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Training staff and volunteers is an important aspect of successful program implementation. This paper follows Part A of an evaluation of the Special Olympics Canada (SOC) Coaching Young Athletes Training course. Consistent with Kirkpatrick's four-level model of training evaluation, Part A evaluated program leaders' reactions to (level 1) and immediate learning from (level 2) the training. This Part B paper covers "on the job" behavior (level 3). In-depth semi-structured interviews were conducted with youth program leaders (n = 11) from eight provinces. Overall, participants felt that more training related to working with children with autism and promoting positive athlete behavior was needed. The findings also lead us to suggest that program leaders need to develop a more fulsome understanding of how to foster skill mastery, including how to practice the same skill in many and varied ways. [ABSTRACT FROM AUTHOR]

This paper examines how experiences with a previous pandemic, particularly HIV/AIDS, may have informed approaches to COVID-19, with a focus on sexual orientation. Method: The sample was drawn from an online survey of Canadians 55+ conducted in 2020, comprising 1143 persons (mean age = 67; 88 gay or bisexual (GB) men, 65 lesbian or bisexual (LB) women, 818 heterosexual women, and 172 heterosexual men). Respondents reported if they, or someone close to them, "had been affected by" one or more pandemics and whether COVID-19 led them to "think more about their prior epidemic/pandemic experiences" and/or feel they "couldn't handle it again". Correlated items reflecting feeling "they have been here before"; "prepared for what is happening"; and "like they needed to act or do something" formed a scale named "agentic familiarity". Results: About half of respondents reported thinking about their previous pandemic experience; about 5% reporting feeling like "they couldn't handle it again" with no gender or sexual orientation differences. Higher agentic familiarity scores were found for GB men and for those with experience with HIV/AIDS vs. other pandemics. Discussion: These outcomes speak to resilience and growth experienced by LGBT (and especially GB) persons through shared stigma and trauma—with implications for current pandemic experiences and future actions, like advance care planning. [ABSTRACT FROM AUTHOR]

Objective: To shorten the Patient Engagement In Research Scale (PEIRS) to its most essential items and evaluate its measurement properties for assessing the degree of patients' and family caregivers' meaningful engagement as partners in research projects. Methods: A prospective cross‐sectional web‐based survey in Canada and the USA, and also paper‐based in Canada. Participants were patients or family caregivers who had engaged in research projects within the last 3 years, were ≥17 years old, and communicated in English. Extensive psychometric analyses were conducted. Results: 119 participants: 99 from Canada, 74 female, 51 aged 17‐35 years and 50 aged 36‐65 years, 60 had post‐secondary education, and 74 were Caucasian/white. The original 37‐item PEIRS was shortened to 22 items (PEIRS‐22), mainly because of low inter‐item correlations. PEIRS‐22 had a single dominant construct that accounted for 55% of explained variance. Analysis of PEIRS‐22 scores revealed the following: (1) acceptable floor and ceiling effects (<15%), (2) internal consistency (ordinal alpha = 0.96), (3) structural validity by fit to a Rasch measurement model, (4) construct validity by moderate correlations with the Public and Patient Engagement Evaluation Tool, (5) good test‐retest reliability (ICC2,1 = 0.86) and (6) interpretability demonstrated by significant differences among PEIRS‐22 scores across three levels of global meaningful engagement in research. Conclusions: The shortened PEIRS is valid and reliable for assessing the degree of meaningful patient and family caregiver engagement in research. It enables standardized assessment of engagement in research across various contexts. Patient or public contribution: A researcher‐initiated collaboration, patient partners contributed from study conception to manuscript write‐up. [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]

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Work-integrated learning (WIL) experiences rely heavily on the development of relationships between the university, industry and often community organizations. As participation in WIL is increasing, the issue of sustainability becomes paramount, requiring processes and practices for effective collaborations and partnerships. This paper reports on an action research project to develop a framework to represent the critical success factors for sustainable WIL relationships. Drawing on reflections from WIL practitioners on what they considered were the critical success factors and a review of literature, a framework was developed, prioritizing three key themes: communication, commitment and compatibility. Within these themes, nine key factors were identified and then evaluated by academic and industry stakeholders in New Zealand, Canada and Australia. Trust, expectations, reciprocity, coordination, vision, learning, resources, reputation, and recognition were confirmed as important factors for sustainable WIL relationships. The framework provides good practice guidelines for all WIL stakeholders. [ABSTRACT FROM AUTHOR]

Background: We initially reported on the cost-effectiveness of a 6-month randomized controlled implementation trial which evaluated Health TAPESTRY, a primary care program for older adults, at the McMaster Family Health Team (FHT) site and 5 other FHT sites in Ontario, Canada. While there were no statistically significant between-group differences in outcomes at month 6 post randomization, positive outcomes were observed at the McMaster FHT site, which recruited 40% (204/512) of the participants. The objective of this post-hoc study was to determine the cost-effectiveness of Health TAPESTRY based on data from the McMaster FHT site. Methods: Costs included the cost to implement Health TAPESTRY at McMaster as well as healthcare resource consumed, which were costed using publicly available sources. Health-related-quality-of-life was evaluated with the EQ-5L-5L at baseline and at month 6 post randomization. Quality-adjusted-life-years (QALYs) were calculated under an-area-under the curve approach. Unadjusted and adjusted regression analyses (two independent regression analyses on costs and QALYs, seemingly unrelated regression [SUR], net benefit regression) as well as difference-in-difference and propensity score matching (PSM) methods, were used to deal with the non-randomized nature of the trial. Sampling uncertainty inherent to the trial data was estimated using non-parametric bootstrapping. The return on investment (ROI) associated with Health TAPESTRY was calculated. All costs were reported in 2021 Canadian dollars. Results: With an intervention cost of $293/patient, Health TAPESTRY was the preferred strategy in the unadjusted and adjusted analyses. The results of our bootstrap analyses indicated that Health TAPESTRY was cost-effective compared to usual care at commonly accepted WTP thresholds. For example, if decision makers were willing to pay $50,000 per QALY gained, the probability of Health TAPESTRY to be cost effective compared to usual care varied from 0.72 (unadjusted analysis) to 0.96 (SUR) when using a WTP of $50,000/QALY gained. The DID and ROI analyses indicated that Health Tapestry generated a positive ROI. Conclusion: Health TAPESTRY was the preferred strategy when implemented at the McMaster FHT. We caution care in interpreting the results because of the post-hoc nature of the analyses and limited sample size based on one site. [ABSTRACT FROM AUTHOR]

This multi-center study examined the safety and effectiveness of cochlear implantation of children between 9 and 11 months of age. The intended impact was to support practice regarding candidacy assessment and prognostic counseling of pediatric cochlear implant candidates. Data in the clinical chart of children implanted at 9–11 months of age with Cochlear Ltd devices at five cochlear implant centers in the United States and Canada were included in analyses. The study included data from two cohorts implanted with one or two Nucleus devices during the periods of January 1, 2012–December 31, 2017 (Cohort 1, n = 83) or between January 1, 2018 and May 15, 2020 (Cohort 2, n = 50). Major adverse events (requiring another procedure/hospitalization) and minor adverse events (managed with medication alone or underwent an expected course of treatment that did not require surgery or hospitalization) out to 2 years post-implant were monitored and outcomes measured by audiometric thresholds and parent-reports on the IT-MAIS and LittlEARS questionnaires were collected. Results revealed 60 adverse events in 41 children and 227 ears implanted (26%) of which 14 major events occurred in 11 children; all were transitory and resolved. Improved hearing with cochlear implant use was shown in all outcome measures. Findings reveal that the procedure is safe for infants and that they show clear benefits of cochlear implantation including increased audibility and hearing development. [ABSTRACT FROM AUTHOR]

