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Introduction: Over 13 million Syrians have been forcibly displaced since the start of the Syrian civil war in 2011. In response to this humanitarian crisis, several high-income countries have settled thousands of Syrian refugees. In Canada, over 50,000 Syrian refugees have resettled through varying resettlement programs. Half of the refugees are women who are mothers or of child-bearing age, and who experience numerous health disparities. This article reports findings from a larger, Canadian-based study inquiring into the factors supporting and shaping the settlement and integration experiences among women who are Syrian refugees and mothering. Methods: A longitudinal intersectionality-framed participatory action approach was initiated through multiple meetings with a diverse range of non-profit community organizations focused on refugee health and settlement. Through these meetings, sustainable relationships were formed, and trust was built toward further engaging with the Syrian refugee mothering women population. A core group of 4 women were employed as peer research assistants and were integrated across research processes. Results: In total, 40 Syrian refugee mothering women participated in this study. Six themes emerged from data analysis of their lived experiences of resettlement. Four of these themes are published elsewhere. We focus this article on two of the six key findings: harnessing strength-based capabilities, and peer research assistant experiences. Conclusions: The two findings described in this article convey facilitators that add to understanding influences on the mental well-being of Syrian refugee mothering women. Unique to this study is the novel integration of peer research assistants and a model of support which contributes to an ethical and inclusive approach to understanding lived experiences among refugee women. This article highlights how this model benefits the peer research assistant and promotes community engagement among women.

Background Islamophobia or, anti-Muslim racism, and more specifically, gendered islamophobia targeting Muslim women who wear a hijab is rising globally and is aggravated by the COVID-19 pandemic. However, anti-Muslim racism is not well understood in Canadian nursing. Purpose This study utilized narrative inquiry to understand anti-Muslim racism through the experiences of nurses who wear a hijab with the goal of putting forward their counter-narrative that disrupts anti-Muslim racism in Canadian nursing. Methods Narrative inquiry informed by Critical Race Feminism, care ethics, and intersectionality were used to analyze the factors shaping anti-Muslim racism and composite narratives were used to present the results. Results The three composite narratives are: ‘This is Who I Am: A Muslim Nurse with a Hijab and an Accent’; ‘I Know What is at Play: Unveiling Operating Power Structures and Power Relations’; and ‘Rewriting the Narrative: Navigating Power Structures and Power Relations’. These composite narratives constituted the nurses’ counter-narrative. They revealed intersections of gendered, racial divisions of labour and religious narratives that shape anti-Muslim racism, as operating power relations in nursing, and how Muslim nurses reclaimed control to resist their racialized stereotypes. Conclusion Findings suggest that anti-Muslim racism in nursing operates through multiple intersecting power relations. Using stories can mobilize transformational change so that anti-racist practices, policies, and pedagogy can be embraced.

Background Over 13 million Syrians have been forcibly displaced since the start of the Syrian civil war in 2011. In response to this overwhelming humanitarian crisis, several high income countries have settled thousands of Syrian refugees. In Canada, over 50,000 Syrian refugees have resettled through varying resettlement programs. Half of these refugees are women who are mothers or of child-bearing age. Women who are refugees and mothering comprise a population that experience numerous health disparities including higher rates of depression and anxiety, social exclusion and lower socioeconomic status. This article reports findings from a larger, Canadian-based study inquiring into the factors supporting and shaping the settlement and integration experiences among women who are Syrian refugees and mothering. Methods This study employed a longitudinal intersectionality-framed participatory action approach. This design was initiated through multiple community-based meetings with a diverse range of non-profit organizations focused on refugee health and settlement. Through these meaningful engagements, sustainable relationships were formed and trust was built toward further immersing ourselves within the Syrian refugee mothering women population. Consequential establishment of a core group of 4 women led to the emergence of a peer research assistant model which informed data collection, reflexive analysis, and knowledge mobilization activities. Results In total, 40 Syrian refugee mothering women participated in this study and six themes emerged from data analysis of their lived experiences of resettlement. Four of the themes are published elsewhere. We focus this article on two of the six key findings: harnessing strength-based capabilities, and peer research assistant experiences. Conclusions While multiple barriers continue to exist within recent re-settlement processes of Syrian refugee mothering women, these two findings convey facilitators that add to understanding influences to the mental well-being of this often overlooked population. Unique to this study is the novel integration of peer research assistants and a model of support which contributes to an ethical and inclusive approach to understanding lived experiences among refugee women. This article highlights how this model benefits the peer research assistant and promotes community engagement among women.

