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OBJECTIVE The purpose of this systematic review is to explore what is known about Indigenous peoples' positive experiences with culturally safe health care. INTRODUCTION Research indicates that Indigenous people often experience stigma and discrimination from non-Indigenous health care providers when accessing health care services. One approach that has been put forward to address Indigenous health inequities is cultural safety. Studies have been conducted to identify what comprises culturally safe care for Indigenous people, however, many of these studies target the health care provider's perspective, rather than the perspective of the Indigenous person who is receiving the care. INCLUSION CRITERIA This review will consider studies that involve Indigenous peoples' positive experiences with culturally safe health care from any study setting. Studies that present relevant qualitative findings including descriptions, examples, or stories about how a health care provider enacted cultural safety from Indigenous perspectives will be considered. METHODS MEDLINE, CINAHL, Embase, PsycINFO, First Nations Periodical Index, the Native Health Database, the Indigenous Studies Portal, and the Arctic and Antarctic Regions Database will be searched for published studies. The search for unpublished studies will include Google and Google Scholar, ProQuest Dissertations and Theses, and OpenGrey. Databases will be searched from 1988 onward and only studies published in English will be included. The JBI systematic review guidelines will be followed. The JBI process of meta-aggregation will be used to identify categories and synthesize findings. The ConQual approach will be used to assess confidence in the review findings. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42020173003.

The Medical College of Wisconsin (MCW) COVID-19 Vaccination Program facilitated early vaccination efforts in metro Milwaukee, Wisconsin from December, 2020 through April, 2021. Goals of the program were to work with clinical partners to ensure rapid vaccination availability for the institution's frontline workforce, to support state public health agencies in offering a vaccination opportunity for underserved and higher education community members, and to train vaccinators. A key component of the program was the MCW COVID-19 Vaccination Clinic, and 88% of MCW's workforce was fully immunized against COVID-19 with the 2-dose, mRNA vaccine by April 30, 2021. Within the MCW clinic, 219 pharmacy and medical students learned to administer vaccinations, and 12,450 community vaccinations were administered.

Background Violence towards women with disabilities is most commonly perpetrated by current or former intimate partners and more than half of disabled women experience intimate partner violence in their lifetime. Disabilities differ by presence, type, and complexity, yet are commonly researched collectively. A more nuanced understanding of the relationship between intimate partner violence and episodic disability is required to better support women living with these concurrent challenges. The objective of this scoping review is to investigate and synthesize the literature reporting on intimate partner violence for women living with an episodic disability to identify key concepts and knowledge gaps on this topic. Ultimately, this review aims to improve health services for this stigmatized group of women with episodic disabilities. Methods This scoping review will consider all studies that focus on women (18 years of age or older) who have experienced intimate partner violence and have an episodic disability. Episodic disabilities will include multiple sclerosis, chronic fatigue syndrome, fibromyalgia, lupus, or rheumatoid arthritis. The broad review question is what is known about intimate partner violence within the context of women living with an episodic disability? Databases to be searched include MEDLINE (OVID), CINAHL, Embase, PsychInfo, and Scopus with no limits on language or time frame. Joanna Briggs Institute methodology will guide this scoping review to address the review questions outlined in the protocol. For papers that meet the inclusion criteria, data will be extracted, and findings will be presented in tables and narrative form. A PRISMA table will be included to enhance the transparency of the process. A descriptive qualitative approach to analysis will be conducted following Braun and Clarke’s reflexive thematic analysis. The findings of the scoping review will be presented through a thematic narrative. Discussion Findings from this review will be used to identify important priorities for future research based on knowledge gaps and inform both health care practices and health and social interventions for women living with intimate partner violence and episodic disabilities.

REVIEW QUESTION/OBJECTIVES The purpose of this scoping review is to systematically identify and describe literature that uses a health equity-oriented (HEO) approach for preventing and reducing the harms of stigma or overdose for people who use illicit drugs or misuse prescription opioids.The question of the review is: What is currently known about the use of an HEO approach for preventing the harms of stigma or overdose when people use illicit or street drugs, or use prescription opioids for other than their intended purposes?Specifically, the review objectives are.