Permanent supportive housing (PSH) is the main approach advocated in Western countries for eradicating homelessness. Considering that PSH residents are not a homogeneous group and that their quality of life (QoL) and community integration (CI) might differ in this setting, improving our understanding of these residents' profiles may help stakeholders formulate informed recommendations to improve PSH. This study identified PSH resident profiles based on their QoL, CI, and sociodemographic and clinical characteristics and associated these profiles with housing features and service use. A total of 308 PSH residents were recruited in Montreal (Canada) in 2020–2022. Structured interviews were conducted. PSH resident profiles were produced with cluster analysis and subsequently compared using chi‐square, Fisher's, and t‐tests, taking into account housing features and service use. Three PSH resident profiles were found. Profile 1 residents (22% of the sample) had low QoL and CI, were younger, and had major social and health issues and unmet needs. Showing moderate QoL and CI, Profile 2 residents (27%) were more educated, had little foster care history, were older on their first homelessness episode, and had few co‐occurring MD‐SUD. Profile 3 residents (51%) had the best QoL and CI and mostly included men with little education, affected by co‐occurring MD‐SUD and satisfied with services. More intensive housing support and care coordination may be recommended for Profile 1 PSH residents in response to their diverse needs. Work integration may be beneficial to Profile 2 residents, with programs such as Individual Placement and Support, along with increased rehabilitation activities. A better integration of MD‐SUD treatments may be promoted for Profile 3 residents. Considering most PSH residents had multiple health issues and unmet needs, satisfaction with care could be monitored better, as it was found to be a key variable in measuring care adequation. [ABSTRACT FROM AUTHOR]

Background: Alcohol-induced injury is one of the leading causes of preventable morbidity and mortality. We investigated the relationship between impulsive personality and physical injury (e.g. falls, sports), and whether peak drinking quantity specifically, and/or risky behaviour more generally, mediates the relationship between impulsivity and injury in undergraduates. Method: We used data from the winter 2021 UniVenture survey with 1316 first- and second-year undergraduate students aged 18–25 years (79.5% female) from five Canadian Universities. Students completed an online survey regarding their demographics, personality, alcohol use, risky behaviours, and injury experiences. Impulsivity was measured with the substance use risk profile scale, past 30-day peak alcohol use with the quantity-frequency-peak Alcohol Use Index, general risky behaviour with the risky behaviour questionnaire, and past 6-month injury experience with the World Health Organization's (2017) injury measurement questionnaire. Results: Of 1316 total participants, 12.9% (n = 170) reported having sustained a physical injury in the past 6 months. Mean impulsivity, peak drinking quantity, and risky behaviour scores were significantly higher among those who reported vs. did not report injury. Impulsivity and peak drinking quantity, but not general risky behaviour, predicted injury in a multi-level generalized mixed model. Mediation analyses supported impulsivity as both a direct predictor of physical injury and an indirect predictor through increased peak drinking (both p <.05), but not through general risky behaviour. Conclusion: Results imply emerging adults with impulsive tendencies should be identified for selective injury prevention programs and suggest targeting their heavy drinking to decrease their risk for physical injury. [ABSTRACT FROM AUTHOR]

Introduction: There is a growing role for patients, family members and caregivers as consultants, collaborators and partners in health system settings in Canada. However, compensation for this role is not systematized. When offered, it varies in both type (e.g., one‐time honorarium, salary) and amount. Further, broad‐based views of patient partners on compensation are still unknown. We aimed to describe the types and frequency of compensation patient partners have been offered and their attitudes towards compensation. Methods: This study uses data from the Canadian Patient Partner Study (CPPS) survey. The survey gathered the experiences and perspectives of those who self‐identified as patient partners working across the Canadian health system. Three questions were about compensation, asking what types of compensation participants had been offered, if they had ever refused compensation, and whether they felt adequately compensated. The latter two questions included open‐text comments in addition to menu‐based and scaled response options. Basic frequencies were performed for all questions and open‐text comments were analyzed through inductive qualitative content analysis. Results: A total of 603 individuals participated in the CPPS survey. Most respondents were never or rarely offered salary (81%), honorarium (64%), gift cards (80%) or material gifts (93%) while half were offered conference registration and expenses at least sometimes. A total of 129 (26%) of 499 respondents reported refusing compensation. Of 511 respondents, half felt adequately compensated always or often, and half only sometimes, rarely or never. Open‐text comments revealed positive, ambivalent and negative attitudes towards compensation. Attitudes were framed by perceptions about their role, sentiments of giving back to the health system, feelings of acknowledgement, practical considerations, values of fairness and equity and accountability relationships. Conclusions: Our findings confirm that compensation is not standardized in Canada. Half of survey respondents routinely feel inadequately compensated. Patient partners have diverse views of what constitutes adequate compensation inclusive of personal considerations such as a preference for volunteering, and broader concerns such as promoting equity in patient partnership. Organizations should attempt to ensure that compensation practices are clear, transparent and attentive to patient partners' unique contexts. Patient Contribution: Two patient partners are members of the CPPS research team and have been fully engaged in all study phases from project conception to knowledge translation. They are co‐authors of this manuscript. The survey was co‐designed and pilot tested with patient partners and survey participants were patient partners. [ABSTRACT FROM AUTHOR]

Background. Exercise is recommended for people with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD), yet there is little information to guide safe and effective mobilization and exercise for these patients. Objectives. The purpose of this study was to develop a clinical decision-making tool to guide health care professionals in the assessment, prescription, monitoring, and progression of mobilization and therapeutic exercise for patients with AECOPD. Design and Methods. A 3-round interdisciplinary Delphi panel identified and selected items based on a preselected consensus of 80%. These items were summarized in a paper-based tool titled Mobilization in Acute Exacerbations of Chronic Obstructive Pulmonary Disease (AECOPD-Mob). Focus groups and questionnaires were subsequently used to conduct a sensibility evaluation of the tool. Results. Nine researchers, 13 clinicians, and 7 individuals with COPD identified and approved 110 parameters for safe and effective exercise in AECOPD. These parameters were grouped into 5 categories: (1) "What to Assess Prior to Mobilization," (2) "When to Consider Not Mobilizing or to Discontinue Mobilization," (3) "What to Monitor During Mobilization for Patient Safety," (4) "How to Progress Mobilization to Enhance Effectiveness," and (5) "What to Confirm Prior to Discharge." The tool was evaluated in 4 focus groups of 18 health care professionals, 90% of whom reported the tool was easy to use, was concise, and would guide a health care professional who is new to the acute care setting and working with patients with AECOPD. Limitations. The tool was developed based on published evidence and expert opinion, so the applicability of the items to patients in all settings cannot be guaranteed. The Delphi panel consisted of health care professionals from Canada, so items may not be generalizable to other jurisdictions. Conclusions. The AECOPD-Mob provides practical and concise information on safe and effective exercise for the AECOPD population for use by the new graduate or novice acute care practitioner. [ABSTRACT FROM AUTHOR]

Background: Performance reporting in primary health care in Canada is challenging because of the dearth of concise and synthesized information. The paucity of information occurs, in part, because the majority of primary health care in Canada is delivered through a multitude of privately owned small businesses with no mechanism or incentives to provide information about their performance. The purpose of this paper is to report the methods used to recruit family physicians and their patients across 10 provinces to provide self-reported information about primary care and how this information could be used in recruitment and data collection for future large scale pan-Canadian and other cross-country studies. Methods: Canada participated in an international large scale study-the QUALICO-PC (Quality and Costs of Primary Care) study. A set of four surveys, designed to collect in-depth information regarding primary care activities was collected from: practices, providers, and patients (experiences and values). Invitations (telephone, electronic or mailed) were sent to family physicians. Eligible participants were sent a package of surveys. Provincial teams kept records on the number of: invitation emails/letters sent, physicians who registered, practices that were sent surveys, and practices returning completed surveys. Response and cooperation rates were calculated. Results: Invitations to participate were sent to approximately 23,000 family physicians across Canada. A total of 792 physicians and 8,332 patients from 772 primary care practices completed the surveys, including 1,160 participants completing a Patient Values survey and 7,172 participants completing a Patient Experience survey. Overall, the response rate was very low ranging from 2% (British Columbia) to 21% (Nova Scotia). However, the participation rate was high, ranging from 72% (Ontario) to 100% (New Brunswick/Prince Edward Island and Newfoundland & Labrador). Conclusions: The difficulties obtaining acceptable response rates by family physicians for survey participation is a universal challenge. This response rate for the QUALICO-PC arm in Canada was similar to rates found in other countries such as Australia and New Zealand. Even though most family physicians operate as self-employed small businesses, they could be supported to routinely submit data through a collective effort and provincial mandate. The groundwork in setting up pan-Canadian collaboration in primary care has been established through this study. [ABSTRACT FROM AUTHOR]