Migrants, that is people who experience forced displacement or move based on being lesbian, gay, bisexual, trans, two-spirit, queer, and intersex (LGBTQI+), experience increased trauma and stigma when compared to heterosexual and cisgender people. The aim of this paper is to highlight LGBTQI+ migrants’ experiences of health and social care encounters in Canada. Gadamerian hermeneutics and an intersectionality lens was used to understand LGBTQI+ migrants’ experiences. A total of 16 semi-structured individual interviews were conducted with LGBTQI+ migrants. Themes of stigma and discrimination were identified as (1) “I never went back”: Stigma as an exclusionary experience, (2) “Is [your country of birth] really that bad”: Fear, safety, and cultural stigma, and (3) “The circle … is not going to fix my life”: LGBTQI+ migrants’ call for affirming care. Results suggest that health and social care practices are stigmatizing and discriminatory which negatively impacts LGBTQI+ migrant mental health. Salient practices for promoting mental health included affirming LGBTQI+ identities and orientations through health and social care practices that are culturally safe as well as trauma and violence informed.

Recovery is a policy framework for mental health in Canada. Key challenges to the integration of recovery include a gap in knowledge about the work that people do to promote their health and well-being in the context of living with mental ill health. This study used Photovoice to explore the lived realities of people living with mental ill health and the impact of the social determinants on their recovery process. Findings from this study inform policy and practice on promoting health work as an important dimension of recovery and community inclusion.

Racism in nursing can be positioned through institutional forms of gendered, racialized, and religious structures. Muslim nurses who choose to honor the Islamic practice of donning hijab may be at risk of experiencing racism in contexts of post-September 11 era and the war on terror. Critical race feminism and intersectionality are theoretical frameworks that when applied to narrative inquiry can illuminate the standpoint of Muslim nurses donning hijab by providing a counternarrative as a point of resistant to racism in nursing.

Patient care and public health require timely, reliable laboratory testing. However, clinical laboratory professionals rarely know whether patient specimens contain infectious agents, making ensuring biosafety while performing testing procedures challenging. The importance of biosafety in clinical laboratories was highlighted during the 2014 Ebola outbreak, where concerns about biosafety resulted in delayed diagnoses and contributed to patient deaths. This review is a collaboration between subject matter experts from large and small laboratories and the federal government to evaluate the capability of clinical laboratories to manage biosafety risks and safely test patient specimens. We discuss the complexity of clinical laboratories, including anatomic pathology, and describe how applying current biosafety guidance may be difficult as these guidelines, largely based on practices in research laboratories, do not always correspond to the unique clinical laboratory environments and their specialized equipment and processes. We retrospectively describe the biosafety gaps and opportunities for improvement in the areas of risk assessment and management; automated and manual laboratory disciplines; specimen collection, processing, and storage; test utilization; equipment and instrumentation safety; disinfection practices; personal protective equipment; waste management; laboratory personnel training and competency assessment; accreditation processes; and ethical guidance. Also addressed are the unique biosafety challenges successfully handled by a Texas community hospital clinical laboratory that performed testing for patients with Ebola without a formal biocontainment unit. The gaps in knowledge and practices identified in previous and ongoing outbreaks demonstrate the need for collaborative, comprehensive solutions to improve clinical laboratory biosafety and to better combat future emerging infectious disease outbreaks.

The global Coronavirus Disease (COVID-19) pandemic caused by the SARS-CoV-2 virus has raised many urgent questions about the transmission of this disease, including the possible roles of aerosols c...

Legalization of medicinal and recreational cannabis use in numerous states within the USA has resulted in the increased commercial cultivation of cannabis. Outdoor cannabis farming operations present a variety of potential physical, chemical, and biological hazards that currently remain uncharacterized. Worker exposures to endotoxins were evaluated at an outdoor US cannabis farm during harvesting and processing activities. Endotoxin area air sample concentrations ranged from below the limit of detection to 15 endotoxin units per cubic meter (EU/m3). Endotoxin breathing zone measurements (2.8–37 EU/m3) were below the Dutch Expert Committee on Occupational Safety occupational exposure limit of 90 /m3. During confidential medical interviews, no adverse health effects were reported by workers while harvesting or processing cannabis. Further endotoxin exposure assessments should be performed especially in larger, indoor cannabis operations where a confined environment may result in higher endotoxin exposures than observed in this outdoor environment.

Immigrant women's mental health is a growing public health policy issue. New immigrant mothers may be particularly vulnerable to less than optimal mental health following childbirth given the cultural and geographic isolation, socioeconomic factors, gender roles, and language difficulties that influence their postpartum experiences. The purpose of this environmental scan was to increase understanding of immigrant women's perinatal mental health care services within the interior of a western Canadian province. Four interrelated themes emerged to impact postpartum health of immigrant women: (i) community capacity building, (ii) facilitators of mental health support and care, (iii) barriers of mental health promotion and support, and (iv) public policy and postpartum depression. Knowledge gained from this study contributes to healthy public policy and practices that promote mental health and support among immigrant women.

