police officers when responding to DV cases and their willingness to provide supportive interventions. The study highlights the complexities surrounding the initiation of protection orders due to officers' legal knowledge and discretion. The study emphasizes the importance of police support in addressing DV in China and the role of agency training in promoting non-coercive responses. It highlights regional variations in police support and underscores the need for addressing disparities in service provision across different provinces. [ABSTRACT FROM AUTHOR]

Family involvement is widely considered an important part of patient care in the intensive care unit. From professional health care organizations, government, and hospital associations, there has been a cultural shift toward family presence as part of a wider commitment to patient-centered care. At the same time, the meaning and impact of family involvement in the intensive care unit setting remain opaque and under-studied. This study employed an ethnographic approach to better understand family involvement in practice and from the perspective of health care professionals and family members by studying an implementation trial of a family involvement tool in two intensive care units over 2 years. The findings revealed that an expanded and self-defined role for family members as carers in the intensive care unit challenged the current configuration of the nurse patient/family relationship and that family members were aware of these dynamics. While the intensive care unit implementation teams were both motivated to implement a novel way of facilitating family involvement, the processual, organizational, and contextual factors in the intensive care units largely determined the possibilities of its application. This suggests that interventions should address the specific context in which they are employed. [ABSTRACT FROM AUTHOR]

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

Using a 60-day daily e-diary tool, 117 women undergraduate students reported sexual harassment on a Canadian university campus (4,283 diary surveys, collectively). Participants reported 181 incidents of both ambient sexual harassment (witnessing 40 incidents, hearing 106 unwelcomed sexual jokes/remarks) and targeted personal experiences of non-physical sexual harassment (35 incidents). Qualitative data document students' descriptions of these encounters and contextualize how these are part of everyday student life. Findings show that students experience this harassment almost daily—in an ongoing, persistent, and normalized way—and that university can be a hostile environment where the possibility of daily unwanted sexual experiences is a lived, endemic reality. [ABSTRACT FROM AUTHOR]

Background: Human papillomavirus (HPV) has recently been implicated as a causative agent in a rapidly growing number of oropharyngeal cancers. Emerging literature supports the hypothesis that HPV vaccination may protect against HPV-related head and neck cancer (HNC) in addition to HPV-related cervical and anogenital disease. While the association between HPV infection and cervical cancer is widely understood, its relation to HNC is less well known. The purpose of this study was to better understand HPV counseling practices for infection and vaccination in relation to HNC of primary care physicians (PCPs), Obstetricians/Gynecologists (OBGYNs), and Otolaryngology - Head and Neck Surgeons (OHNSs) in Canada. Methods: A Canada-wide electronic questionnaire regarding counseling practices on HPV infection, transmission, and vaccination was designed and distributed to PCPs, OBGYNs, and OHNSs across Canada through electronic and paper-based methods. Basic Descriptive statistics were used to analyze responses. Results: In total, 337 physicians responded (239 family physicians, 51 OHNSs, 30 OBGYNs, and 17 pediatricians). Three out of four PCPs reported routine counseling of their patients regarding HPV infection, transmission, and vaccination. Among this group, 68% reported "never" or "rarely" counseling patients that HPV can cause HNC. The most commonly reported reason that PCPs cited for not counseling was a lack of knowledge. The majority of OHNSs (81%) and OBGYNs (97%) counseled patients regarding HPV infection, transmission, and vaccination. However, very few OHNSs (10%) regularly counseled patients with HPV-related HNC about HPV-related anogenital cancer. Similarly, very few OBGYNs (18%) regularly counseled patients with HPV related cervical/anogenital cancer about HPV related HNC. Conclusions: The rate of counseling on HPV infection, transmission, and vaccination in relation to HNC among PCPs is low. The most common reason is a lack of knowledge. Specialists rarely counsel patients with confirmed HPV-related cancer about other HPV-related malignancies. More research is needed on the relationship between different HPV-related cancers in order to better inform counseling practices. [ABSTRACT FROM AUTHOR]

Purpose: To identify trends in female authorship in the Canadian Association of Radiologists Journal (CARJ) from 2010 to 2019. Methods: We retrieved papers published in the CARJ over a 10-year period, and retrospectively reviewed 602 articles. All articles except editorials and advertisements were included. We categorized the names of the first and last position authors as female or male and excluded articles that had at least one author of which gender was not known. We compared the trends in the first and last position authors of the articles from 2010 to 2019. For statistical analysis, logistic regression was performed with reported odds ratios (ORs), and a P value of <.05 was defined as statistically significant. Results: Five hundred thirteen articles met inclusion criteria. Among them, 23 articles with a single author were classified as having only a first author. 39.8% (204/513) of first authors were female and 26.9% (132/490) of last authors were female. There has been an overall temporal increase in the odds of both the first and last author being female in CARJ publications (OR: 1.11, P =.034). Similarly, the odds a CARJ publication's first author being female increased over time (OR: 1.07, P =.033). Female last author did not predict female first author (OR: 1.48, P =.056). There was no association identified between female last author and year of publication (OR: 1.04, P =.225). Conclusion: There has been an overall increase in engagement of female authorship in CARJ. [ABSTRACT FROM AUTHOR]

