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Background: The coexistence of childhood asthma and mental health (MH) conditions can impact management and health outcomes but we need to better understand the etiology of multimorbidity. We investigated the association between childhood asthma and MH conditions as well as the determinants of their coexistence. Methods: We used data from the Canadian Health Survey of Children and Youth 2019 (3–17 years; n = 47,871), a cross‐sectional, nationally representative Statistics Canada dataset. Our primary outcome was condition status (no asthma or MH condition; asthma only; MH condition only; both asthma, and a MH condition (AMHM)). Predictors of condition status were assessed using multiple multinomial logistic regression. Sensitivity analyses considered individual MH conditions. Results: MH condition prevalence was almost two‐fold higher among those with asthma than those without asthma (21.1% vs. 11.6%, respectively). There were increased risks of each condition category associated with having allergies, other chronic conditions, and family members smoking in the home while there were protective associations with each condition status category for being female and born outside of Canada. Four additional variables were associated with AMHM and MH condition presence with one additional variable associated with both AMHM and asthma. In sensitivity analyses, the associations tended to be similar for most characteristics, although there was some variability. Conclusion: There are common risk factors of asthma and MH conditions along with their multimorbidity with a tendency for MH risk factors to be associated with multimorbidity. MH condition presence is common and important to assess among children with asthma. [ABSTRACT FROM AUTHOR]

Pain associated with bleeding disorders has been demonstrated to have an impact on patients’ and families’ quality of life. Both acute and chronic pain are common experiences and require attention by professionals working in haemophilia treatment centres (HTCs). The benefits of psychological pain management strategies such as cognitive behaviour therapy and self-management skills training are well documented; however, it is not well understood how Canadian social workers involved in haemophilia care perceive and provide pain management support to patients.

Introduction Respiratory Health Professionals (RHPs) with specialty training in the management of asthma and COPD, often care for patients with advanced respiratory disease, who have less access to palliative care than patients with similar disease burden. The aims of this study were to: (i) explore the current and desired roles of RHPs in terms of palliative care and (ii) examine barriers to discussions with patients about palliative care. Methods An online survey addressing the aims of this study was developed and pilot tested. The survey was distributed nationally using the database of the Lung Association's RESPTREC respiratory educator training program. Descriptive statistics were performed. Results A total of 123 completed surveys were returned, with respiratory therapists comprising the largest group of respondents. The majority indicated that end-of-life care was less than optimal for patients with advanced respiratory illnesses and agreed that palliative care should be a role of RHPs. Patient- and family-related barriers to having end-of-life discussions included: difficulty accepting prognosis, limitations and complications, and lack of capacity. For providers, the most important barriers were: lack of training, uncertainty about prognosis, and lack of time. The health care system barriers of concern were increasing demand for palliative care services and limited accessibility of palliative care for those with advanced respiratory diseases and difficulties in accurate prognostication for these conditions. Discussion Incorporating a more defined role in palliative care was generally seen as a desirable evolution of the RHP role. A number of strategies to mitigate identified barriers to discussions with the patient are described. Better alignment of the services required with the needs of patients with advanced respiratory disease can be addressed in a number of ways. Conclusions As RHP roles continue to evolve, consideration should be given to the ways in which RHPs can contribute to improving the quality of care for patients with advanced respiratory disease. Building collaborations with RHPs, palliative care, and other existing health programs can ensure high quality of care. Creating and taking advantage of learning opportunities to build skills and comfort in using a palliative approach will benefit respiratory patients.

The article is a response to comments made by Tsai and Wei regarding a study on the association between childhood asthma and mental health conditions. The authors acknowledge the importance of considering maternal mental health and its interplay with socio-economic factors in the investigation of childhood multimorbidity. They also discuss the limitations of using secondary data sources and the complexity of the relationship between asthma and mental health conditions. The authors recommend further research to understand the risk and protective factors of this multimorbidity and to develop strategies for prevention and management. [Extracted from the article]