Context: Mood and anxiety disorders appear to be overrepresented in adults with cardiovascular diseases (CVDs). These disorders have been associated with poorer biopsychosocial outcomes in this population. Mood and anxiety disorders often co-occur, but the prevalence of this comorbidity and their potential additive effects in patients with CVD remain understudied. Aims: This study aimed to estimate the prevalence and co-occurrence rates of mood and anxiety disorders in the general adult population living with CVD. Associations between mood and anxiety disorder status and sociodemographic characteristics, somatic comorbidities, perceived mental health, and health-care service use were also investigated. Methods: A total of 6,792 adults aged 25 years or older and living with CVD were selected from the 2015-2016 Canadian Community Health Survey. Mood and anxiety disorders were identified based on self-report diagnoses made by a qualified health professional. All other variables were assessed using questionnaires. Results: An estimated 17.7% of the studied population reported having been diagnosed with a mood or anxiety disorder. More precisely, 6.6% reported a mood disorder, 5.5% reported an anxiety disorder, and an additional 5.6% reported both. The presence of mood or anxiety disorders was associated with poorer perceived mental health and higher health-care service use, and these associations were stronger when mood and anxiety co-occurred. Conclusions: Approximately one in six adults with CVD reported suffering from mood or anxiety disorders, and a third of them presented both conditions. This study also suggests that co-occurring anxiety and mood disorders lead to greater vulnerability than either disorder in adults with CVD. [ABSTRACT FROM AUTHOR]

Introduction: Exiting sex work is a complex process which can be facilitated by integrated action on health and its social determinants such as housing and employment. Few programs offer such coordinated support, and even fewer have been evaluated. We assessed if and how Exit Doors Here, a program anchored in the Critical Time Intervention (CTI) model, facilitated women's progress towards their goals, and exit from sex work. Description: We performed a contribution analysis by combining pre-post questionnaire and administrative data from 55 women enrolled in the program (2018-2021), yearly interviews with program staff and peer mentors, and literature reviews to assess program outcomes and mechanisms as described in the theory of change. Discussion: We found evidence that the program contributed to participants progressing on their pre-employment, housing, income, and sex work exiting goals. We identified four "key ingredients" facilitating success: trust building, collaborative goal setting, connecting with community supports and weekly drop-in sessions. Conclusion: This rigorous theory-based evaluation provides much needed evidence on the process and effectiveness of an integrated sex work exiting program. Findings regarding key program ingredients can inform other interventions serving similarly marginalized populations. [ABSTRACT FROM AUTHOR]

We aimed to evaluate the impact of a web-based school nutrition intervention on eating behavior traits, body weight concern, body size perception and body size dissatisfaction in adolescents. Ten classes of secondary students in Canada (13.6 ± 0.8 years) were randomized into an intervention (n = 162 students) or control group (n = 75 students). Adolescents in the intervention, conducted between 2011 and 2013, participated in an online nutrition challenge to increase their consumption of vegetables, fruits and dairy products using a web-based platform over six weeks. Measurements were taken at baseline (PRE) and post-intervention (POST). No significant negative changes were observed between the intervention and control groups for eating behavior traits, body weight concern, body size perception and dissatisfaction. However, results suggest a trend for a positive effect of the intervention on susceptibility to hunger in boys (group × time interaction, p = 0.10). Specifically, boys experienced a reduction in their susceptibility to hunger in response to the intervention (PRE: 6.1 ± 3.8, POST: 4.8 ± 3.7, p = 0.009). An intervention aimed at improving the eating habits of adolescents did not negatively influence body size preoccupations. In response to the intervention, boys tended to show a lower susceptibility to hunger, which might help them to prevent overeating and adopt healthy eating habits. [ABSTRACT FROM AUTHOR]

BACKGROUND: Managing the heterogeneity and unpredictability of multiple sclerosis (MS) symptoms can be difficult for MS care partners. This study aimed to characterize the symptoms managed by MS care partners, recognize relationships between symptom management difficulty and other aspects of the caregiving role, and identify supplemental sources of caregiving support used by care partners. METHODS: A Canadian cohort of MS care partners completed an online survey capturing care-partner characteristics, carerecipient symptoms, care-partner difficulty with managing symptoms, and sources of caregiving assistance. Descriptive analysis, analysis of variance, and χ2 tests were used to compare differences in care-partner characteristics by symptom management difficulty groups, defined as low (<4 symptoms), medium (5-7 symptoms), and high difficulty (>7 symptoms). RESULTS: Care partners to individuals with MS (N = 475) reported a median of 8 symptoms (IQR = 4) experienced by their care-recipients. The most frequent symptoms reported were fatigue (89.1%), weakness (87.2%), and depression (81.9%). Care partners reported a median of 6 (IQR = 5) symptoms being somewhat or very difficult to manage. Balance or mobility impairments (20.3%), depression (14.3%), and vision difficulties (13.1%) were most frequently reported as very difficult to manage. Assisting with activities of daily living (P < .001) and time spent caregiving (P = .035) varied significantly between symptom management difficulty groups. Additional help available was reported by 77.5%, 17.8%, and 41.6% of care partners reporting low, medium, and high symptom management difficulty, respectively (P < .001). CONCLUSIONS: Care partners of individuals with MS report difficulty in managing multiple, variable symptoms and often have no additional help. These findings suggest that MS care partners experience difficulty managing many diverse symptoms and may benefit from additional support. [ABSTRACT FROM AUTHOR]

The article discusses a survey on smokers that assessed if the relationship between beliefs and smoking behaviors was in consistent with Cognitive Dissonance Theory. It included adult smokers from Canada, U.S., Great Britain and Australia. The findings revealed that smokers with no intetion of quitting across the three waves, were inclined towards the highest levels of rationalizations for smoking. It suggests studies to determine if the change in beliefs has any effect on intentions to quit.

Background. To date, there has been no attempt to describe or compare physical therapy as practiced globally, nor any evidence that an international data set exists to support this effort. It is known that research evidence can be used in strategic and tactical ways, especially within the highly politicized context of the policy arena. The International Private Practitioners Association recognized the potential value a global evidence base could have in influencing policy and supporting professional development in a number of countries, yet it lacked a mechanism to achieve these aims. Objectives. The purposes of this study were: (1) to identify and test an international data set, definitions, and means of data collection and (2) to establish views in relation to the value of international collaborations. Design. A mixed, prospective design was used in the study. Method. Phase 1 (2006-2007) involved the development of a data set, definitions, and Web-based and paper-based data collection options involving 98 physical therapists from 68 physical therapy practices in 7 countries. Phase 2 (2008-2009) involved testing of the data set in 34 practices involving 3,195 patient episodes and included physical therapist feedback of experience, local relevance of the data set, and value of international collaborations. Results. Testing confirmed the relevance and reliability of the data set and definitions and a preference for Web-based data collection (74.0%). Physical therapist feedback supported these findings. Most respondents (60.0%-100.0%) reported the value of further international collaborations for their profession nationally or internationally. Limitations. Although a true international collaboration, the limited sample size should be recognized. Conclusions. It is possible to develop an agreed-upon international data set and means of data collection. Testing appears to support its acceptability and relevance for use in practice. Participants highly valued the opportunity to undertake international collaborations that may benefit their profession nationally and internationally. Further testing and use of the data set are advocated before final validation is sought. [ABSTRACT FROM AUTHOR]

This paper examines the moderating role of negative affectivity and risk aversion in the relationships of two bases of continuance organizational commitment (continuance-sacrifices and continuance-alternatives) to turnover, within a stress-coping perspective. More specifically, we propose that (a) the perspective of leaving is a source of stress for those who stay due to the fear of losing valued advantages (i.e. high continuance-sacrifices commitment) and (b) staying is perceived to be stressful by individuals who remain based on a lack of employment alternatives (i.e. high continuance-alternatives commitment). We argue that these perceptions are magnified by negative affectivity and risk aversion, resulting in individuals who present these traits to use avoidance-withdrawal strategies in coping with these situations. Accordingly, based on a sample of 509 human resource management professionals, we found (a) negative affectivity and risk aversion to strengthen the negative relationship of continuance-sacrifices commitment to turnover and (b) continuance-alternatives commitment to relate positively to turnover among individuals with high negative affectivity. We discuss the implications of these findings for our understanding of how commitment mindsets and personality traits affect turnover decisions. [ABSTRACT FROM AUTHOR]

