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This research aims to describe the identity coherence and differentiated life trajectories of social work students according to their age of enrollment. This article reports analyses of a cross-sectional study with repeated measures surveying students enrolled in the first two years of the Bachelor of Social Work program between 2001 and 2019 at the University of Sherbrooke (Québec, Canada). Analyses of the responses of the 431 younger students (18 to 24 years old) and 125 older students (25 and over) showed that both groups of students had a similar profile in terms of their personal experiences, training, values and personal interests that led them to enroll in social work. Additionally, these students considered several alternative help-related professional disciplines at the time of their enrollment. Older students (25 years and over) seemed to be more certain of their choice to enroll in this academic program. These choices were based on previous professional experiences that they had integrated in their life experiences. These findings contrasted with younger students (24 years old and under) who seemed to be certain about their choice of program. In fact, their choice of social work seemed to be positioned as the obvious continuity of their pre-university studies. [ABSTRACT FROM AUTHOR]

This study presents findings from a qualitative study conducted in two relatively remote, primarily rural regions of the Canadian province of Quebec whose resource-based economic structures exacerbate inequalities between men and women. The purpose of this study was to understand how violence and homelessness intertwine in women's life courses in such regions. On the basis of past research showing that gender socialization around traditional roles and conservative values is particularly tenacious in non-urban areas, we conducted life-course interviews with 22 women in 13 different towns and villages of these two regions. Our content analysis of these interviews showed that specific social responses have forced women to maintain relationships with their aggressors or with people who have protected them, thus relegating these women's lives to the private sphere while reducing their opportunities for social participation in the public sphere. These social responses, together with women's economic and social disadvantages in these regions, were also the main factors that explain homelessness experienced by the participants in this study. Our analysis of these responses illustrates the patriarchal social structure of power in these regions, which is perpetuated in the interpersonal, institutional, and representational dimensions and keeps women in precarious, subordinate social positions, while ostracizing or punishing women who try to resist. [ABSTRACT FROM AUTHOR]

Copyright of International Journal of Integrated Care (IJIC) is the property of Ubiquity Press 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.)

Introduction: The implementation of integrated care models requires significant efforts, especially due to institutional and organisational inertial forces that characterize health and social care systems of developed countries. It is therefore crucial to deploy strategies that promote continuous adjustment to these barriers so as to improve the benefits of integrating care. Measuring the implementation and effects of integrated care models are key component of these strategies. However, measuring integrated care also faces major challenges. This study aims to identify and characterise integrated care measurement challenges. Methods: A review of reviews on the measurement of integrated care identified 12 papers. A thematic analysis was conducted to identify and categorize measurement challenges. Document analysis was done on the measurement of an integrated care model for older adults in Québec. Results: Eight categories of measurement challenges were identified. These challenges include difficulties in measuring structures, processes, and effects of models; conceptual ambiguity and heterogeneity of organisational forms; involving multiple actors in the measurement strategy; and including multiple data sources, amongst others. These challenges revealed and explained potential gaps in the measurement of integrated care for older adults in Québec. For instance, the Québec measurement strategy did not include effects indicators. Conclusion: Although the measurement of integrated care is a complex endeavour, there is a need for adequate measurement strategies that allow to appreciate important elements of integrate care. The findings of this study could be used as a reflexive tool in advancing research and practice of measuring integrated care. [ABSTRACT FROM AUTHOR]

Background: The relational continuity of care is an essential function of primary health care. This study reports on the perspectives of Cree communities and their primary health care providers regarding the barriers and enablers of relational continuity of oral health care integrated at a primary health care organization. Methods: A multiple case study design within a qualitative approach and developmental evaluation methodology were used to conduct this research study in Cree communities of Northern Québec. Maximum variation sampling and snowball techniques were used to recruit the participants. Data collection consisted of individual interviews and focus group discussions. Thematic analysis was conducted which included transcription, debriefing, codification, data display, and interpretation. The consolidated criteria for reporting qualitative studies (COREQ) were used to guide the reporting of study findings. Results: A total of six focus group discussions and 36 individual interviews were conducted. Five major themes emerged from the thematic analyses for barriers (two) and enablers (three). Themes for barriers included impermanence and lack of effective communication, whereas themes for enablers included culturally competent professionals, working across professional boundaries, and proactive organizational engagement. Conclusions: Based on these findings, relational continuity can be empowered by effective strategies for overcoming barriers and encouraging enablers, such as recruitment of permanent professionals, organizing cultural competency training, development of a Cree language dental glossary, encouraging inter-professional collaboration, and promoting the organization's efforts. [ABSTRACT FROM AUTHOR]

