Search

Racial microaggressions are defined as daily indignities directed towards disempowered racial groups that communicate hostile, derogatory, or negative racial slights (Sue et al. "American Psychologist," 62, 271-286, 2007b). The purpose of the present study was to investigate Indigenous Canadian university students' experiences of racial microaggresions and provide suggestions for culturally competent educational practices. The study utilized a qualitative method and involved a focus-group and follow-up interviews. Seven domains or themes emerged. These domains were: "overt discrimination"; "assumption of intellectual inferiority"; "assumption of criminality"; "invalidation or denial"; "second-class citizen"; "racial segregation"; and "myth of meritocracy". Implications for counselors and educators were discussed.

Background Potentially avoidable emergency department transfers (PAEDTs) and hospitalizations (PAHs) from long-term care (LTC) homes are two key quality improvement metrics. We aimed to: 1) Measure proportions of PAEDTs and PAHs in a Quebec sample; and 2) Compare them with those reported for the rest of Canada. Methods We conducted a repeated cross-sectional study of residents who were received at one tertiary hospital between April 2017 and March 2019 from seven LTC homes in Quebec, Canada. The MedUrge emergency department database was used to extract transfers and resident characteristics. Using published definitions, PAEDTs and PAHs were identified from principal emergency department and hospitalization diagnoses, respectively. PAEDT and PAH proportions were compared to those reported by the Canadian Institute for Health Information. Results A total of 1,233 transfers by 692 residents were recorded, among which 36.3% were classified as being potentially avoidable: 22.8% 'PAEDT only', 11.6% 'both PAEDT & PAH', and 1.9% 'PAH only'. Shortness of breath was the most common reason for transfer. Pneumonia was the most common diagnosis from the 'both PAEDT & PAH' category. PAEDTs and PAHs accounted for 95% and 37% of potentially avoidable transfers, respectively. Among 533 hospitalizations, 31.3% were PAHs. These proportions were comparable to the rest of Canada, with some differences in proportions of transfers due to congestive heart failure, urinary tract infection, and implanted device management. Conclusions PAEDTs far outweigh PAHs in terms of frequency, and their monitoring is important for quality assurance as they may inform LTC-level interventions aimed at their reduction. [ABSTRACT FROM AUTHOR]

We give an exploratory analysis of daily 10 meter wind speed averages for all weather stations in Alberta, Canada with observations from January 2008 to May 2019. The data is provided by the Alberta Climate Information Service (ACIS), Alberta Agriculture and Forestry. Our goal is to categorize the wind patterns in Alberta for the purpose of incorporating this knowledge into spatiotemporal modeling of wind across Alberta. We aim to identify the relationship between prevalent wind directions, geographical locations and seasons. We use seasonal clustering to identify stations with similar statistical properties. The linkage criterion between two sites is based on the Euclidean distance of the two-dimensional moments of their wind speed distributions. We identify four types of behavior emerging through the year, and give a seasonal summary of each behavior. We interpret the wind behaviors in terms of the terrain. [ABSTRACT FROM AUTHOR]