Background: It has been hypothesised that intrauterine exposures are important for subsequent prostate cancer risk. Prior epidemiological studies have used birthweight as a proxy of cumulative intrauterine exposures to test this hypothesis, but results have been inconsistent partly because of limited statistical power. Methods: We investigated birthweight in relation to prostate cancer in the Medical Research Council (MRC) National Survey of Health and Development (NSHD) using Cox proportional hazards models. We then conducted a meta-analysis of birthweight in relation to total and aggressive/lethal prostate cancer risks, combining results from the NSHD analysis with 13 additional studies on this relationship identified from a systematic search in four major scientific literature databases through January 2015. Results: Random-effects models found that per kg increase in birthweight was positively associated with total (OR=1.02, 95% confidence interval (95% CI)=1.00, 1.05; I2=13%) and aggressive/lethal prostate cancer (OR=1.08, 95% CI=0.99, 1.19; I2=40%). Sensitivity analyses restricted to studies with birthweight extracted from medical records demonstrated stronger positive associations with total (OR=1.11, 95% CI=1.03, 1.19; I2=0%) and aggressive/lethal (OR=1.37, 95% CI=1.09, 1.74; I2=0%) prostate cancer. These studies heavily overlapped with those based in Nordic countries. Conclusions: This study provides evidence that heavier birthweight may be associated with modest increased risks of total and aggressive/lethal prostate cancer, which supports the hypothesis that intrauterine exposures may be related to subsequent prostate cancer risks.

Work relationships between registered nurses (RNs) and practical nurses (LPNs) are changing as new models of nursing care delivery are introduced to create more flexibility for employers. In Canada, a team-based, hospital nursing care delivery model, known as Care Delivery Model Redesign (CDMR), redesigned a predominantly RN-based staffing model to a functional team consisting of fewer RNs and more LPNs. The scope of practice for LPNs was expanded, and unregulated health care assistants introduced. This study began from the standpoint of RNs and LPNs to understand their experiences working on redesigned teams by focusing on discourses activated in social settings. Guided by institutional ethnography, the conceptual and textual resources nurses are drawing on to understand these changing work relationships are explicated. We show how the institutional goals embedded in CDMR not only mediate how nurses work together, but how they subordinate holistic standards of nursing toward fragmented, task-oriented, divisions of care.

Resume Objectif Offrir des conseils factuels aux femmes et a leurs fournisseurs de soins de sante quant a la prise en charge de l'oubli ou de la prise differee d'une ou de plusieurs doses de contraceptif hormonal, afin de prevenir les grossesses non souhaitees. Resultats Des recherches ont ete menees dans Medline, PubMed et la base de donnees Cochrane afin d'en tirer les articles, publies en anglais entre 1974 et 2007, qui portaient sur les modes de contraception hormonale disponibles au Canada et pouvant faire l'objet d'un oubli ou d'une prise differee. Les publications et les declarations de principe pertinentes issues d'organisations de planification familiale et de sante genesique competentes ont egalement ete analysees. La qualite des resultats est evaluee au moyen des criteres elabores par le Groupe d'etude canadien sur les soins de sante preventifs. Avantages, desavantages et couts La presente opinion de comite aidera les fournisseurs de soins de sante a offrir des renseignements clairs aux femmes n'ayant pas fait preuve d'observance quant au mode de contraception hormonale qu'elles utilisent, dans le but de prevenir les grossesses non souhaitees. Commanditaire : La Societe des obstetriciens et gynecologues du Canada. Declarations sommaires 1.Les consignes destinees aux femmes qui oublient de prendre une ou plusieurs doses de contraceptif hormonal se sont jusqu'ici averees complexes et ces femmes ne les comprennent pas correctement. (I) 2.Le risque d'ovulation le plus eleve se manifeste lorsque l'intervalle sans hormones se prolonge au-dela de sept jours, que cette prolongation soit attribuable au report de l'utilisation d'un nouvel emballage de contraceptifs hormonaux combines ou a l'oubli de doses d'hormones actives au cours de la premiere ou de la troisieme semaine du cycle d'utilisation de contraceptifs hormonaux combines. (II) Une ovulation survient rarement apres sept jours consecutifs d'utilisation de contraceptifs hormonaux combines. (II) Recommandations 1.Les fournisseurs de soins de sante devraient, dans le cadre du counseling sur la contraception, offrir des consignes claires et simples, tant de vive voix que sous forme ecrite, quant a la prise en charge de l'oubli de doses de contraceptif hormonal. (III-A) 2.Les fournisseurs de soins de sante devraient offrir aux femmes des ressources telephoniques / electroniques auxquelles elles peuvent se referer a la suite de l'oubli ou de la prise differee de doses de contraceptif hormonal. (III-A) 3.Afin d'eviter une hausse du risque de grossesse non souhaitee chez les utilisatrices de contraceptifs hormonaux combines, l'intervalle sans hormones ne devrait pas etre prolonge au-dela de sept jours. (II-A) 4.Une contraception d'appoint devrait etre mise en oeuvre a la suite de l'oubli d'une dose au cours de la premiere semaine du cycle de contraception hormonale, et ce, jusqu'a ce que sept jours consecutifs d'utilisation correcte du contraceptif hormonal en question se soient ecoules. Lorsque l'oubli de doses de contraceptif hormonal combine survient au cours de la deuxieme ou de la troisieme semaine du cycle de contraception hormonale, l'intervalle sans hormones devrait etre elimine en ce qui concerne le cycle en question. (III-A) 5.La mise en oeuvre d'une contraception d'urgence et d'une contraception d'appoint peut s'averer requise dans certains cas d'oubli de doses de contraceptif hormonal, particulierement lorsque l'intervalle sans hormones s'est prolonge au-dela de sept jours. (III-A) 6.Une contraception d'appoint devrait etre mise en oeuvre a la suite de l'oubli de trois doses / jours consecutifs de contraceptif hormonal combine ou plus au cours de la deuxieme et de la troisieme semaine du cycle de contraception, et ce, jusqu'a ce que sept jours consecutifs d'utilisation correcte du contraceptif hormonal en question se soient ecoules. Pour des raisons pratiques, l'intervalle sans hormones prevu devrait etre elimine dans de telles circonstances. (II-A) 7.La mise en oeuvre d'une contraception d'urgence est rarement indiquee a la suite de l'oubli de doses de contraceptif hormonal combine au cours de la deuxieme ou de la troisieme semaine du cycle, a moins que l'on ait affaire a des omissions repetees ou qu'aucune contraception d'appoint n'ait ete mise en oeuvre a la suite des oublis en question. En presence d'omissions repetees, la mise en oeuvre d'une contraception d'urgence peut s'averer requise et une contraception d'appoint devrait etre utilisee. Dans de telles circonstances, les professionnels de la sante devraient conseiller les femmes quant a l'adoption d'un mode de contraception moins exigeant sur le plan de l'observance. (III-A)