This article reports preliminary research results on a professional development (PD) model as a mechanism for supporting absorption of the Healthy School (HS) approach into school functioning. The purpose of our study was to document the model implementation process and understand whether it influenced, or not, the accompanied actors' knowledge and practices about HS. The theoretical basis of the model and a description of its implementation, its appreciation by actors and its influence on their knowledge and confidence are presented. The research was conducted in three Quebec schools that had adopted this approach for at least 2 years. Multiple case study methodology, with pre- (T0) and post- (T1) intervention comparison, was adopted. The results disclose that the PD model implemented, which involves socio-constructivist accompaniment, has several assets that support the acquisition and application of new knowledge related to HS in order to promote its absorption within schools. Our findings indicate that PD likely reinforced the actors' knowledge and understanding as well as their confidence. The lessons drawn from the evaluation of this PD model could serve to enhance accompaniment methods implemented to promote the absorption of such initiatives in schools. Our data highlight the relevance and effectiveness of accompaniment anchored in action, calling for practice based on reflection and expert recommendations to meet the objectives of health and academic success. [ABSTRACT FROM AUTHOR]

Objective: To study the acute relationship between olfactory function and traumatic brain injury (TBI), cognitive functions and outcome. Methods: Sixty-two patients with TBI were evaluated within the first 2 weeks following TBI. The Sniffin'Sticks identification test was used to assess olfaction. A neuropsychological evaluation was carried out to assess attention, verbal fluency, naming, memory, problemsolving and mental flexibility. The extended Glasgow Outcome Scale (GOSE) and the Disability Rating Scale (DRS) were rated at discharge from acute care. Results: Traumatic lesions located in the basal frontal area resulted in odour identification scores that were significantly lower than when lesions were elsewhere (p < 0.001). A significant positive correlation was shown between odour identification scores and mental flexibility scores (p = 0.004) and patients with hyposmia had worse performances on executive tests measuring problem-solving, verbal fluency and mental flexibility (p< 0.01). Moreover, the odour identification score and the DRS total score were related (p = 0.019). Conclusions: These findings add information regarding acute olfactory status following TBI and provide evidence on the importance of assessing olfaction very early post-TBI in order to plan intervention and determine what accident prevention advice will be required for home or work re-integration. [ABSTRACT FROM AUTHOR]

This study looked at performance on the conversational discourse checklist of the Protocole Montréal d'évaluation de la communication (D-MEC) in 195 adults with TBI of all severity hospitalized in a Level 1 Trauma Centre. To explore validity, results were compared to findings on tests of memory, mental flexibility, confrontation naming, semantic and letter category naming, verbal reasoning, and to scores on the Montreal Cognitive Assessment. The relationship to outcome as measured with the Disability Rating Scale (DRS), the Extended Glasgow Outcome Scale (GOS-E), length of stay, and discharge destinations was also determined. Patients with severe TBI performed significantly worse than mild and moderate groups (χ2KW2df = 24.435, p = .0001). The total D-MEC score correlated significantly with all cognitive and language measures (p < .05). It also had a significant moderate correlation with the DRS total score (r = −.6090, p < .0001) and the GOS-E score (r = .539, p < .0001), indicating that better performance on conversational discourse was associated with a lower disability rating and better global outcome. Finally, the total D-MEC score was significantly different between the discharge destination groups (F(3,90) = 20.19, p < .0001). Thus, early identification of conversational discourse impairment in acute care post-TBI was possible with the D-MEC and could allow for early intervention in speech-language pathology. [ABSTRACT FROM AUTHOR]

ABSTRACT Moose ( Alces alces) populations exceed 3 individuals/km2 in some wildlife reserves and parks of northeastern Canada. Heavy browsing pressure at such densities is potentially altering the ecological integrity of forests with eventual negative consequences for moose. We hypothesized that regulation by resources would be limited by the capacity of female moose to modulate their reproductive strategies to maintain high fertility despite a decline in body condition. We observed a 20-33% decline in rump fat thickness in males and females, respectively, from the high density Matane Wildlife Reserve in Eastern Québec in October compared to an adjacent population. We also observed a lower mass of the peroneus group of muscles for males (−3%) and prime-aged females (−8%) in the Matane Wildlife Reserve than in the adjacent population. Females from the Matane Wildlife Reserve population had a lower twinning ovulation rate (1 out of 20 vs. 7 out of 21 ovulating females in the adjacent population) but >15% higher overall ovulation rate. Our results suggest that female moose can maintain high fertility despite a decline in body condition, by reducing their litter size at ovulation and conserving energy to increase the probability of annual reproduction. The adjustment of female reproductive strategies illustrates the plasticity of moose in response to decreasing habitat quality. We conclude that in the absence of specialist predators, equilibrium with forage is unlikely for large herbivores in the short or mid-term. Active management of moose populations is likely required to maintain the ecological integrity of boreal forests. © 2014 The Wildlife Society. [ABSTRACT FROM AUTHOR]