The refugee Odyssey is often not a linear, straightforward movement from point A to point B, from sending country to receiving one. Rather, it involves multiple paths, gateways, entry and exit points, and territories en route to the country of resettlement. Crucially, the journey involves not only mobility but also immobility and/or periods of stasis—breaks that are, in many cases, a natural part of the journey. Alongside this diversity of paths and movements, the refugee experience—understood in terms of the practices and acts of refugees en route—is also far from homogeneous. Each journey may well have an episodic character, where the course, direction, and periods of waiting for one asylum traveller can differ significantly from those of previous and/or future travellers—even if the departure point and destination are the same. Within this context, this article examines the breaks or periods of stasis that punctuate the refugee Odyssey, which we call mobistasis. We base our empirical findings on research conducted with people en route to resettlement in Canada via Turkey where they initially seek asylum and await resettlement. Drawing on fieldwork in Turkey and Canada between April 2014 and October 2016 and semi-structured interviews conducted with asylum travellers from non-European countries, the article illustrates how Turkey as the country of asylum is more than a space of mere 'transit'. It rather constitutes a space of mobistasis —stasis within movement—in the asylum voyage towards countries of resettlement. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess the validity of a 14-item mental health self-efficacy scale developed to assess the effectiveness of the Road to Mental Readiness (R2MR) – a program aimed at improving the well-being and mental health of Canadian Armed Forces (CAF) personnel. The validity of the scale was assessed through an analysis of data collected as part of a pilot study and a larger group randomized control trial (GRCT) on the effectiveness of R2MR administered to CAF noncommissioned member recruits during basic training. Using data collected for the pilot study (N = 276), an initial review of items indicated a need to eliminate two redundant items and two items that were weakly correlated with other scale items. A parallel analysis and exploratory factor analysis (EFA) conducted on the resulting 10-item scale pointed to a one-factor model with all items loading satisfactorily. Using data from the GRCT (N = 1962), a confirmatory factor analysis (CFA) was conducted to further assess the revised scale. This CFA suggested good model fit (Root Mean Square Error of Approximation of.07 and Standardized Root Mean Square Residual of.06). The revised scale had an alpha of.88, was very strongly correlated with the full scale (r =.97, p <.001), and significantly predicted perceived control and self-efficacy regarding accessing mental health care and intention to access care. [ABSTRACT FROM AUTHOR]

Introduction: Frailty is a condition of elderly characterized by increased vulnerability to stressful events. Frail patients are more likely to have adverse events. The purposes of this study were to define frailty in patients aged = 70 years with chronic coronary syndrome (CCS) and to evaluate mortality and prognostic significance of frailty in these patients. Methods: We included 99 patients, = 70 years old (mean age 74±5.3 years), with diagnosis of CCS. They were followed-up for up to 12 months. The frailty score was evaluated according to the Canadian Study of Health and Aging (CSHA). All patients were divided as frail or non-frail. The groups were compared for their characteristics and clinical outcomes. Results: Fifty patients were classified as frail, and 49 patients as non-frail. The 12-month Major Adverse Cardiac Events (MACE) rate was 69.4% in frail patients and 20% in non-frail patients. Frailty increases the risk for MACE as much as 3.48 times. Two patients died in the non-frail group and 11 patients died in the frail group. Frailty increases the risk for death as much as 6.05 times. When we compared the aforementioned risk factors by multivariate analysis, higher CSHA frailty score was associated with increased MACE and death (relative risk [RR] = 22.94, 95% confidence interval [CI] 3.33-158.19, P=0.001, for MACE; RR = 7.41, 95% CI 1.44-38.03, P=0.016, for death). Conclusion: Being a frail elderly CCS patient is associated with worse outcomes. Therefore, frailty score should be evaluated for elderly CCS patients as a prognostic marker. [ABSTRACT FROM AUTHOR]