Background: The "long tail" of the COVID-19 pandemic will be reflected in disabling symptoms that persist, fluctuate or recur for extended periods for an estimated 20%–30% of those who had a SARS-CoV-2 infection; development of effective interventions to address these symptoms must account for the realities faced by these patients. We sought to describe the lived experience of patients living with persistent post-COVID-19 symptoms. Methods: We conducted a qualitative study, using interpretive description, of the lived experiences of adults experiencing persistent post-COVID-19 symptoms. We collected data from in-depth, semistructured virtual focus groups in February and March 2022. We used thematic analysis to analyze the data and met with several participants twice for respondent validation. Results: The study included 41 participants (28 females) from across Canada with a mean age of 47.9 years and mean time since initial SARS-CoV-2 infection of 15.8 months. Four overarching themes were identified: the unique burdens of living with persistent post-COVID-19 symptoms; the complex nature of patient work in managing symptoms and seeking treatment during recovery; erosion of trust in the health care system; and the process of adaptation, which included taking charge and transformed self-identity. Interpretation: Living with persistent post-COVID-19 symptoms within a health care system ill-equipped to provide needed resources profoundly challenges the ability of survivors to restore their well-being. Whereas policy and practice increasingly emphasize the importance of self-management within the context of post-COVID-19 symptoms, new investments that enhance services and support patient capacity are required to promote better outcomes for patients, the health care system and society. [ABSTRACT FROM AUTHOR]

Introduction: Residents of Saskatchewan, particularly those in rural communities, have less access to family physician services than people in other parts of the country. This is partly due to the difficulty of attracting and retaining physicians. The objective of this study was to understand the major factors that influence the location decisions of family physicians in Saskatchewan. Methods: We employed a mixed-methods approach, including a questionnaire survey of family physicians and interviews with individuals from stakeholder health agencies. We used interpretive description to analyze interview responses. Results: Neither family physicians nor interviewees from health agencies named compensation as the most influential factor in location decisions. More important factors were family influences, work-life balance and community influences. Conclusion: We recommend that recruitment of family physicians be regarded as a matching process, in which family physicians and communities are strategically matched. Compensating incentives should be targeted at communities that cannot meet the requirements of family physicians. Introduction: Les residents de la Saskatchewan, en particulier ceux qui vivent dans des communautes rurales, ont un acces plus limite aux services d'un medecin de famille que les Canadiens des autres parties du pays. Cela s'explique en partie par la difficulte d'attirer et de retenir les medecins. Le but de cette etude etait de comprendre les principaux facteurs qui influencent les medecins de famille de la Saskatchewan quand ils choisissent l'endroit oU ils vont exercer. Methodes: Nous avons utilise diverses methodes, notamment un sondage par questionnaire aupres des medecins de famille et des entretiens avec du personnel des organismes de sante vises. Nous avons analyse les reponses aux entretiens en faisant une description d'interpretation. Resultats: Ni les medecins de famille ni les representants des organismes de sante n'ont dit que la remuneration etait le principal facteur influencant leur decision. Les facteurs les plus importants sont l'influence de la famille et de la communaute, et l'equilibre vie-travail. Conclusion: Nous avons recommande que le recrutement des medecins de famille soit considere comme un processus de jumelage, selon lequel les medecins et les communautes sont jumeles de facon strategique. Des mesures incitatives devraient etre offertes aux communautes qui ne peuvent pas repondre a la demande de medecins de famille., INTRODUCTION A strong workforce of family physicians is important for the health status of citizens. (1) Family physician services are particularly important for rural and small communities, where there is [...]

Aim: This study was undertaken to determine the care needs of Canadian seniors living at home with advanced chronic obstructive pulmonary disease (COPD). Background: COPD is a leading cause of morbidity and mortality worldwide. Although hospitalizations for illness exacerbations and end-stage care may be common, most persons with COPD live out their lives in the community. Little is known about the care needs of this significant population. Methods: This study was guided by the research question: "What are the care needs and care priorities of senior citizens with end-stage COPD?" An ethnographic qualitative approach was used to address this question. Twelve community-dwelling seniors living in a Canadian city and diagnosed with advanced COPD were interviewed three times in their homes over an eight-month period in 2006. Findings: Three themes emerged, each with concrete care needs: (a) self-reliance and independence through adaptation, (b) stable health through maintenance, and (c) living with constraints. The predominant theme was that all participants wanted to maintain their independence. This required considerable adaptation, as well as assistance from others. Conclusions: Ensuring and improving assistance is important to prevent additional suffering and reduce exacerbations requiring hospitalization, a particularly important aim given the high and rising incidence of advanced COPD. A number of other insightful findings reveal the significance of learning directly from the persons who live with chronic illnesses about their lives.