Primary objective: To date, little information is available regarding communication and conversational discourse proficiency post-traumatic brain injury (TBI) in the acute care phase. The main goal of this study was to examine how conversational discourse impairment following TBI predicts early outcome. Factors which influence conversational discourse performance were also explored. Methods: The conversational discourse checklist of the Protocole Montréal d'évaluation de la communication (D-MEC) was administered in an acute tertiary care trauma centre to 195 adults within 3 weeks post-TBI. Outcome was measured with the Disability Rating Scale (DRS), the extended Glasgow Outcome Scale (GOS-E) and included discharge destinations from acute care. Main outcomes and results: Linear regression results showed that the D-MEC total score, age and initial GCS score accounted for 50% of the variation of the DRS scores. The DRS score was lower, signifying better outcome, when the total D-MEC score was higher, the subject was younger and when the initial GCS score was higher. Moreover, D-MEC performance significantly predicted the moderate and severe disability categories of the GOS-E and the probability of requiring rehabilitation ( p < 0.05). Conclusion: These results provide additional information to guide healthcare professionals in predicting overall outcome acutely post-TBI. [ABSTRACT FROM AUTHOR]

Inpatient geriatric assessment units (GAUs) exist in Quebec, Canada, to deliver comprehensive, integrated care to older vulnerable patients. Most cases should be discussed at interprofes-sional meetings (IMs), but research has shown this not to be so for 39% of GAU patients. Consequently, a study was undertaken to (1) describe GAU team composition and (2) identify GAU and patient characteristics associated with case discussion at IMs at least once during a patient's stay. To this end, 877 hospitalization records from 44 GAUs were reviewed. Results showed most teams were composed of attending physicians, nurses, physical and occupational therapists, dietitians and social workers; 66% included clinical pharmacists and 43% liaison nurses. Multilevel modeling showed longer length of stay to be the strongest predictor of case discussion at an IM. Case discussion was also more likely for patients admitted via in- or inter-hospital transfer rather than via the emergency department, if the GAU included a liaison nurse, and if the GAU was not located in an urban area. In summary, case discussion at an IM depended more on how and where a patient was admitted than on the patient characteristics per se, suggesting that this is a matter of care organization. [ABSTRACT FROM AUTHOR]

Primary objective: To compare results on the Montreal Cognitive Assessment (MoCA) to those on the Mini-Mental State Examination (MMSE) in patients with traumatic brain injury (TBI) and to predict the outcome at discharge from the acute care setting. Research design: A retrospective study. Methods and procedures: The MoCA and the MMSE were administered to 214 patients with TBI during their acute care hospitalization in a Level I trauma centre. Outcome was measured with the Disability Rating Scale (DRS). Main outcomes and results: A linear regression determined that the MoCA, the MMSE, TBI severity, education level and presence of diffuse injuries predicted 57% of the total variability of the DRS scores. The model without the MMSE had a R2 of 53.7% and the model without the MoCA had a R2 of 55.0%. The models without the MMSE or the MoCA had a R2 of 24.9%. Conclusions: These results indicated that the MoCA and the MMSE function as similar predictors of the DRS at discharge. [ABSTRACT FROM AUTHOR]

Copyright of Recherches Sociologiques et Anthropologiques is the property of Centre Recherches Sociologique 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.)