Context: Among people living with dementia (PLWD), in-person care for ongoing follow-up and management may become challenging due to declining mobility and increasing reliance on caregivers. Family physicians (FPs) have been rapidly adopting virtual care (VC) which became vital with the COVID-19 pandemic. Objective: To describe prevalences of VC use among PLWD, their caregivers, and FPs (triads), determine factors associated with VC use, and explore FPs' perceptions of facilitators and barriers to VC provision. Study Design: Concurrent mixed-methods design. Setting: Canada. Population: PLWD, caregivers, and FPs. Methods: We analyzed the questions pertinent to VC in three nationwide cross-sectional surveys conducted with PLWD, caregivers, and FPs across Canada (October 2020 and March 2021). Measures: Virtual care is defined as two-way synchronous communication using a phone and/or a web camera. Factors included age, frequency seeing and receiving support for connecting FPs (PLWD/caregiver); years of practice, attachment to community or interdisciplinary teams, and training for care of elderly (FPs); gender, ethnicity, and urbanicity (population centre size > 100,000) for all participants. Analysis: Prevalences of VC provision by FPs and its uptake by PLWD and caregivers were described. Logistic regression models were used to determine factors associated with VC use. Inductive thematic analysis of open-ended questions explored FPs' perceptions of barriers and facilitators of providing VC. Results: 131 PLWD, 341 caregivers, and 125 FPs participated. Virtual care users were 61.2% of PLWD, 59.5% of caregivers, and 77.4% of FPs. The models for PLWD (included age and ethnicity) and caregivers (included gender, urbanicity, and receiving support to connect FP from a family member/friend) were inconclusive. Among FPs, having more than 20 years of practice was significantly associated with a decreased likelihood of providing VC when attachment to a community-based team was held constant (OR=0.23,95%CI:0.08-0.62, p<0.01). Care preferences (decision stage), office/family support (preparation stage), technology and family presence (execution stage), and remuneration for FPs (compensation stage) were the most recurring themes. Conclusions: Virtual primary dementia care uptake is substantial and depends on patient-caregiverphysician shared decision-making, interoperability in healthcare, support for triads before and during execution, and appropriate compensation. [ABSTRACT FROM AUTHOR]

Background: Mental disorders constitute a significant public health problem worldwide. Ensuring that those who need mental health services access them in an appropriate and timely manner is thus an important public health priority. We used data from 4 cross-sectional, nationally representative population health surveys that employed nearly identical methods to compare MHSU trends in the Canadian military versus comparable civilians.Method: The surveys were all conducted by Statistics Canada, approximately a decade apart (Military-2002, Military-2013, Civilian-2002, and Civilian-2012). The sample size for the pooled data across the surveys was 35,984. Comparisons across the 4 surveys were adjusted for differences in need in the 2 populations at the 2 time points.Results: Our findings suggested that first, in the Canadian military, there was a clear and consistent pattern of improvement (i.e., increase) in MHSU over the past decade across a variety of provider types. The magnitudes of the changes were large, representing an absolute increase of 7.15% in those seeking any professional care, corresponding to an 84% relative increase. Second, in comparable Canadian civilians, MHSU remained either unchanged or increased only slightly. Third, the increases in MHSU over time were consistently greater in the military than in the comparable civilian sample.Conclusions: Our findings point to advantages with respect to MHSU of the military mental health system over the civilian system in Canada; these advantages have widened substantially over time. These findings speak strongly to the potential impact of analogous changes in other health systems, both military and civilian. [ABSTRACT FROM AUTHOR]

Background: In the context of the Canadian mission in Afghanistan, substantial media attention has been placed on mental health and lack of access to treatment among Canadian Forces personnel. We compared trends in the prevalence of suicidal behaviour and the use of mental health services between Canadian military personnel and the general population from 2002 to 2012/13.Methods: We obtained data for respondents aged 18-60 years who participated in 4 nationally representative surveys by Statistics Canada designed to permit comparisons between populations and trends over time. Surveys of the general population were conducted in 2002 (n = 25 643) and 2012 (n = 15 981); those of military personnel were conducted in 2002 (n = 5153) and 2013 (n = 6700). We assessed the lifetime and past-year prevalence of suicidal ideation, plans and attempts, as well as use of mental health services.Results: In 2012/13, but not in 2002, military personnel had significantly higher odds of both lifetime and past-year suicidal ideation than the civilian population (lifetime: adjusted odds ratio [OR] 1.32, 95% confidence interval [CI] 1.17-1.50; past year: adjusted OR 1.34, 95% CI 1.09-1.66). The same was true for suicidal plans (lifetime: adjusted OR 1.64, 95% CI 1.35-1.99; past year: adjusted OR 1.66, 95% CI 1.18-2.33). Among respondents who reported past-year suicidal ideation, those in the military had a significantly higher past-year utilization rate of mental health services than those in the civilian population in both 2002 (adjusted OR 2.02, 95% CI 1.31-3.13) and 2012/13 (adjusted OR 3.14, 95% CI 1.86-5.28).Interpretation: Canadian Forces personnel had a higher prevalence of suicidal ideation and plans in 2012/13 and a higher use of mental health services in 2002 and 2012/13 than the civilian population. [ABSTRACT FROM AUTHOR]