Purpose The purpose of this paper is to describe Karen refugee women’s experience of resettlement and the factors which structured community capacity to support their mental health and well-being. Design/methodology/approach A postcolonial and feminist standpoint was used to bring Karen women’s voice to the knowledge production process. Data were collected through ethnographic field observation, in-depth semi-structured individual and focus group interviews with Karen women as well as healthcare and social service providers. Findings Three interrelated themes emerged from the data: Karen women’s construction of mental health as “stress and worry”; gender, language and health literacy intersected, shaping Karen women’s access to health care and social resources; flexible partnerships between settlement agencies, primary care and public health promoted community capacity but were challenged by neoliberalism. Research limitations/implications Karen women and families are a diverse group with a unique historical context. Not all the findings are applicable across refugee women. Practical implications This paper highlights the social determinants of mental health for Karen women and community responses for mitigating psychological distress during resettlement. Social implications Public health policy requires a contextualized understanding of refugee women’s mental health. Health promotion in resettlement must include culturally safe provision of health care to mitigate sources of psychological distress during resettlement. Originality/value This research brings a postcolonial and feminist analysis to community capacity as a public health strategy.

This innovative pilot study used the Critical conversations: The NLN Guide for Teaching Thinking monograph to promote critical conversation during debriefing in an interprofessional education group setting following a disaster preparedness simulation. Interprofessional health care students (n = 120) participated in the Debriefing Assessment for Simulation in Healthcare survey as well as four focus groups to understand student perspectives related to the Context, Content, and Course format used to cocreate meaning related to the simulation experience. Findings revealed that use of this method promoted critical dialogue underscored by self-efficacy, critical reflection, safety, group size, and interdisciplinary learning.

During August–October, 2018, an outbreak of severe respiratory illness was reported among poultry slaughter plant workers in Virginia and Georgia, USA. A multiorganizational team investigated the cause and extent of illness, determined that the illness was psittacosis, and evaluated and recommended controls for health hazards in the workplace to prevent additional cases.

In July 2015, a municipal health department in Ohio received complaints of respiratory and ocular symptoms from patrons of an indoor waterpark resort. In response, the health department conducted an online survey in August 2015 through which 19 (68%) patron and employee respondents reported eye burning, nose irritation, difficulty breathing, and vomiting. On August 11, 2015, the health department requested a health hazard evaluation by CDC's National Institute for Occupational Safety and Health to characterize the prevalence of symptoms among employees and determine the etiology of work-related symptoms. In January 2016, CDC investigators performed a cross-sectional epidemiologic study, environmental sampling, and ventilation system assessment (1). Findings suggested that chlorine disinfection byproducts and environmental conditions contributed to a higher prevalence of work-related respiratory and ocular symptoms among employees in the waterpark compared with employees in other resort areas. Recommendations included servicing the ventilation system, changing work practices to decrease the amount of disinfection byproduct precursors, and responding promptly to employee reports of symptoms.

IntroductionTo advance person- and family-centred healthcare, government initiatives have supported the engagement of patients and family caregivers in decision-making in healthcare systems. There is, however, no consensus on how to define success for such initiatives. This scoping review aims to identify the key elements for defining the quality of patient and family caregiver engagement in decision-making across the engagement domains (individual, community/organisation, system) of British Columbia’s healthcare system. We will use those elements to develop a conceptual evaluation framework.Methods and analysisThis scoping review follows Arskey and O’Malley’s methodology. (1) The research question was identified through team discussions. (2) Articles for data source will be identified using a librarian-informed search strategy for seven bibliographic databases as well as grey literature sources. (3) Selected articles will be relevant to the evaluation of patient and family caregiver engagement in healthcare systems. (4) Two researchers will independently extract data into predefined and emerging categories. (5) The researchers will reconcile and organise the identified elements. The research team’s collective perspective will then refine the elements, and select, interpret and summarise the results. (6) Persons from key stakeholder groups will be consulted to refine the emergent conceptual framework.Ethics and disseminationWe will seek ethics approval for the stakeholder consultation. This study follows an integrated knowledge translation approach. The results will inform evaluation of the Patients as Partners Initiative of the British Columbia Ministry of Health, and will be disseminated as a scientific article, a research brief, and presentations at conferences and stakeholder meetings.