Early research suggests that the COVID-19 pandemic may impact parental functioning. The purpose of this study was to examine parents' concerns during the pandemic and to explore the characteristics of families who may be particularly vulnerable to parenting concerns. Data were drawn from an online crowdsourcing survey of parents of children under age 15 in Canada (N = 32,228). Many parents were very or extremely concerned about managing child behaviour (61%) and having less patience with, scolding, or yelling at their children (46%). Family characteristics, including working from home, age of children, number of adults in the home, and child disability were associated with these parenting concerns in logistic regression models. Results are discussed in the context of the known impacts of stress on parenting and families, highlighting family-level and pandemic-specific stressors. [ABSTRACT FROM AUTHOR]

Background: The introduction of CDK 4/6 inhibitors for breast cancer patients has contributed to increased ambulatory patient visits for oncologists. The Medication Assessment by Pharmacist program aims to evaluate the impact of oncology pharmacists performing medication assessment follow-up visits. Methods: Breast cancer patients on a CDK 4/6 inhibitor deemed suitable by their oncologist for pharmacist assessment could be booked for a pharmacist medication assessment appointment at alternate treatment cycles. Results: Between February 2019 to November 2021, 29 of 128 patients (22.7%) were selected for 46 total Medication Assessment by Pharmacist visits resulting in 920 min of clinic time savings for physicians. There were similar rates of adhering to provincial protocols for scheduling visits (99% vs. 96%, p = 0.12) and monitoring investigations (98% vs. 98%, p = 0.96) between those enrolled in Medication Assessment by Pharmacist or not. Surveys completed by medical oncologists and pharmacists demonstrated that nine of nine oncologists felt Medication Assessment by Pharmacist reduced workload and wanted Medication Assessment by Pharmacist expanded to additional oncology drugs. Pharmacist-completed surveys revealed that nine of nine pharmacists felt Medication Assessment by Pharmacist increased job satisfaction, and allowed further application of clinical skills. All agreed that patients were receptive to meeting with pharmacists. According to survey results, 33% of oncologists versus 100% of pharmacists routinely asked about medication adherence, new medications or supplements. Conclusion: Integrating pharmacists into a shared care model reduces ambulatory patient visits for oncologists without deviating from provincial protocol guidelines for monitoring and visits for patients on CDK 4/6 inhibitors. Leveraging the medication expertise of pharmacists also increases the frequency of addressing medication adherence and concurrent therapies. Medication Assessment by Pharmacist may be an effective strategy in alleviating projected shortages of oncology providers. [ABSTRACT FROM AUTHOR]

Introduction: COVID-19-related restrictions resulted in changes to time use and occupational participation, impacting individual and collective well-being. This study addressed a knowledge gap concerning the adaptive process during periods of occupational disruption. We explored the experience of occupational disruption and how people managed disruption during the COVID-19 pandemic. Methods: We used a qualitative descriptive approach and interviewed 18 participants of a larger survey study of time use during the COVID-19 pandemic undertaken around a medium-sized city in Canada. Transcript analysis was conducted inductively using conventional content analysis. Findings: Two overarching themes were constructed during data analysis: The Disruption Experience and Adopting New Habits and Routines. In the face of disruption, participants described a sense of loss and disconnection, and challenges with time management. Establishing new habits and routines required new learning associated with increased time and flexibility, connecting with others and health and wellness. Conclusion: During changing pandemic restrictions, participants expressed a sense of loss, disconnection and time management challenges associated with occupational disruptions, but also described ways they adapted, improving their health and well-being. Strategies identified through this work may be used to enhance adaptation during disruptions. Future research should explore differences in adaptation, among more diverse populations. [ABSTRACT FROM AUTHOR]

This study adds to a small body of Canadian literature investigating the ways that newcomer women experience, and are impacted by, intimate partner violence (IPV). The study involved qualitative interviews with 15 newcomer women who migrated to Saskatchewan, Canada, from 12 different countries. These findings provide insight into participants' complex lived experiences and illustrate how women's status as newcomers intersected with their experiences of IPV. As well as abuse related to language ability and immigration status, participants in our study described their experiences of physical; sexual; emotional; psychological; economic; and legal abuse; as well as coercive control; isolation; surveillance, stalking, and harassment while in the relationship and after separation; challenges with shared parenting; and the imposition of patriarchal values. Perpetrators of IPV maintained control by intentionally isolating survivors, and participants were also isolated due to their status as a newcomer and their limited English-language ability and social connections. [ABSTRACT FROM AUTHOR]