Based on in-depth interviews with highly skilled and business Turkish nationals (HSBTN) in Canada and Germany, this study aims to explore why HSBTN decide to move and whether migration policy differences among the countries of destination affect recent migration motivations of HSBTN. It mainly focuses on the reasons and rationale of HSBTN and their explanations. This study argues that the high skilled and business migrants in general and HSBTN in particular move internationally as a consequence of individual-level gain beyond economic prospects. [ABSTRACT FROM AUTHOR]

Objectives: Failure to perceive need for care (PNC) is the leading barrier to accessing mental health care. After accessing care, many individuals perceive that their needs were unmet or only partially met, an additional problem related to perceived sufficiency of care (PSC). The Canadian Armed Forces (CAF) invested heavily in workplace mental health in the past decade to improve PNC/PSC; yet, the impact of these investments remains unknown. To assess the impact of these investments, this study 1) captures changes in PNC/PSC over the past decade in the CAF and 2) compares current PNC/PSC between the CAF and civilians.Methods: Data were drawn from the 2013 and 2002 CAF surveys and the 2012 civilian mental health survey (total N = ∼40 000), conducted by Statistics Canada using similar methodology. Exclusions were applied to the civilian sample to make them comparable to the military sample. Prevalence rates for No need, Need met, Need partially met, and Need unmet categories across service types (Information, Medication, Counselling and therapy, Any services) were calculated and compared between 1) the 2 CAF surveys and 2) the 2013 CAF and 2012 civilian surveys after sample matching.Results: Reports of Any need and Need met were higher in the CAF in 2013 than in 2002 by approximately 6% to 8% and 2% to 8%, respectively, and higher in the CAF than in civilians by 3% to 10% and 2% to 8%, respectively.Conclusions: These results suggest that investments in workplace mental health, such as those implemented in the CAF, can lead to improvements in recognizing the need for care (PNC) and subsequently getting those needs met (PSC). [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.)

We examine the impact of culture on the work behaviour of second-generation immigrant women in Canada. We contribute to the literature by analysing the role of intermarriage in intergenerational transmission of culture and its effect on labour market outcomes. Using female labour force participation and total fertility rates in the country of ancestry as cultural proxies, we find that culture affects the female labour supply. Cultural proxies are significant in explaining number of hours worked by second-generation women with immigrant parents. The impact of culture is significantly larger for women with immigrant parents who share the same ethnic background than for those with intermarried parents. The weaker effect of culture for women raised in intermarried families stresses the importance of intermarriage in assimilation process. Our findings imply that government policies targeting women's labour supply may have differential effects on the labour market behaviour of immigrant women of different ancestries. [ABSTRACT FROM AUTHOR]

ABSTRACTBackground:Clinical trials have shown that implantable cardioverter defibrillators are effective in primary prevention of sudden cardiac death (SCD) in patients with high risk profiles.Objectives:To conduct a cost-benefit assessment of prevention of sudden cardiac death with an implantable cardioverter defibrillator (ICD) vs. amiodarone from the Canadian health-care system perspective.Methods:A simulation model that estimates the patient''s course following an implantation with an ICD or initiation of amiodarone treatment was created. A thousand pairs of patients with identical characteristics in each treatment group, with similar demographic profiles as observed in the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) were simulated. Based on the simulated individual patient characteristics, the model estimated the timing of severe arrhythmic events and deaths due to other causes and implemented the consequences at the time of the events. Patients might die at the time of severe arrhythmia (sudden cardiac death) or survive and become secondary prevention cases and be exposed to a higher risk of severe arrhythmia for the following 6 months. The rates of arrhythmia and death due to other causes were assumed to be the same, whereas the cases of fatality from severe arrhythmia differed between treatments. During the course of the simulation, the clinical (i.e., deaths) and economic outcomes were tallied for both treatment groups. All model parameters were obtained from the literature. The primary data source for clinical inputs was the published results of the SCD-HeFT trial which investigated the impact of ICDs on patients’ survival in primary prevention of sudden cardiac deaths compared to amiodarone and conventional therapy. The value of a statistical life (CND 5.8 million) was obtained from an analysis previously performed by Health Canada. The direct medical costs and monetary value of lives saved were estimated over 5 years. Sensitivity analyses on key parameters were carried out. The most important study limitation was using two different sources to derive the age dependent clinical risks. This issue was resolved by calibrating the derived risks to account for the population differences.Results:The model predicted that the overall mortality would be reduced by 19.1 (7.1 absolute reduction) with ICD compared to amiodarone over 5 years. The incremental benefit with ICD was estimated at CND526 700 and additional cost at CND28 300, which translated into a 0.05 cost: benefit ratio – around 1: 20 return of investment.Conclusion:In Canada, ICDs are a worthwhile alternative to amiodarone in the primary prevention of sudden cardiac death. [ABSTRACT FROM AUTHOR]