Objective: Little is known about self-concept in adolescents with physical-mental comorbidity. This study investigated whether physical-mental comorbidity was associated with self-concept in adolescents and examined if adolescent age or sex moderated the association between physical-mental comorbidity and self-concept. Methods: Study data were obtained from the Multimorbidity in Youth across the Life-course (MY LIFE), an ongoing Canadian study of adolescents with chronic physical illness who were recruited from outpatient clinics at a pediatric hospital. A total of 116 adolescents aged ≥ 10 years provided self-reports on key measures. Results: Adolescents with comorbidity (n = 48) had lower self-concept scores on the Self-Determination Questionnaire (SDQ; d = 0.62) and Self-Perception Profile for Children (SPPC; d = 0.53) vs. adolescents without comorbidity (n = 68). An age × comorbidity status interaction was found and age-stratified models were computed to investigate this moderating effect of age. Amongst older adolescents, comorbidity was associated with lower SDQ (B = -2.55, p <.001), but this association was not found among younger adolescents (B = -0.29, p =.680). A similar effect was found for SPPC among older (B = -0.48, p =.001) and younger adolescents (B = 0.03, p =.842). Adolescent sex was not found to be a moderator. Conclusions: Physical-mental comorbidity in adolescence was associated with lower self-concept and this association was moderated by age—differences between adolescents with vs. without comorbidity were greater for older adolescents and were clinically relevant. Opportunities to support positive self-perceptions for adolescents with comorbidity are warranted, especially when planning the transition from pediatric to adult health services. [ABSTRACT FROM AUTHOR]

Hemophilia is a bleeding disorder caused by a single absent/defective gene and characterized by a lack of functional clotting factors. People with hemophilia may experience joint damage, pain, and psychological impairments, all of which could contribute to reduced health-related quality of life (HRQoL). The current standard of care is clotting factor replacement, which is associated with regular infusions; therefore, alternative treatments such as gene therapy (GT) are in development. GT involves the delivery of a functional copy of the clotting factor 8/9 gene by a single infusion into the patient's cells, enabling them to produce their own clotting factor VIII/IX. The impact of treatment on patients' HRQoL can be assessed using hemophilia-specific patient-reported outcome (PRO) measures. Since these measures were designed before the advent of GT, there is a need for updated individualized PRO measures. Patient groups and regulatory authorities emphasize the need for increased patient engagement when considering clinical trial design. Here, we provide patients' perspective on undergoing GT and discuss how to capture the patient voice when measuring the therapy's transformative impact. [ABSTRACT FROM AUTHOR]

Introduction: Patient engagement in patient‐oriented research (POR) is described as patients collaborating as active and equal research team members (patient research partners [PRPs]) on the health research projects and activities that matter to them. The Canadian Institutes of Health Research (CIHR), Canada's federal funding agency for health research, asks that patients be included as partners early, often and at as many stages of the health research process as possible. The objective of this POR project was to co‐build an interactive, hands‐on training programme that could support PRPs in understanding the processes, logistics and roles of CIHR grant funding applications. We also conducted a patient engagement evaluation, capturing the experiences of the PRPs in co‐building the training programme. Methods: This multiphased POR study included a Working Group of seven PRPs with diverse health and health research experiences and two staff members from the Patient Engagement Team. Seven Working Group sessions were held over the 3‐month period from June to August 2021. The Working Group worked synchronously (meeting weekly online via Zoom) as well as asynchronously. A patient engagement evaluation was conducted after the conclusion of the Working Group sessions using a validated survey and semi‐structured interviews. Survey data were analysed descriptively and interview data were analysed thematically. Results: The Working Group co‐built and co‐delivered the training programme about the CIHR grant application process for PRPs and researchers in five webinars and workshops. For the evaluation of patient engagement within the Working Group, five out of seven PRPs completed the survey and four participated in interviews. From the survey, most PRPs agreed/strongly agreed to having communication and supports to engage in the Working Group. The main themes identified from the interviews were working together‐communication and supports; motivations for joining and staying; challenges to contributing; and impact of the Working Group. Conclusion: This training programme supports and builds capacity for PRPs to understand the grant application process and offers ways by which they can highlight the unique experience and contribution they can bring to each project. Our co‐build process presents an example and highlights the need for inclusive approaches, flexibility and individual thinking and application. Patient or Public Contribution: The objective of this project was to identify the aspects of the CIHR grant funding application that were elemental to having PRPs join grant funding applications and subsequently funded projects, in more active and meaningful roles, and then to co‐build a training programme that could support PRPs to do so. We used the CIHR SPOR Patient Engagement Framework, and included time and trust, in our patient engagement approaches to building a mutually respectful and reciprocal co‐learning space. Our Working Group included seven PRPs who contributed to the development of a training programme. We suggest that our patient engagement and partnership approaches, or elements of, could serve as a useful resource for co‐building more PRP‐centred learning programmes and tools going forward. [ABSTRACT FROM AUTHOR]

Background: Low back and neck pain are common in the general population, but the prevalence among Canadian post-secondary students is not well known. We aimed to determine the one-week prevalence of neck pain (NP) and low back pain (LBP) among postsecondary students in Canada. Methods: We conducted a cross-sectional study of students enrolled in the Faculty of Health Sciences and Faculty of Education at Ontario Tech University, and the Canadian Memorial Chiropractic College (CMCC) in the Fall of 2017. Neck and low back pain intensity in the past week were measured with the 11-point numerical rating scale. We report the cumulative, gender- and institution-specific one-week prevalence (95% CI) of any pain (1–10/10) and moderate to severe pain (≥ 3/10). Results: The one-week prevalence of any neck pain ranged from 45.4% (95% CI: 38.4, 52.4) in the Faculty of Education to 76.9% (95% CI: 72.9, 80.4) at CMCC. The one-week prevalence of neck pain ≥3/10 ranged from 44.4% (95% CI: 37.5, 51.4) in the Faculty of Education to 58.4% (95% CI: 54.0, 62.7) at CMCC. The one-week prevalence of any low back pain ranged from 60.9% (95% CI: 53.8, 67.5) in the Faculty of Education to 69.0% (95% CI: 64.8, 73.0) at CMCC, and the one-week prevalence of low back pain ≥ 3/10 ranged from 47.8% (95% CI: 43.4, 52.2) at CMCC to 55.1% (95% CI: 51.2, 58.9) in the Faculty of Health Sciences. The prevalence of any back or neck pain and pain ≥ 3/10 was consistently higher in females than males, with the largest difference seen for neck pain at CMCC. Conclusion: Most post-secondary students in our samples experienced LBP and NP in the past week. Overall, the one-week prevalence of NP and LBP was higher among chiropractic students and among females. This study should draw attention to school administrators about the burden of NP and LBP in post-secondary students. [ABSTRACT FROM AUTHOR]

Introduction: Recent shifts in the patient, family and caregiver engagement field have focused greater attention on measurement and evaluation, including the impacts of engagement efforts. Current evaluation tools offer limited support to organizations seeking to reorient their efforts in this way. We addressed this gap through the development of an impact measurement framework and accompanying evaluation toolkit—the Engage with Impact Toolkit. Methods: The measurement framework and toolkit were co‐designed with the Evaluating Patient Engagement Working Group, a multidisciplinary group of patient, family and caregiver partners, engagement specialists, researchers and government personnel. Project activities occurred over four phases: (1) project scoping and literature review; (2) modified concept mapping; (3) working group deliberations and (4) toolkit web design. Results: The project scope was to develop a measurement framework and an evaluation toolkit for patient engagement in health systems that were practical, accessible, menu‐driven and aligned with current system priorities. Concept mapping yielded 237 impact statements that were sorted, discussed and combined into 81 unique items. A shorter list of 50 items (rated 8.0 or higher out of 10) was further consolidated to generate a final list of 35 items mapped across 8 conceptual domains of impact: (1) knowledge and skills; (2) confidence and trust; (3) equity and inclusivity; (4) priorities and decisions; (5) effectiveness and efficiency; (6) patient‐centredness; (7) culture change and (8) patient outcomes and experience. Working Group members rated the final list for importance (1–5) and identified a core set of 33 items (one for each of the 8 domains and 25 supplementary items). Two domains (priorities and decisions; and culture change) yielded the highest overall importance ratings (4.8). A web‐based toolkit (www.evaluateengagement.ca) hosts the measurement framework and related evaluation supports. Conclusion: The Engage with Impact Toolkit builds on existing engagement evaluation tools but brings a more explicit focus to supporting organizations to assess the impacts of their engagement work. Patient Contribution: Patient, family and caregiver partners led the early conceptualization of this work and were involved at all stages and in all aspects of the work. As end‐users of the toolkit, their perspectives, knowledge and opinions were critical. [ABSTRACT FROM AUTHOR]