Background: Self-rated health (SRH) is a globally recognized measure of health status. Both impaired sleep (IS) and the presence of multimorbidity are related to poorer SRH, but the precise nature of these associations remains unclear. This study explored the association between IS, multimorbidity, and SRH among Canadian adults. Method: We used 2017-18 Canadian Community Health Survey (CCHS) data for this study. The main variable of interest, self-rated health (SRH), measured participants' health on a 5-point Likert scale, later categorized as "good or better" vs. "fair or poor". The primary predictor, IS, was derived from two variables and categorized into four groups: no sleep issues; fewer sleeping hours (<7 hours) only; trouble sleeping only; and fewer hours & trouble sleeping. Multimorbidity was present (yes/no) if a participant indicated being diagnosed with two or more chronic conditions. Results: Just over one in ten Canadians reported fair/poor SRH and approximately one-quarter had multimorbidity or experienced few sleep hours in combination with trouble sleeping. The adjusted model indicated greater odds of fair/poor SRH associated with the 40-64 years age group, male sex, and lower socio-economic status. It also suggested the presence of multimorbidity (AOR= 4.63, 95% CI: 4.06-5.28) and a combination of fewer sleep hours and troubled sleep (AOR= 4.05, 95% CI: 2.86-5.74) is responsible for poor SRH. Forty-four percent of the total effect of IS on SRH was mediated by multimorbidity. Conclusion: This unique finding highlights the mediating role of multimorbidity, emphasizing the importance of addressing it alongside sleep issues for optimal health outcomes. [ABSTRACT FROM AUTHOR]

Objectives: Despite Canada's universal health system, sex workers across the country face an alarmingly high number of barriers when they seek to healthcare services. This has resulted in unmet healthcare needs and substantially poorer health outcomes than the general Canadian population. The objective of this study was to use a systems thinking approach to gain an in-depth understanding of the barriers sex workers face and how access could be improved. Methods: The analysis was conducted using a systems thinking methodology, which incorporates systems tools and inquiry processes. The methodology comprised 2 domains of inquiry: (1) Problem Landscape, (2) Solutions Landscape. Systems tools and methods, such as causal loop diagrams, iceberg diagram, and systems mapping, investigated the problem landscape for understanding the interconnected nature of the issue, alongside review of both published and gray literature. An environmental scan explored the current solutions landscape. These methods connected through systemic inquiry processes, including ongoing review and application of diverse perspectives, boundary judgments, interrelationships; enabled gaps and levers of change to be determined. Results: The main barriers sex workers face are stigma, criminalization, accessibility, and cost of healthcare. The stigma of sex work stems from otherization, paternalism, and moralistic, faith-based beliefs. The barriers unique to sex work are stigma and criminalization; both of which surface as avoidance, dislike, and/or fear of medical professionals. Five gaps each with a lever of change to improve access were identified: (1) Stigma – Collectivization and external collaboration, (2) Criminal status of sex work – Decriminalization, (3) Lack of adequate education - Improved healthcare professional training and anti-discriminatory health policies, (4) Lack of support – Increased community-based healthcare services, (5) Cost of healthcare – Universal coverage of "secondary" healthcare components. Conclusion: Through reducing the stigma surrounding sex work, making changes that improve the healthcare services that sex workers receive, and collaboration between involved parties, sex workers can be prevented from falling through the cracks of the Canadian healthcare system; lessening the health inequities sex workers face and improving their health outcomes. [ABSTRACT FROM AUTHOR]

Medical assistance in dying (MAiD) has been legal in Canada since 2016 and some incarcerated patients who are at the end of their lives are eligible for the procedure. Interviews with nine incarcerated men at a federal penitentiary in Canada provide insight into some of the ways that people who are navigating aging and end-of-life in prison think about MAiD. Interview themes are organized around: experience with death and dying; possibilities and barriers related to applications for release from prison at end-of-life; experiences of peer-caregiving in a prison palliative care program; support for MAiD and the expansion of eligibility criteria; what a good death looks like. Themes are contextualized alongside federal guidelines related to end-of-life care (EOLC) and MAiD for prisoners, highlighting that sound policy requires both generalizable principles and attention to nuance. MAiD rests on patient voluntariness, and thus autonomy over EOLC decisions is paramount for prisoners. [ABSTRACT FROM AUTHOR]