Objective: The goal of this study was to identify rates, characteristics, and predictors of mental health treatment seeking by military members with posttraumatic stress disorder (PTSD).Method: Our sample was drawn from the 2002 Canadian Community Health Survey-Canadian Forces Supplement (CCHS-CF) dataset. The CCHS-CF is the first epidemiologic survey of PTSD and other mental health conditions in the Canadian military and includes 8441 nationally representative Canadian Forces (CF) members. Of those, 549 who met the criteria for lifetime PTSD were included in our analyses. To identify treatment rates and characteristics, we examined frequency of treatment contact by professional and facility type. To identify predictors of treatment seeking, we conducted a binary logistic regression with lifetime treatment seeking as the outcome variable.Results: About two-thirds of those with PTSD consulted with a professional regarding mental health problems. The most frequently consulted professionals, during both the last year and lifetime, included social workers and counsellors, medical doctors and general practitioners, and psychiatrists. Consultations during the last year most often took place in a CF facility. Treatment seeking was predicted by cumulative lifetime trauma exposure, index traumatic event type, PTSD symptom interference, and comorbid major depressive disorder. Those with comorbid depression were 3.75 times more likely to have sought treatment than those without.Conclusions: Although a significant portion of military members with PTSD sought mental health treatment, 1 in 3 never did. Trauma-related and illness and (or) need factors predicted treatment seeking. Of all the predictors of treatment seeking, comorbid depression most increased the likelihood of seeking treatment. [ABSTRACT FROM AUTHOR]

This study aimed to identify predictors of treatment seeking in military members with posttraumatic stress disorder (PTSD) using data from the 2002 Canadian Community Health Survey–Canadian Forces Supplement (Statistics Canada, 2003). To identify predictors, two complementary analyses (binary logistic regression and recursive partitioning of independent variables) were conducted in military members with PTSD (N = 509). Results indicate that trauma-related (index traumatic event type, cumulative trauma exposure), demographic (marital status), enabling (income), and need (PTSD interference) factors predict treatment seeking in military members with PTSD, and that treatment seekers and nontreatment seekers are both comprised of distinct subgroups. Interventions aimed at increasing treatment-seeking behaviors should be tailored to the specific needs of various subgroups of nontreatment seekers. [ABSTRACT FROM AUTHOR]