Introduction: The home care and services provided to older adults with the same needs are often inadequate and highly varied. Integrated care pathways (ICPs) can resolve these issues. The aim of this study was to develop the content of ICPs to follow-up frail and disabled community-dwelling older people. Theory and method: A rigorous process was applied according to a series of steps: identification of desirable characteristics and a theoretical framework; review of evidence-based practices and current practices; and determination of ICPs by an interdisciplinary task team. Results: ICPs are intended to prevent specific problems, maximize independence, and promote successful aging. They are organized according to a dynamic process: (1) needs assessment and assessment of risk/protection factors; (2) data-collection summary and goals identification; (3) planning of interventions from a client-centered view; (4) coordination, delivery, and follow-up; and (5) identification of variances, as well as review and adjustment of plans. Conclusion: Once computerized, these ICPs will facilitate the exchange of information as well as the clinical decision-making process with a perspective to adequately matching the needs of an individual person with resources that delay or slow the progression of frailty and disability. Once aggregated, the data will also support managers in organizing teamwork and follow-up for clients. [ABSTRACT FROM AUTHOR]

Primary objective: To verify criterion validity of measures from a functional cognitive task (FCT) carried out with patients with severe traumatic brain injury (sTBI) at 2-5 years post-injury. Methods and procedures: Forty-six patients with sTBI took part in a long-term outcome study where the FCT and the Neurobehavioural Rating Scale-Revised (NBRS-R) were administered and the FIM™ instrument was rated. The FCT is a telephone information gathering task for evaluating functional cognitive skills. Results: Ten of 16 measures of the FCT were significantly correlated with similar or related concepts from the NBRS-R. The FIM™ cognitive score and the individual items of this score were significantly correlated with 13 of the FCT measures and with the percentage of amount of information gathered. Internal consistency was good for 13 of 16 measures. Overall, patients generally had mild difficulty on the FCT concepts. Conclusion: The FCT can be used with patients with sTBI to evaluate certain aspects of functional cognition. It has good criterion validity and internal consistency, but additional research is required to further measure reliability and its applicability to other severity of TBI and to other phases of recovery. [ABSTRACT FROM AUTHOR]

This paper focuses on dissemination of the healthy schools (HS) approach in the province of Quebec, Canada. Dissemination aims at raising awareness about HS and promoting its adhesion among actors concerned with youth health in school. As HS is a joint initiative based on agreement and collaboration between health and educational sectors, the positions of stakeholders that foster cooperation between these sectors were considered to be critical to optimize its dissemination. The study's objectives were to: (i) examine and contrast the stakeholders' conceptions of HS and (ii) understand how converging and diverging stakeholders' positions on HS favourably or negatively influence its dissemination in Quebec. Gray's analytical approach to collaboration and its focus on stakeholders' mindframe about a domain served as a conceptual lens to examine stakeholders' positions regarding HS. Collection methods included documentary analysis and semi-structured interviews of 34 key internal and external informants at the provincial, regional and local levels. The results showed consensual adhesion to fundamental principles of the HS approach. However, differences in conceptualization between provincial authorities of the two sectors concerning the way to disseminate HS have been observed. These differences represented a significant barrier to HS optimal dissemination. A dialogue between the two authorities appears to be essential to arrive at a negotiated and shared conceptualization of this issue in the Quebec context, thus allowing agreements for adequate support. The results may serve as the basis for a more fruitful dialogue between actors from the two sectors, at different administrative levels. [ABSTRACT FROM AUTHOR]

Copyright of Nouvelles Pratiques Sociales is the property of Revue Nouvelles Pratiques Sociales 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 Nouvelles Pratiques Sociales is the property of Revue Nouvelles Pratiques Sociales 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 Lien Social et Politiques is the property of Institut National de Recherche Scientifique (INRS) 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.)

Individual condition generally depends on density and is partly determined by habitat quality and climate. We studied long-term trends in the condition and productivity of female caribou (Rangifer tarandus (L., 1758)) in two large migratory herds in the Quebec-Labrador peninsula (Canada), the George and the Feuilles herds. Females from the George herd were in better summer condition than those from the more abundant Feuilles herd in 2001-2002, while it was the opposite in 1988 when the Feuilles herd was less abundant than the George herd. Summer nutrition followed the same pattern between herds through time. Spring body condition of females in the George herd declined from 1976 to the mid-1980s during early population growth. Fall condition, however, did not change from 1983 to 2002 when caribou numbers first peaked and later declined. Pregnancy rates were inversely related to herd size in both herds. Vegetation quality (NDVI) in June was significantly related to body proteins in the fall. Albeit unusual for a northern ungulate, body fat increased from fall to spring in the George herd. We conclude that a relatively small and highly grazed summer range, as well as density-dependent effects, affected summer nutrition and the need to continue lipogenesis during winter. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Social Work Review / Revue Canadienne de Service Social is the property of Canadian Association for Social Work Education 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.)