Background: Severe grief is highly distressing and prevalent up to 1 year post-death among people bereaved during the first wave of COVID-19, but no study has assessed changes in grief severity beyond this timeframe. Aim: Understand the trajectory of grief during the pandemic by reassessing grief symptoms in our original cohort 12–18 months post-death. Design: Prospective matched cohort study. Settings/participants: Family members of decedents who died in an acute care hospital between November 1, 2019 and August 31, 2020 in Ottawa, Canada. Family members of patients who died of COVID (COVID +ve) were matched 2:1 with those who died of non-COVID illness (COVID −ve) during pandemic wave 1 or immediately prior to its onset (pre-COVID). Grief was assessed using the Inventory of Complicated Grief (ICG). Results: Follow-up assessment was completed by 92% (111/121) of family members in the initial cohort. Mean ICG score on the 12–18-month assessment was 19.9 (SD = 11.8), and severe grief (ICG > 25) was present in 28.8% of participants. One-third (33.3%) had either a persistently high (>25) or worsening ICG score (⩾4-point increase between assessments). Using a modified Poisson regression analysis, persistently high or worsening ICG scores were associated with endotracheal intubation in the deceased, but not cause of death (COVID +ve, COVID −ve, pre-COVID) or physical presence of the family member in the final 48 h of life. Conclusions: Severe grief is a substantial source of psychological morbidity in the wake of the COVID-19 pandemic, persisting more than a year post-death. Our findings highlight an acute need for effective and scalable means of addressing severe grief. [ABSTRACT FROM AUTHOR]

Trauma- and violence-informed physical activity (TVIPA) is a feasible approach to improve access/engagement in physical activity for pregnant/parenting women with experiences of trauma. Through feminist participatory action research, 56 semistructured interviews were completed to understand TVIPA. Four themes were identified: (1) "I have to be on edge": Trauma and violence pervade women's lives, (2) "It should be mandatory that you feel safe": Emotional safety is essential, (3) "The opportunity to step up and be decision-makers and leaders": Choice, collaboration, and connection create safety, and (4) "It's a good start for healing," strengths-based and capacity building foster individual and community growth. [ABSTRACT FROM AUTHOR]

Improving breastfeeding rates is a global goal. To achieve it, actions targeting modifiable factors that influence the breastfeeding experience, such as maternal self-efficacy, could be a promising path, especially with preterm infants' mothers. Considering the current ubiquitous technology, we developed a mobile application for mothers of preterm infants to constitute a breastfeeding information and support platform. The study was developed in three phases: a survey to determine characteristics and preferences of preterm infants' mothers; the app development by an interdisciplinary team, following the principles of Disciplined Agile Delivery; and the face and content validation by 10 professionals. The app contains 80 screens and 11 strategies to address prematurity, lactation, breastfeeding, peer support, maternal emotions, resilience, and motivation. Nurses can apply their expertise by designing mHealth-based interventions, employing scientific evidence, and considering the interests and preferences of the target population. Future studies will assess the user experience, the effect on breastfeeding self-efficacy, and breastfeeding rates, and develop a culturally adapted English version of the app for women in Canada. [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]

Background: In 2016, Canada joined the growing number of jurisdictions to legalize medical assistance in dying (MAiD), when the Supreme Court of Canada's decision in Carter v Canada took effect and the Canadian Parliament passed Bill C-14. Five years later, Bill C-7 introduced several significant amendments. These included removing the 'reasonably foreseeable natural death' requirement (an aspect that was widely debated) and introducing the final consent waiver. Since Bill C-7 is so new, very little research has investigated its operation in practice. Objectives: This study investigates the experiences of MAiD assessors and providers regarding the Bill C-7 amendments. It explores implications for understanding and improving regulatory reform and implementation. Design: Qualitative thematic analysis of semi-structured interviews. Methods: In all, 32 MAiD assessors and providers (25 physicians and 7 nurse practitioners) from British Columbia (n = 10), Ontario (n = 15) and Nova Scotia (n = 7) were interviewed. Results: The analysis resulted in five themes: (1) removing barriers to MAiD access; (2) navigating regulatory and systems recalibration; (3) recognizing workload burdens; (4) determining individual ethical boundaries of practice and (5) grappling with ethical tensions arising from broader health system challenges. Conclusion: This is one of the first studies to investigate physicians' and nurse practitioners' experiences of the impact of Bill C-7 after the legislation was passed. Bill C-7 addressed key problems under Bill C-14, including the two witnesses requirement and the 10-day waiting period. However, it also introduced new complexities as practitioners decided how to approach cases involving a non-reasonably foreseeable natural death (and contemplated the advent of MAiD for persons with a mental disorder as a sole underlying condition). This study highlights the importance of involving practitioners in advance of legislative changes. It also emphasizes how the regulation of MAiD involves a range of organizations, which requires strong leadership and coordination from the government. [ABSTRACT FROM AUTHOR]