Background: Perceived financial security impacts physical, mental, and social health and overall wellbeing at community and population levels. Public health action on this dynamic is even more critical now that the COVID-19 pandemic has exacerbated financial strain and reduced financial wellbeing. Yet, public health literature on this topic is limited. Initiatives targeting financial strain and financial wellbeing and their deterministic effects on equity in health and living conditions are missing. Our research-practice collaborative project addresses this gap in knowledge and intervention through an action-oriented public health framework for initiatives targeting financial strain and wellbeing. Methods: The Framework was developed using a multi-step methodology that involved review of theoretical and empirical evidence alongside input from a panel of experts from Australia and Canada. In an integrated knowledge translation approach, academics (n = 14) and a diverse group of experts from government and non-profit sectors (n = 22) were engaged throughout the project via workshops, one-on-one dialogues, and questionnaires. Results: The validated Framework provides organizations and governments with guidance for the design, implementation, and assessment of diverse financial wellbeing- and financial strain-related initiatives. It presents 17 priority actionable areas (i.e., entry points for action) likely to have long-lasting, positive effects on people's financial circumstances, contributing to improved financial wellbeing and health. The 17 entry points relate to five domains: Government (All Levels), Organizational & Political Culture, Socioeconomic & Political Context, Social & Cultural Circumstances, and Life Circumstances. Conclusions: The Framework reveals the intersectionality of root causes and consequences of financial strain and poor financial wellbeing, while also reinforcing the need for tailored actions to promote socioeconomic and health equity for all people. The dynamic, systemic interplay of the entry points illustrated in the Framework suggest opportunities for multi-sectoral, collaborative action across government and organizations towards systems change and the prevention of unintended negative impacts of initiatives. [ABSTRACT FROM AUTHOR]

Background: Canadians endured unprecedented mental health (MH) and support access challenges during the first COVID-19 wave. Identifying groups of individuals who remain at risk beyond the acute pandemic phase is key to guiding systemic intervention efforts and policy. We hypothesized that determinants of three complementary, clinically actionable psychiatric outcomes would differ across Canadian age groups. Methods: The Personal Impacts of COVID-19 Survey (PICS) was iteratively developed with stakeholder feedback, incorporating validated, age-appropriate measures. Baseline, cross-sectional online data collected between November 2020-July 2021 was used in analyses. Age group-specific determinants were sought for three key baseline MH outcomes: (1) current probable depression, generalized anxiety disorder, obsessive–compulsive disorder and/or suicide attempt during COVID-19, (2) increased severity of any lifetime psychiatric diagnosis, and (3) inadequate MH support access during COVID-19. Multivariable logistic regression models were constructed for children, youth (self- and parent-report), young adults (19–29 years) and adults over 29 years, using survey type as a covariate. Statistical significance was defined by 95% confidence interval excluding an odds ratio of one. Results: Data from 3140 baseline surveys were analyzed. Late adolescence and early adulthood were identified as life phases with the worst MH outcomes. Poverty, limited education, home maker/caregiver roles, female and non-binary gender, LGBTQ2S + status and special educational, psychiatric and medical conditions were differentially identified as determinants across age groups. Interpretation: Negative psychiatric impacts of COVID-19 on Canadians that include poor access to MH support clearly persisted beyond the first wave, widening pre-existing inequity gaps. This should guide policy makers and clinicians in current and future prioritization efforts. [ABSTRACT FROM AUTHOR]

Background: This study examined self-reported physical activity (PA) participation, well-being, and perceived needs of Canadians with disabilities during the COVID-19 pandemic. In addition, we assessed physical and mental health and the extent to which pre-identified needs were being met or unmet. Methods: Two iterations of the COVID-19 Disability Survey were conducted during two pandemic timeframes: June–December 2020 (iteration 1, n = 599) and December 2020–September 2021 (iteration 2, n = 528). PA participation was assessed with the International Physical Activity Questionnaire. Physical and mental health were assessed with the PROMIS Global-10 questionnaire. A needs assessment was conducted on 11 needs pre-identified in partnership with community organizations. Results: Approximately 50% of respondents to both iterations reported that they did not do any moderate-vigorous intensity PA. While physical health was not different between timeframes, mental health was worse during iteration 2 than iteration 1 (p = 0.028). During both timeframes, access to recreation and leisure facilities was the greatest unmet need. Conclusion: These data highlight the low levels of PA and the perceived changes in PA, mental health, and recreational needs of Canadians with disabilities during the pandemic. The findings of the Survey were used to support policy change to remove barriers to PA participation for people with disabilities in Ontario. [ABSTRACT FROM AUTHOR]

Background: Total hip arthroplasty (THA) is a successful procedure that provides pain relief, restores function, and improves quality of life (QOL) for patients with advanced arthritis in their hip joint. To date, little research has examined the role of cognitive appraisal processes in THA outcomes. This study examined the role of cognitive appraisal processes in THA outcomes in the first year post-surgery. Methods: This longitudinal cohort study collected data at pre-surgery, 6 weeks post-surgery, 3 months post-surgery, and 12 months post-surgery. Adults (n = 189) with a primary diagnosis of osteoarthritis were consecutively recruited from an active THA practice at a Canadian academic teaching hospital. Measures included the Hip Disability and Osteoarthritis Outcome Score (HOOS), the Mental Component Score (MCS) of the Rand-36, and the Brief Appraisal Inventory (BAI). Analysis of Variance examined the association between BAI items and the HOOS or MCS scores. Random effects models investigated appraisal main effects and appraisal-by-time interactions for selected BAI items. Results: HOOS showed great improvement over the first 12 months after THA, and was mitigated by three appraisal processes in particular: focusing on problems with healthcare or living situation, and preparing one's family for health changes. MCS was stable and low over time, and the following appraisal processes were implicated by very large effect sizes: not comparing themselves to healthier people, focusing on money problems, preparing their family for their health changes, or trying to shed responsibilities. Conclusions: Appraisal processes are relevant to health outcomes after THA, with different processes coming into play at different points in the recovery trajectory. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the structural and construct validity, and internal consistency of the Quality of Life Scale among Canadian women with histories of intimate partner violence. Methods: Consistent with COSMIN Guidelines, a secondary analysis was conducted using data from a community sample of 250 adult (over 18 years) Canadian women with histories of partner violence and who participated in Wave 5 of the longitudinal Women's Health Effects Study. Data were collected 4 years after baseline using structured interviews that included the Quality of Life Scale and two mental symptom scales (Center for Epidemiological Depression Scale and Davidson Trauma Scale) used to assess construct validity of the Quality of Life Scale. Results: Confirmatory factor analysis in MPLUS 8 with maximum likelihood estimation supported the hypothesized unidimensional structure of the 9-item Quality of Life Scale based on acceptable fit indices. Internal consistency, estimated using Cronbach's alpha and composite reliability, were.91 and.92, respectively, with item-total correlations ranging from.46 to.84. Inter-item correlation coefficients (range =.30–.79), suggesting that all items contribute to the total score. As hypothesized, the quality of life total score was negatively related to the total scores on both the Center for Epidemiologic Studies-Depression (r = –.739) and Davidson Trauma Scale (r = –.537), providing evidence of construct validity of the Quality of Life Scale. Conclusion: The Quality of Life Scale is a brief, reliable, valid, unidimensional self-report measure appropriate for use with women who have experienced partner violence. By addressing an important measurement gap, results of this study have potential to advance research on women's quality of life in the context of partner violence, including improving the evaluation of a growing body of advocacy and health interventions designed to support women's healing and well-being. [ABSTRACT FROM AUTHOR]

There is evidence to suggest that dietary intake of children differs by rural/urban place of residence: rural children may have a higher intake of foods high in fat and sugar than those living in urban environments. The aim of this study was to examine the intake of fruits and vegetables (FV) and the frequency of sugar-sweetened beverage (SSB) consumption, among a sample of rural children in Northern Ontario, Canada, in two different seasons. Sociodemographic factors and children's FV and SSB intake were measured using two repeated cross-sectional surveys, and seasonal information was based on the month of data collection. Logistic regressions were used to examine the odds of children eating five or more FVs, and the odds of 'frequently or always' consuming SSBs. During the fall, children reported eating five or more FV more often, when compared to winter (53.9% vs. 48.3%). In the fall, 25.8% of children reported 'frequently or always' drinking SSB, compared with 16.9% in winter. Indigenous children were less likely to eat five or more FV (OR 0.34 (95% CI 0.12–0.95)) in the fall when compared to non-Indigenous children. Findings indicate that intake of FV among rural students in this region is low, and the frequency of SSB is high, when compared with national recommendations. [ABSTRACT FROM AUTHOR]