Abstract: The goal of this long-term project is to fulfill present and future rehabilitation personnel needs in a 7-million population province by implementing a university training program in Orientation and Mobility and Rehabilitation Teaching. A study conducted at the government level of Quebec in 2001 stated that, as the actual workers in the field will retire massively between years 2009 and 2016, newly trained personnel in the field of visual impairment would need to integrate the field by that time. A competency-based graduate level university personnel training program was developed and implemented by the École d''optométrie of the Université de Montréal. Considering a strong expertise in the field developed in the past 25 years and a unique public rehabilitation model throughout the province, the training program established partnership with the field, a partnership that shows promises for the future. The program strives for professional standards set in the field of visual impairment in order to prepare a new wave of leaders able to meet future challenges. [Copyright &y& Elsevier]

Context: Two major reforms 2004 and 2015 have transformed Quebec's health and social care system over the last twenty years. In 2004, the reform was based on a coordination model of integration in order to promote the implementation of the principle of population-based responsibility. The population-based approach emphasises planning and delivery of services aimed at improving the health and well-being of a geographically defined population. Concretely, this principle was manifested in 2004 by the implementation of Local Health Networks LHNs, which promote inter-organisational consultations between public, community and private health services of a given territory. On the other hand, the 2015 reform instead pushed in a fully integrated model that breaks down organizational and geographical boundaries over vast territories; effectively abandoning consultations. Aims: To analyze how Quebec's health and social services system has succeeded in embodying and combining the principles that underlie the integration of services and the populationbased approach. Methods: This research is part of an international research program "implementing community based integrated care for older adults with complex health needs" ICOACH. This presentation is based on data collected in Québec from 44 semi-structured interviews with policy makers n = 11 and managers n = 33. The thematic analysis of interviews was based on the principles of the population-based approach Couturier, Bonin and Belzile, 2016, Roy, Litvak and Paccaud, 2010. Results: The population-based approach remained a core principle in the design and structuring of both reforms, but its operationalization weakened over time. For instance, an important operational indicator such as the presence of intersectoral consultation mechanisms, were undermined during the transition from the first to the second reform, thus favoring a managerial rather than participatory conception of governance. The LHNs which were the consultation sites, were intended, in principle, to enable integrated organizations to respond to the needs of the population under their responsibility, and to produce health upstream of traditional curative strategies alone. These LHNs were abandoned by the second reform, in favor of the creation of large centralized organizations, implanted over large geographical areas. Their essentially top-down governance is centralized, making consultation venues irrelevant, characterised by a curtailment of organizations towards their own internal priorities rather than the needs of the population. However, the population-based approach has recently re-emerged as a potential solution to the excesses of the second reform. The populational-based approach makes it possible to revisit the concerns about the relationship between the health system and the dynamics of local populations in their territories, which are small by nature. Conclusion: The population-based approach seems useful to positively conceive integrative reforms at the systemic level of healthcare systems. But its capacity to be durably translated into practices is limited by the implementation of such reforms. They primarily respond to political and managerial imperatives, hence, producing a more service-driven managerial logic rather than a population needs driven logic. [ABSTRACT FROM AUTHOR]

Introduction: The PRISMA implementation research has used an innovative tool: the penetration rate of integrated model in the system. The experimentation in France of the PRISMA adopts and adapts this methodology. Aims and objective: This measurement relates to the functions of the 6 tools and mechanisms of the model: coordination boards, single entry point, case-management, single assessment instrument, individualised services plan and information system. In contrast with Quebec, no public policy in France incites to move towards this model of integration. In addition, in the French system the construction of coordination boards is complex because there is as much as ten supervision authorities and about fifteen organisation managers involved in each experimental site. Methods of adaptation of the tool in France: The measurement was not only the absence, partial existence or existence of the 6 components but takes into account the appropriation process for each one, the administrative time and the new definition of thresholds to reach as compared to the model. Results: This research tool presents two advantages. The measurement scale enables also the partners to appropriate the function of each model component and more precisely the global model of the integration. Actors do not feel evaluated but accompanied. [ABSTRACT FROM AUTHOR]