To review current knowledge about emergency contraception (EC), including available options, their modes of action, efficacy, safety, and the effective provision of EC within a practice setting.The combined estradiol-levonorgestrel (Yuzpe regimen) and the levonorgestrel-only regimen, as well as post-coital use of copper intrauterine devices, are reviewed.Efficacy in terms of reduction in risk of pregnancy, safety, and side effects of methods for EC and the effect of the means of access to EC on its appropriate use and the use of consistent contraception.Studies published in English between January 1998 and March 2010 were retrieved though searches of Medline and the Cochrane Database, using appropriate key words (emergency contraception, post-coital contraception, emergency contraceptive pills, post-coital copper IUD). Clinical guidelines and position papers developed by health or family planning organizations were also reviewed.The studies reviewed were classified according to criteria described by the Canadian Task Force on Preventive Health Care, and the recommendations for practice were ranked according to this classification (Table 1).These guidelines are intended to help reduce unintended pregnancies by increasing awareness and appropriate use of EC.The Society of Obstetricians and Gynaecologists of Canada. Summary Statements 1. Hormonal emergency contraception may be effective if used up to 5 days after unprotected intercourse. (II-2) 2. The earlier hormonal emergency contraception is used, the more effective it is. (II-2) 3. A copper IUD can be effective emergency contraception if used within 7 days after intercourse. (II-2) 4. Levonorgestrel emergency contraception regimens are more effective and cause fewer side effects than the Yuzpe regimen. (I) 5. Levonorgestrel emergency contraception single dose (1.5 mg) and the 2-dose levonorgestrel regimen (0.75 mg 12 hours apart) have similar efficacy with no difference in side effects. (I) 6. Of the hormonal emergency contraception regimens available in Canada, levonorgestrel-only is the drug of choice. (I) 7. A pregnancy that results from failure of emergency contraception need not be terminated (I) Recommendations 1. Emergency contraception should be used as soon as possible after unprotected sexual intercourse. (II-2A) 2. Emergency contraception should be offered to women if unprotected intercourse has occurred within the time it is known to be effective (5 days for hormonal methods and up to 7 days for a copper IUD). (II-2B) 3. Women should be evaluated for pregnancy if menses have not begun within 21 days following emergency contraception treatment. (III-A) 4. During physician visits for periodic health examinations or reproductive health concerns, any woman in the reproductive age group who has not been sterilized may be counselled about emergency contraception in advance with detailed information about how and when to use it. (III-C).

Two research studies explored rural nurses' experience with the provision of maternity care in rural British Columbia, Canada. Frontline nurses, managers, and health-care providers were interviewed and their practices observed. One of the main challenges identified by rural nurses was ensuring that a knowledgeable/skilled maternity or perinatal nurse was always available at the local hospital. Learning how to provide safe and supportive maternity care is difficult for nurses working in small rural hospitals today due to declining birth rates, increased workloads, and a decrease in opportunities for mentoring. Decisions about the allocation of time off and resources for rural nurses' continuing professional education (CPE) were structured by discourses of personal responsibility for "continuing competence." These institutional work processes increase the burden on rural nurses, negatively affecting their opportunities for CPE and their experiences of providing maternity care, with implications for both patient safety and nurse retention.