Introduction Health warning labels (HWLs) on tobacco packaging can be used to provide smoking cessation information, but the impact of this information is not well understood. Methods Online consumer panels of adult smokers from Canada, Australia and Mexico were surveyed in September 2012, January 2013 and May 2013; replenishment was used to maintain sample sizes of 1000 participants in each country at each wave. Country-stratified logistic Generalised Estimating Equation (GEE) models were estimated to assess correlates of citing HWLs as a source of information on quitlines and cessation websites. GEE models also regressed having called the quitline, and having visited a cessation website, on awareness of these resources because of HWLs. Results At baseline, citing HWLs as a source of information about quitlines was highest in Canada, followed by Australia and Mexico (33%, 19% and 16%, respectively). Significant increases over time were only evident in Australia and Mexico. In all countries, citing HWLs as a source of quitline information was significantly associated with self-report of having called a quitline. At baseline, citing HWLs as a source of information about cessation websites was higher in Canada than in Australia (14% and 6%, respectively; Mexico was excluded because HWLs do not include website information), but no significant changes over time were found for either country. Citing HWLs as a source of information about cessation websites was significantly associated with having visited a website in both Canada and Australia. Conclusions HWLs are an important source of cessation information. [ABSTRACT FROM AUTHOR]

Dementia-related continuing education opportunities are important for rural primary health care (PHC) professionals given scarce specialized resources. This report explores the initial perceptions and continuing education needs of rural interprofessional memory clinic team members and other PHC professionals related to a short series of dementia-related education webinars. Three webinars on separate topics were delivered over an 8-month period in 2020 in Saskatchewan, Canada. The research design involved analysis of webinar comments and post-webinar survey data. Sixty-eight individuals participated in at least one webinar, and 46 surveys were completed. Rural memory clinic team members accounted for a minority of webinar participants and a majority of survey respondents. Initial perceptions were positive, with webinar topics and interactivity identified as the most effective aspects. Continuing education needs were mainly aligned with professional roles; however, some overlap of interests occurred. Future webinars will further explore learning needs within an interprofessional environment. [ABSTRACT FROM AUTHOR]

Background: Hand osteoarthritis is a common and disabling problem without effective therapies. Accumulating evidence suggests the role of local inflammation in causing pain and structural progression in hand osteoarthritis, and hand osteoarthritis with synovitis is a commonly encountered clinical phenotype. Methotrexate is a well-established, low-cost, and effective treatment for inflammatory arthritis with a well-described safety profile. The aim of this multicentre, randomised, double-blind, placebo-controlled trial is to determine whether methotrexate reduces pain over 6 months in patients with hand osteoarthritis and synovitis.Methods: Ninety-six participants with hand osteoarthritis and synovitis will be recruited through the Osteoarthritis Clinical Trial Network (Melbourne, Hobart, Adelaide, and Perth), and randomly allocated in a 1:1 ratio to receive either methotrexate 20 mg or identical placebo once weekly for 6 months. The primary outcome is pain reduction (assessed by 100 mm visual analogue scale) at 6 months. The secondary outcomes include changes in physical function and quality of life assessed using Functional Index for Hand Osteoarthritis, Australian Canadian Osteoarthritis Hand Index, Health Assessment Questionnaire, Michigan Hand Outcomes Questionnaire, Short-Form-36, tender and swollen joint count, and grip strength, and structural progression assessed using progression of synovitis and bone marrow lesions from magnetic resonance imaging and radiographic progression at 6 months. Adverse events will be recorded. The primary analysis will be by intention to treat, including all participants in their randomised groups.Discussion: This study will provide high-quality evidence to address whether methotrexate has an effect on reducing pain over 6 months in patients with hand osteoarthritis and synovitis, with major clinical and public health importance. While a positive trial will inform international clinical practice guidelines for the management of hand osteoarthritis, a negative trial would be highly topical and change current trends in clinical practice.Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR), ACTRN12617000877381. Registered 15 June 2017, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373124. [ABSTRACT FROM AUTHOR]

Background: Although much research has focused on nurses' retirement intentions, little is known about nurses who formally retire yet continue to practice, particularly in rural and remote settings where mobilization of all nurses is needed to assure essential health services. To optimize practice and sustain the workforce stretched thin by the COVID-19 pandemic, it is necessary to understand what it means for retired registered nurses (RNs) and licensed practical nurses (LPNs) to work after retirement. This study explored what nursing practice means for RNs and LPNs who have formally retired but continue to practice in rural and remote communities. Methods: A pan-Canadian cross-sectional survey conducted in 2014–2015 of nurses in rural and remote Canada provided data for analysis. Textual responses from 82 RNs and 19 LPNs who indicated they had retired but were occasionally employed in nursing were interpreted hermeneutically. Results: Retired nurses who continued to practice took on new challenges as well as sought opportunities to continue to learn, grow, and give back. Worklife flexibility was important, including having control over working hours. Nurses' everyday practice was inextricably tied up with their lives in rural and remote communities, with RNs emphasizing serving their communities and LPNs appreciating community recognition and the family-like character of their work settings. Conclusions: Retired nurses who continue to work in nursing see retirement as the next phase in their profession and a vital way of engaging with their rural and remote communities. This study counters the conventional view of retaining retired nurses only to combat nursing shortages and alleviate a knowledge drain from the workplace. Rural and remote nurses who retire and continue working contribute to their workplaces and communities in important and innovative ways. They can be characterized as dedicated, independent, and resilient. Transitioning to retirement in rural and remote practice can be re-imagined in ways that involve both the community and the workplace. Supporting work flexibility for retired nurses while facilitating their practice, technological acumen, and professional development, can allow retired nurses to contribute their joy of being a nurse along with their extensive knowledge and in-depth experience of nursing and the community. [ABSTRACT FROM AUTHOR]

Background We examined clinically significant substance use among homeless or vulnerably housed persons in three Canadian cities and its association with residential stability over time using data from the Health and Housing in Transition study. Methods In 2009, 1190 homeless or vulnerably housed individuals were recruited in three Canadian cities and followed for 4 years. We collected information on housing and incarceration history, drug and alcohol use, having a primary care provider at baseline and annually for 4 years. Participants who screened positive for substance use at baseline were included in the analyses. We used a generalized logistic mixed effect regression model to examine the association between clinically significant substance use and residential stability, adjusting for confounders. Results Initially, 437 participants met the criteria for clinically significant substance use. The proportion of clinically significant substance use declined, while the proportion of participants who achieved residential stability increased over time. Clinically significant substance use was negatively associated with achieving residential stability over the 4-year period (AOR 0.7; 95% CI 0.57, 0.86). Conclusions In this cohort of homeless or vulnerably housed individuals, clinically significant substance use was negatively associated with achieving residential stability over time, highlighting the need to better address substance use in this population. [ABSTRACT FROM AUTHOR]

BACKGROUND: Diabetes is a prevalent chronic condition that poses a major burden for patients and the health care system. Evidence suggests that patient engagement in self-care improves diabetes control and reduces the risk of complications. To provide effective interventions that aim to improve empowerment processes relating to diabetes, a comprehensive and valid measure of empowerment is needed. This article details the development and validation of the McGill Empowerment Assessment–Diabetes (MEA-D). METHODS: The development and validation of the MEA-D questionnaire comprised three steps: item generation, qualitative face validation, and factorial content validation. An initial version was created by combining existing items and inductively generated items. Items were mapped to an empowerment framework with four domains: attitude, knowledge, behavior, and relatedness. Semi-structured interviews were conducted with 21 adults living with diabetes to assess face validity. The questionnaire was revised by a team of clinicians, researchers, and patient-partners. Factorial content validation was then performed using responses from 300 adult Canadians living with type 1 or type 2 diabetes. RESULTS: The final version of the MEA-D contained 28 items. A moderately good item-domain correlation was found between the individual items within the four domains. Cronbach's α was 0.81 (95% CI 0.78–0.85) for attitude, 0.73 (95% CI 0.67–0.79) for knowledge, 0.84 (95% CI 0.81–0.87) for behavior, and 0.81 (95% CI 0.77–0.84) for relatedness. CONCLUSION: The evaluation of diabetes programs demands a validated measure of empowerment. We developed the MEA-D to address this need. The MEA-D may be adapted to measure patients' empowerment regarding other chronic health conditions. [ABSTRACT FROM AUTHOR]