To evaluate the scale-up of the OPUS-AP program to improve the care of residents at long-term care (LTC) centers through the systematic implementation of resident-centered approaches to care, the application of nonpharmacologic interventions for the management of behavioral and psychological symptoms of dementia (BPSD), and the deprescribing of antipsychotics where these are not clinically indicated. Prospective, closed cohort. Residents with major neurocognitive disorder (MNCD) from 24 (phase 1) and 129 (phase 2) publicly funded LTC centers in Quebec, Canada. The primary outcome was antipsychotic deprescribing (cessation or dose reduction). Secondary outcomes included changes in benzodiazepine and antidepressant prescriptions, BPSD, and falls. Comparisons were made between assessments at baseline and after 9 months. OPUS-AP phase 2 was conducted from March to December 2019 in 329 clinical wards at 129 LTC centers. At baseline, the 10,601 included residents had a mean age of 82.9: 64.6% were of female sex, 73.7% had a diagnosis of MNCD, and 47.0% had an antipsychotic prescription. These characteristics were similar to those of the 1054 residents at the 24 LTC centers in phase 1. In phase 2, successful antipsychotic deprescribing was achieved for 77.1% of residents in whom this approach was attempted, compared to 85.5% in phase 1. Phase 1 and 2 showed statistically significant improvements in the Cohen-Mansfield Agitation Inventory score and reduced use of benzodiazepines in residents with successful antipsychotic deprescribing. These improvements were of a smaller magnitude in phase 2. Statistically significant reductions in falls were observed in phase 2. The scale-up of the OPUS-AP program from 24 to 129 LTC centers was successful and resulted in a significant reduction in antipsychotic use, as well as improvement in BPSD, and reductions in benzodiazepine use and falls in residents with successful antipsychotic deprescribing. [ABSTRACT FROM AUTHOR]

Objective: To seek input from long-term care (LTC) administrators and staff on solutions for overcoming established barriers to continence care and the roles each team member must play in implementing them. Design: Cross-sectional, qualitative study using in-depth semi-structured individual interviews. Setting: Four LTC institutions in Montreal, Quebec. Participants: Sixteen health administrators, including the general director, the medical director, the director of nursing and the head nurse of the 4 institutions were interviewed. As well, 16 front-line health care workers including 8 nurses and 8 nursing assistants participated in the interviewing process. Intervention: During the interviews, participants were asked to comment on a list of established barriers to continence care and to recommend solutions, involving themselves or other members of the LTC team, for overcoming these barriers. The interviews were recorded and transcribed verbatim. Data obtained during the interviews were analyzed and specific solutions to each barrier were identified, as well as the roles each team member should play in implementing them. Results: Analysis of our data revealed 10 solutions, involving administrators as well as staff members: (1) setting continence care as an institutional priority; (2) establishing a continence committee; (3) involving the staff from the onset; (4) tailoring the continence program to each institution and resident; (5) providing training on incontinence; (6) elevating the standard of care for incontinence; (7) creating an incontinence-efficient working environment; (8) improving communication around continence care; (9) supervision, feedback and accountability; (10) championing the effectiveness of continence care. Typically, top-down solutions were proposed, but the value of bottom-up processes was included as part of the systemwide approach. Conclusion: Implementing and maintaining a continence program in LTC requires a systemwide approach involving LTC administrators and staff. The results of our research provide guidance for overcoming barriers to the implementation and maintenance of a continence program and for defining team members’ roles in this endeavour. [Copyright &y& Elsevier]

To increase capacities and control over health, it is necessary to foster assets (i.e. factors enhancing abilities of individuals or communities). Acting as a buffer, assets build foundations for overcoming adverse conditions and improving health. However, little is known about the distribution of assets and their associations with social position and health. In this study, we documented the distribution of health assets and examined whether these assets moderate associations between adverse social position and self-reported health. A representative population-based cross-sectional survey of adults in the Eastern Townships, Quebec, Canada (n = 8737) was conducted in 2014. Measures included assets (i.e. resilience, sense of community belonging, positive mental health, social participation), self-reported health (i.e. perceived health, psychological distress), and indicators of social position. Distribution of assets was studied in relation to gender and social position. Logistic regressions examined whether each asset moderated associations between adverse social position and self-reported health. Different distributions of assets were observed with different social positions. Women were more likely to participate in social activities while men were more resilient. Resilience and social participation were moderators of associations between adverse social position (i.e. living alone, lower household income) and self-reported health. Having assets contributes to better health by increasing capacities. Interventions that foster assets and complement current public health services are needed, especially for people in unfavorable situations. Health and social services decision-makers and practitioners could use these findings to increase capacities and resources rather than focusing primarily on preventing diseases and reducing risk factors. [ABSTRACT FROM AUTHOR]