Background: Despite increased interest in workplace mental health interventions, the evidence for beneficial effects is mixed. Furthermore, many existing studies lack methodological rigor. We report results from a group randomized control trial to test the efficacy of a vastly popular intervention in Canada, the Road to Mental Readiness (R2MR) program, which has been widely disseminated in military, first responder, and civilian settings. Methods: The trial took place among Canadian Armed Forces military recruits completing their basic military qualification (BMQ) training, and randomized 65 platoons (N = 2831) into either (a) an Intervention (R2MR at week 2 of BMQ), or (b) a delayed Intervention Control (R2MR at week 9 of BMQ) condition. The principal investigator, participants, and data collection staff were blinded to platoon condition. Individual-level psychological functioning, resilience, mental health service use attitudes, intentions, and behaviours, and additional covariates were assessed with questionnaires around week 2 (a day or two before Intervention platoons received R2MR), at week 5, and at week 9 (a day or two before the Control platoons received R2MR). Military performance outcomes were obtained from administrative databases. Results: The full trial results were mixed; for some outcomes (psychological functioning, resilience, and military performance), we saw no evidence of beneficial effects; where we did see benefits (mental health service use attitudes, intentions, behaviours), the effects were very small, or disappeared over time. Analyses among two subsamples (Group 1: Intervention platoons with a Fidelity Check and their Controls, and Group 2: Intervention platoons without Fidelity Check and their Controls) indicated that for some outcomes (attitudes and help-seeking), under high fidelity conditions, the beneficial effects of R2MR were increased and better sustained; Conversely, under poor fidelity conditions, decreased beneficial effects or even iatrogenic effects were observed. Analyses across three training divisions indicated the larger organizational climate further influences efficacy. Conclusions: Our findings paint a very complex picture in which it is made evident that sensible, evidence-informed workplace mental health interventions such as R2MR may work under high fidelity conditions, but may yield no discernable benefit or even inadvertent iatrogenic effects if implemented poorly or without sufficient consideration to the larger organizational context. Trial registration: ISRCTN 52557050 Registered 13 October 2016. [ABSTRACT FROM AUTHOR]

This study aims to shed light on how high-skilled and business Turkish immigrants (HSBTI) decide to acquire host country's citizenship and why some of them choose not to seek naturalization. With this in mind, a comparative case study of Canada and Germany was designed. It is proposed that host country citizenship and migration policy, social, economic and political costs and benefits of host country's citizenship and individuals' conceptualization of citizenship impact the decision-making process of HSBTI. Based on the data results, the study argues that social, economic and political opportunities in host countries (such as the right to vote), multicultural migration and citizenship policies of those countries and valuing citizenship as a commodity positively influence the naturalization decisions of HSBTI interviewees, while restricted policies, economic costs of citizenship and seeing citizenship as a sense of belonging adversely affect their decisions. [ABSTRACT FROM AUTHOR]

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a genetically determined heart muscle disorder associated with an increased risk of life-threatening arrhythmias in some patients. Risk stratification remains challenging. Therefore, we sought a non-invasive, easily applicable risk score to predict sustained ventricular arrhythmias in these patients. Cohort of Patients who fulfilled the 2010 ARVC task force criteria were consecutively recruited. Detailed clinical data were collected at baseline and during follow up. The clinical endpoint was a composite of recurrent sustained ventricular arrhythmias and hospitalization due to ventricular arrhythmias. Multivariable logistic regression was used to develop models to predict the arrhythmic risk. A cohort including patients from other registries in UK, Canada and Switzerland was used as a validation population. One hundred and thirty-five patients were included of whom 35 patients (31.9%) reached the endpoint. A model consisting of filtered QRS duration on signal-averaged ECG, non-sustained VT (NSVT) on 24 h-ECG, and absence of negative T waves in lead aVR on 12‑lead surface ECG was able to predict arrhythmic events with a sensitivity of 81.8%, specificity of 84.0% and a negative predictive value of 95.5% at the first presentation of the disease. This risk score was validated in international ARVC registry patients. A risk score consisting of a filtered QRS duration ≥117 ms, presence of NSVT on 24 h-ECG and absence of negative T waves in lead aVR was able to predict arrhythmic events at first presentation of the disease. • A risk score for ARVC utilizing ECG, signal averaged ECG and 24 h-ECG was developed. • The risk score predicts the arrhythmic risk at the initial investigation. • A risk score of 0 points virtually excludes an arrhythmic risk. • A higher score indicates a higher arrhythmic risk. • The risk score has been validated in an international cohort. [ABSTRACT FROM AUTHOR]