In the context of low consumption of vegetables and fruits and milk and alternatives among Canadian mothers and children, novel strategies are needed to improve maternal and child nutrition. This study evaluated the long‐term effects of an evidence‐informed healthy eating blog on dietary intakes and food‐related behaviours of mothers and their child. The study presents a secondary outcome analysis of a randomised controlled trial in which 84 mothers (mean age of 37.6 ± 6.7 years) of 2‐ to 12‐year‐old children living in Quebec City, Canada, were randomly assigned to a dietary intervention delivered through a healthy eating blog written by a registered dietitian (RD; n = 42) or a control group (n = 42) during a period of 6 months. Dietary intakes, maternal eating behaviours, food parenting practices, and body weight were measured at baseline, 3 months, at the end of the intervention (6 months), and 6‐month post‐intervention (12 months). Differences between groups were assessed with mixed linear models. Globally, this study found no evidence of long‐term differences in mean dietary intakes in mothers exposed to the blog and their children as well as other food‐related outcomes and body weight compared with the control condition. Potential predictors of adherence to dietary recommendations in mothers and children (e.g., involvement of children in household food activities) were identified. In conclusion, a healthy eating blog written by an RD did not result in evidence of any long‐term differences in dietary intakes and food‐related behaviours in mothers and their children compared with the control condition. [ABSTRACT FROM AUTHOR]

Background: The McMaster Health Utilities Index Mark 3 (HUI3) is a generic multi-attribute, preference-based system for assessing health-related quality of life (HRQOL). This study describes the translation procedures and cultural adaptation of the Japanese HUI3 and its measurement properties in a community sample. Methods: The Japanese HUI3 was developed through forward and back translations in cooperation with the developers of the HUI. Acceptability, comprehensibility of questionnaires, and test-retest reliability were assessed. In a community survey of a total of 3860 people (age: 41 ± 14.3, male/female: 2651/1209), the Canadian scoring function was used to calculate utility scores. Construct validity was assessed by examining the relationship between 20 personal characteristics and utility scores. Results: Linear regression estimates demonstrated a significant negative relation between HUI3 utility score and low education, male gender, poor interpersonal relationships, older age, and a higher number of chronic diseases. Single-attribute utility scores were associated with chronic conditions in the manner expected. The community samples were relatively healthy. More than 90% of the respondents were distributed in levels 1 and 2 in all attributes except cognition. Interpretability of utility score was assessed by estimation of the relationship between visual analogue scale (VAS) and the self-rated health and utility score. Independence of attributes was assessed. For only 3 of the 28 possible cross-comparisons among the 8 attributes were correlations coefficients greater than 0.25. Conclusion: Translation and adaptation of the HUI3 questionnaire into Japanese was successful, but the sample size and selection bias limit the interpretation of our study conclusions. [ABSTRACT FROM AUTHOR]

Background: Multimorbidity, the co-existence of 2+ (or 3+) chronic diseases in an individual, is an increasingly common global phenomenon leading to reduced quality of life and functional status, and higher healthcare service use and mortality. There is an urgent need to develop and test new models of care that incorporate the components of multimorbidity interventions recommended by international organizations, including care coordination, interdisciplinary teams, and care plans developed with patients that are tailored to their needs and preferences. Purpose: To determine the effectiveness of a 6-month, community-based, multimorbidity intervention compared to usual home care services for community-dwelling older adults (age 65+ years) with multimorbidity (3+ chronic conditions) that were newly referred to and receiving home care services. Methods: A pragmatic, parallel, two-arm randomized controlled trial evaluated the intervention, which included in-home visits by an interdisciplinary team, personal support worker visits, and monthly case conferences. The study took place in two sites in central Ontario, Canada. Eligible and consenting participants were randomly allocated to the intervention and control group using a 1:1 ratio. The participants, statistician/analyst, and research assistants collecting assessment data were blinded. The primary outcome was the Physical Component Summary (PCS) score of the 12-Item Short-Form health survey (SF-12). Secondary outcomes included the SF-12 Mental Component Summary (MCS) score, Center for Epidemiological Studies of Depression (CESD-10), Generalized Anxiety Disorder (GAD-7), Self-Efficacy for Managing Chronic Disease, and service use and costs. Analysis of covariance (ANCOVA) tested group differences using multiple imputation to address missing data, and non-parametric methods explored service use and cost differences. Results: 59 older adults were randomized into the intervention (n = 30) and control (n = 29) groups. At baseline, groups were similar for the primary outcome and number of chronic conditions (mean of 8.6), but the intervention group had lower mental health status. The intervention was cost neutral and no significant group differences were observed for the primary outcome of PCS from SF-12 (mean difference: −4.94; 95% CI: −12.53 to 2.66; p = 0.20) or secondary outcomes. Conclusion: We evaluated a 6-month, self-management intervention for older adults with multimorbidity. While the intervention was cost neutral in comparison to usual care, it was not found to improve the PCS from SF-12 or secondary health outcomes. Recruitment and retention challenges were significant obstacles limiting our ability to assess intervention effectiveness. Yet, the intervention was grounded in internationally-endorsed recommendations and implemented in a practice setting (home care) viewed as a key upstream resource fostering independence in older adults. These features collectively support the identification of ways to recruit/retain older adults and test alternative implementation strategies for interventions that are based on sound principles of multimorbidity management. [ABSTRACT FROM AUTHOR]

Objective: This study examined accessibility of communication tools in the workplace, use of education to update nursing knowledge, and use of information to make specific decisions in practice among registered nurses (RNs) and licensed practical nurses (LPNs) in rural and remote communities in Canada. Methods: Data were analyzed from the cross-sectional survey, "Nursing Practice in Rural and Remote Canada II," of regulated nurses practicing in all provinces and territories of Canada. Data were collected from April 2014 to August 2015. Results: The survey was completed by 3,822 of 9,622 nurses (40% response), and the present analysis was conducted with a subsample of 2,827 nurses. High-speed Internet was the most accessible communication tool, and nurses used "online/electronic education" more often than "in-person education" to update their nursing knowledge. Internet searches were used more often than several other online/electronic sources to inform decision making. Compared to LPNs, RNs reported greater workplace access to most communication tools and greater use of online/electronic education as well as information sources in online/electronic and print formats. Compared to nurses in community-based health care and hospital settings, nurses in long-term care settings reported lower access to most communication tools, lower use of online/electronic and in-person education, and lower use of online/electronic information. Conclusions: Access to continuing education and up-to-date information is important for effective patient care. This study points to a need for further research on the continuing education and information needs of rural and remote RNs and LPNs, and on their capacity to incorporate and apply new knowledge in practice. [ABSTRACT FROM AUTHOR]

Objective: To determine the prevalence and correlates of healthy vitamin D status in lactating Inuit women living in remote regions of the Arctic.Design: Cross-sectional.Setting: Households were selected randomly in thirty-six communities of Nunavut, Nunatsiavut and Inuvialuit Settlement Region. Dietary intake was assessed using a 24 h recall and an FFQ. Anthropometric measurements, household living conditions, supplement use and health status were assessed. In fasting samples, serum 25-hydroxyvitaimn D (25(OH)D) was measured using a chemiluminescent assay (LIAISON; Diasorin Inc.).Subjects: Lactating Inuit women participating in the 2007-2008 International Polar Year Inuit Health Survey conducted in the months of August to October.Results: Among participants (n 34), 8·8, 26·5 and 50·0 % had 25(OH)D concentrations at or above 75, 50 and 40 nmol/l, respectively. More than one-third of participants did not consume traditional foods during the previous day and only 11·3 % of total energy intake was derived from traditional foods. Only 14·7 % of the sample consumed the daily number of milk servings recommended by Canada's Food Guide (two servings) for First Nations, Inuit and Métis. Using multivariable logistic regression to examine 25(OH)D≥40 nmol/l, only higher body fat was inversely correlated with 25(OH)D concentration.Conclusions: The present study is the first to assess simultaneously vitamin D status and other known factors that affect it among lactating Inuit women living in remote communities in the Arctic. Healthy maternal vitamin D status was observed in 25 % of participants during the late summer and early autumn. This requires further assessment in a larger sample spanning more seasons. [ABSTRACT FROM AUTHOR]