The objective of this study was to determine the extent of machine learning (ML) application in asthma research and to identify research gaps while mapping the existing literature. We conducted a scoping review. PubMed, ProQuest, and Embase Scopus databases were searched with an end date of September 18, 2020. DistillerSR was used for data management. Inclusion criteria were an asthma focus, human participants, ML techniques, and written in English. Exclusion criteria were abstract only, simulation-based, not human based, or were reviews or commentaries. Descriptive statistics were presented. A total of 6,317 potential articles were found. After removing duplicates, and reviewing the titles and abstracts, 102 articles were included for the full text analysis. Asthma episode prediction (24.5%), asthma phenotype classification (16.7%), and genetic profiling of asthma (12.7%) were the top three study topics. Cohort (52.9%), cross-sectional (20.6%), and case-control studies (11.8%) were the study designs most frequently used. Regarding the ML techniques, 34.3% of the studies used more than one technique. Neural networks, clustering, and random forests were the most common ML techniques used where they were used in 20.6%, 18.6%, and 17.6% of studies, respectively. Very few studies considered location of residence (i.e. urban or rural status). The use of ML in asthma studies has been increasing with most of this focused on the three major topics (>50%). Future research using ML could focus on gaps such as a broader range of study topics and focus on its use in additional populations (e.g. location of residence). Supplemental data for this article is available online at http://dx.doi.org/. [ABSTRACT FROM AUTHOR]

Background: Health literacy is increasingly recognized as a major determinant of health; however, our insights into the health literacy strengths and needs of adults living with serious or persistent mental illness remain limited by a notable lack of research in this area. Improving our understanding is important because people in this group are especially vulnerable to numerous negative health outcomes, many preventable. Objective: To assess the health literacy strengths and needs of people living with serious or persistent mental illness in terms of their ability to acquire, understand, and use information about their illness and the health services they require. Methods: A cross-sectional convergent mixed methods design guided by the Ophelia Access and Equity Framework. People diagnosed with serious or persistent mental illness were offered participation. Quantitative and qualitative data was collected using questionnaires (Health Literacy Questionnaire [HLQ], World Health Organization [WHO-5]) and semi-structured interviews. Hierarchical cluster analysis identified and grouped participants with similar health literacy scores into mutually exclusive groups, for the development of clinical vignettes. Key Results: Participants struggled most with the appraisal of health information (HLQ mean 2.72, standard deviation [SD].63 [scale 1–4]) and navigating what they often perceived to be a confusing health care system (HLQ mean 3.29, SD.79 [scale 1–5]). On the other hand, most participants reported positive experiences with their health care providers (HLQ mean 3.19, SD.62 [scale 1–4]) and generally felt understood and supported. The cluster analysis suggests we should not assume people living with serious or persistent mental illness have homogeneous HL strengths and needs, meaning a one-size-fits-all solution for improving health literacy in this diverse group will likely not be a successful strategy. It will be important to explore solutions that embrace patient-centered care approaches. Conclusions: This study is one of only a handful assessing the health literacy strengths and needs of people living with serious or persistent mental illness. By collecting both quantitative and qualitative data, then analyzing the results using sophisticated cluster analysis methods, the authors were able to develop clinical vignettes per the Ophelia Framework that offer results in a practical way that can be readily understood and acted upon by stakeholders. We found that the HLQ is a measure of HL that is acceptable to mental health clients, and our findings provide preliminary data on the use of this instrument in the mental health population. [HLRP: Health Literacy Research and Practice. 2023;7(1):e2–e13.] Plain Language Summary: This study explored the health literacy strengths and needs of people living with serious or persistent mental illness. The results showed a mix of strengths and needs among our participants, though several consistent themes emerged. Most of our participants felt understood and supported by their health care providers, but many often struggle with judging the quality of health information and finding their way through the health care system. [ABSTRACT FROM AUTHOR]