To provide evidence-based guidance for women and their health care providers on the management of missed or delayed hormonal contraceptive doses in order to prevent unintended pregnancy.Medline, PubMed, and the Cochrane Database were searched for articles published in English, from 1974 to 2007, about hormonal contraceptive methods that are available in Canada and that may be missed or delayed. Relevant publications and position papers from appropriate reproductive health and family planning organizations were also reviewed. The quality of evidence is rated using the criteria developed by the Canadian Task Force on Preventive Health Care.This committee opinion will help health care providers offer clear information to women who have not been adherent in using hormonal contraception with the purpose of preventing unintended pregnancy.The Society of Obstetricians and Gynaecologists of Canada. SUMMARY STATEMENTS: 1. Instructions for what women should do when they miss hormonal contraception have been complex and women do not understand them correctly. (I) 2. The highest risk of ovulation occurs when the hormone-free interval is prolonged for more than seven days, either by delaying the start of combined hormonal contraceptives or by missing active hormone doses during the first or third weeks of combined oral contraceptives. (II) Ovulation rarely occurs after seven consecutive days of combined oral contraceptive use. (II) RECOMMENDATIONS: 1. Health care providers should give clear, simple instructions, both written and oral, on missed hormonal contraceptive pills as part of contraceptive counselling. (III-A) 2. Health care providers should provide women with telephone/electronic resources for reference in the event of missed or delayed hormonal contraceptives. (III-A) 3. In order to avoid an increased risk of unintended pregnancy, the hormone-free interval should not exceed seven days in combined hormonal contraceptive users. (II-A) 4. Back-up contraception should be used after one missed dose in the first week of hormones until seven consecutive days of correct hormone use are established. In the case of missed combined hormonal contraceptives in the second or third week of hormones, the hormone-free interval should be eliminated for that cycle. (III-A) 5. Emergency contraception and back-up contraception may be required in some instances of missed hormonal contraceptives, in particular when the hormone-free interval has been extended for more than seven days. (III-A) 6. Back-up contraception should be used when three or more consecutive doses/days of combined hormonal contraceptives are missed in the second and third week until seven consecutive days of correct hormone use are established. For practical reasons, the scheduled hormone-free interval should be eliminated in these cases. (II-A) 7. Emergency contraception is rarely indicated for missed combined hormonal contraceptives in the second or third week of the cycle unless there are repeated omissions or failure to institute back-up contraception after the missed doses. In cases of repeated omissions of combined hormonal contraceptives, emergency contraception may be required, and back-up contraception should be used. Health care professionals should counsel women in these situations on alternative methods of contraception that do not demand such stringent compliance. (III-A).

With the recent introduction of preterm birth prevention programs there has been a shift in our understanding of what the presence of contractions during pregnancy means and a reconstituting of risk in ways that position increasing numbers of women at risk for preterm birth. This paper highlights the findings of a study exploring the influences of risk discourses on women's experiences of preterm labour. The primary goals of this institutional ethnographic study were to describe the effects of societal discourses, institutional structures, and nursing work processes on the everyday lives of childbearing women experiencing preterm labour. The findings suggest that risk discourses exert social control over pregnant women and result in fear, guilt, feelings of being judged or punished, and an overwhelming sense of personal responsibility for preventing preterm birth. The study also exposes ways in which biomedical constructions of risk and preterm labour affect the organization of health services, including nursing practice.

Eighteen musicians and nine nonmusicians judged the direction of tritone intervals between pairs of octave‐complex (Shepard) tones. The tones in each pair had the same spectral envelope centered on either C or F♯ in one of three octaves. Nine of the musicians sang the intervals on one‐half of the trial blocks instead of making the usual up/down judgments. Monte Carlo analysis revealed that 83% of the musicians and 33% of the nonmusicians showed a significant direction bias for regions of the chroma circle. This corroborates the notion of a chroma‐circle template of definite orientation [Deutsch et al., Mus. Perc. 5 (1987)], but suggests that musical training may play a greater role in either its establishment or access. Biases in upward judgments were toward the C‐chroma region, consistent with Deutsch’s [J. Acoust. Soc. Am. Suppl. 1 88, S139 (1990)] findings for native Californians as opposed to British. With the exception of one musician, envelope peak position had little effect on the results. In general, the two response modes, singing and up/down judgments, produced converging evidence.