Background Physical activity ( PA) is beneficial for all people, yet people affected by multiple sclerosis ( MS) find regular PA challenging. These people may include individuals with the disease who have moderate-to-severe disability and their family caregivers. For researchers and clinicians to effectively promote PA among caregiver/care-recipient dyads with moderate-to-severe MS, a comprehensive understanding of the shared PA experiences of these dyads would be beneficial. Objective We explored shared experiences of caregiver/care-recipient dyads affected by moderate-to-severe MS about PA and directions for intervention. Methods Six focus groups with 23 people with moderate-to-severe MS and 12 family caregivers were conducted. Data were analysed using a constant comparative approach. Results Three major themes emerged as follows: (i) PA is a continuum, (ii) cycle of disengagement and (iii) cycle of adjustment. The first theme captured the dyads understanding that PA falls along a continuum ranging from highly structured to unstructured activities. Cycle of disengagement captured the experiences of dyads engaging in little or no PA. These dyads perceived internal and external issues as drivers of the cycle of disengagement, while availability of supportive programmes and services or people helped the dyads to break out of the cycle. When the cycle of disengagement was broken, the dyads described moving towards the cycle of adjustment, where they were able to learn skills and take action to incorporate PA into daily routines. Conclusion This research highlights the need to adopt an integrative approach that acknowledges the caregiver/care-recipient dyad with moderate-to-severe MS as a focus for PA intervention. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Psychiatry 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.)

Copyright of Canadian Journal of Psychiatry 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.)

BACKGROUND: Polybrominated diphenyl ethers (PBDEs) are flame retardants found in North American household products during the past four decades. These chemicals leach out in dust as products age, exposing individuals daily through inhalation and ingestion. Animal studies suggest that PBDEs disrupt sex hormones and adversely affect development of the reproductive system. OBJECTIVES: In the present study, we examined whether there is a link between maternal hair PBDE concentrations and the risk of cryptorchidism (undescended testes) in male infants; testis descent is known to be dependent on androgens. METHODS: Full-term male infants were recruited through clinics in Montreal, Toronto, and London, Canada. Boys with cryptorchidism at 3-18 months of age (n=137) were identified by pediatric urologists and surgeons; similar-aged controls (n=158) had no genitourinary abnormalities as assessed by pediatricians. Eight BDE congeners (BDE-28, -47, -99, -100, -153, -154, -183, -209) were measured by GC-MS (gas chromatography-mass spectrometry) in maternal hair samples collected at the time of recruitment. RESULTS: The ∑PBDE geometric mean for maternal hair was 45.35 pg/mg for controls and 50.27 pg/mg for cases; the concentrations of three BDEs (BDE-99, -100, and -154) were significantly higher in cases than controls in unadjusted models. In adjusted models, every 10-fold increase in the concentration of maternal hair BDE-99 [OR=2.53 (95% CI: 1.29, 4.95)] or BDE-100 [OR=2.45 (95% CI: 1.31, 4.56)] was associated with more than a doubling in the risk of cryptorchidism. BDE-154 [OR=1.88 (95% CI: 1.08, 3.28)] was also significant. CONCLUSIONS: Our results suggest that maternal exposure to BDE-99, -100, and -154 may be associated with abnormal migration of testes in the male fetus. This may be due to the anti-androgenic properties of the PBDEs. [ABSTRACT FROM AUTHOR]

Background: Walking, and in particular, outdoor walking, is the most common form of physical activity for older adults. To date, no study investigated the association between the neighborhood built environment and physical activity habits of older adults of low SES. Thus, our overarching aim was to examine the association between the neighborhood built environment and the spectrum of physical activity and walking for transportation in older adults of low socioeconomic status.Methods: Cross-sectional data were from the Walk the Talk Study, collected in 2012. Participants (n = 161, mean age = 74 years) were in receipt of a rental subsidy for low income individuals and resided in neighbourhoods across Metro Vancouver, Canada. We used the Street Smart Walk Score to objectively characterize the built environment main effect (walkability), accelerometry for objective physical activity, and the Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaire to measure walking for transportation. We used regression analyses to examine associations of objectively measured physical activity [total volume, light intensity and moderate intensity physical activity (MVPA)] and self-reported walking for transportation (any, frequency, duration) with walkability. We adjusted analyses for person- and environment-level factors associated with older adult physical activity.Results: Neighbourhood walkability was not associated with physical activity volume or intensity and self-reported walking for transportation, with one exception. Each 10-point increase in Street Smart Walk Score was associated with a 45% greater odds of any walking for transportation (compared with none; OR = 1.45, 95% confidence interval = 1.18, 1.78). Sociodemographic, physical function and attitudinal factors were significant predictors of physical activity across our models.Conclusions: The lack of associations between most of the explored outcomes may be due to the complexity of the relation between the person and environment. Given that this is the first study to explore these associations specifically in older adults living on low income, this study should be replicated in other settings. [ABSTRACT FROM AUTHOR]

Background To examine citizens' agreement with policy options to reduce social inequalities in health and socio-demographic factors associated with support for these policies. Methods A random digit dialling sample of 16 125 households with access to a landline telephone was conducted in Saskatoon, Canada in 2013. Saskatoon is located in the Canadian prairies and had a population of 222 189 in 2011. A total of 1002 individuals aged 18 or older answered a questionnaire indicating their support for policies to improve health equity. Socio-demographic variables of interest were household income, education, occupation and ethnicity. Latent class analysis and logistic regression analyses were conducted. Results The latent class analysis showed that 37% of respondents were in the selective agreement group, while 63% were in the high agreement group. The selective agreement group showed lower policy support compared with the high agreement group, in particular for guaranteed annual income, welfare for adults and parents with children, lower tuition for post-secondary students. In the final logistic regression model, socioeconomic factors associated with the likelihood of being in the selective agreement group were: age >40 years, male, Caucasian ethnicity and higher household income. Conclusions Residents support for policies to reduce poverty and increase funding for education, creation of health promotion and disease prevention programmes. However, support for these policies is different across social groups. [ABSTRACT FROM AUTHOR]

Background: The Canadian 24-h movement guidelines were developed with the hope of improving health and future health outcomes in children and youth. The purpose of this study was to evaluate adherence to the 3 recommendations most strongly associated with health outcomes in new 24-h movement guidelines and their relationship with adiposity (obesity and body mass index z-score) across countries participating in the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE). Methods: Cross-sectional results were based on 6128 children aged 9-11 years from the 12 countries of ISCOLE. Sleep duration and moderate-to-vigorous physical activity (MVPA) were assessed using accelerometry. Screen time was measured through self-report. Body weight and height were measured. Body mass index (BMI, kg ⋅ m-2) was calculated, and BMI z-scores were computed using age- and sex-specific reference data from the World Health Organization. Obesity was defined as a BMI z-score > +2 SD. Meeting the overall 24-h movement guidelines was defined as: 9 to 11 h/night of sleep, ≤2 h/day of screen time, and at least 60 min/day of MVPA. Age, sex, highest parental education and unhealthy diet pattern score were included as covariates in statistical models. Associations between meeting vs. not meeting each single recommendation (and combinations) with obesity were assessed with odds ratios calculated using generalized linear mixed models. A linear mixed model was used to examine the differences in BMI z-scores between children meeting vs. not meeting the different combinations of recommendations. Results: The global prevalence of children meeting the overall recommendations (all three behaviors) was 7%, with children from Australia and Canada showing the highest adherence (15%). Children meeting the three recommendations had lower odds ratios for obesity compared to those meeting none of the recommendations (OR = 0.28, 95% CI 0.18-0.45). Compared to not meeting the 24-h movement recommendations either independently or combined, meeting them was significantly associated with a lower BMI z-score. Whenever the MVPA recommendation was included in the analysis the odds ratios for obesity were lower. Conclusions: For ISCOLE participants meeting these 3 healthy movement recommendations the odds ratios of being obese or having high BMI z-scores were lower. However, only a small percentage of children met all recommendations. Future efforts should aim to find promising ways to increase daily physical activity, reduce screen time, and ensure an adequate night's sleep in children. Trial registration: The International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) was registered at ClinicalTrials.gov (Identifier NCT01722500) (October 29, 2012). [ABSTRACT FROM AUTHOR]