Background:Underserved populations, such as ethnic minorities, low-income adults, and Indigenous people living with arthritis are more likely to have lower health literacy, higher rates of multi-morbidity, and face challenges in accessing care1-3. Self-management support (SMS) can help to mitigate the impacts of living with arthritis4. However, we require a more in-depth understanding of the daily barriers underserved communities face in living with arthritis in order to develop effective SMS that can meaningfully improve well-being and quality of life.Objectives:The study objective was to bring together underserved people living with arthritis to identify common barriers they face in taking care of their conditions in daily life, and to identify their solutions to the identified challenges.Methods:A team of researchers from several universities, nurse practitioners, physicians, policy makers, an arthritis consumer-patient leader and our community partners (Multi-lingual Orientation Service Association for Immigrant Communities and the Portland Hotel Society Community Services Society) engaged in a Community-based Participatory and Concept Mapping (CM) study5-7 where participants from underserved communities identified major barriers they face in managing arthritis, agreed on key themes that emerged, and determined priorities for actions. This involved three key CM activities: 1) brainstorming ideas; 2) sorting and rating ideas; and 3) analyzing and interpreting concept maps8. Data was collected through face-to-face interviews and prioritized and interpreted in workshop settings.Results:Sixty-three individuals who were ethnic minorities, immigrants, refugees, low-income, over 65, and/or housing insecure and living with arthritis identified 35 common barriers and made recommendations in the areas of financial difficulties, social services, access to health services, quality of health services, lack of knowledge, and mental health. Additional funding has been sought through Community-University Engagement Support Funding to enable our community partners to prioritize the recommendations in their communities, and to develop mechanisms for implementation using already existing community structures, processes, and services.Conclusion:Persons living with arthritis in diverse underserved communities face significant health and social inequities, including lack of access to basic life necessities such as food, housing, employment, and safety, which creates barriers to self-managing arthritis and other chronic conditions in daily life. SMS for these communities needs to address these social and environmental barriers shaping capacity for self-management, and ultimately, quality of life and well-being.References:[1]Ackerman I, Busija L. Access to self-management education, conservative treatment and surgery for arthritis according to socioeconomic status. Best Pr Res Clin Rheumatol. 2012;26(5):561–83.[2]Shadmi E. Multimorbidity and equity in health. Int J Equity Heal. 2013;12(59):59.[3]Foster M, Kendall E, Dickson P, Chaboyer W, Hunter B, Gee T. Participation and chronic disease self-management: are we risking inequitable resource allocation? Aust J Prim Health. 2003;9(3):132–40.[4]Brady T, Anderson L, Kobau R. Chronic disease self-management support: public health perspectives. Front Public Heal. 2015;2(234).[5]Trochim W. An introduction to concept mapping for planning and evaluation. Eval Progr Plann. 1989;12(1):1–16.[6]Anderson L, Day K, Vandenberg A. Using a concept map as a tool for strategic planning: the healthy brain initiative. Prev Chronic Dis. 2011;8(5):A117.[7]Petrucci C, Quinlan K. Bridging the research practice gap: concept mapping as a mixed methods strategy in practice-based research and evaluation. J Soc Serv Res. 2007;34(2):25–42.[8]Kane M, Trochim W. Concept mapping for planning and evaluation. Thousand Oaks (CA): SAGE Publications; 2007.Disclosure of Interests:None declared

Young children are able to benefit from early science teaching but many preschool teachers have not had opportunities to deepen their own understanding of science or to develop their pedagogical content knowledge (PCK) in relation to specific science topics and concepts. This study presents the results of efficacy research on Foundations of Science Literacy (FSL), a comprehensive professional development program designed to support teachers’ knowledge of early childhood science; their PCK around 2 physical science topics (water, and balls and ramps); and their abilities to plan, facilitate, and assess young children’s learning during inquiry-based science explorations. Research Findings: In a randomized trial with 142 preschool teachers and 1,004 4-year-old children, FSL teachers demonstrated significantly higher quality science teaching in general and greater PCK in the 2 physical science topics than did teachers in comparison classrooms. Furthermore, children in FSL classrooms performed signific...

Heart failure is one of the most common causes of hospitalization, hospital readmission and death. Patients with heart failure have many complications, with multiple co-existing diagnoses which result in polypharmacy. Following instructions provided by many physicians, medication adjustments based on changes in their symptoms are required. Behavioral adjustments concerning diet and exercise regime are recommended. Therefore, the patient plays a crucial role in the management of heart failure.To review the available studies on heart failure self-management, and investigate educational, behavioral and psychosocial strategies that plays an important role to improve patient self-management.A literature review was conducted based upon the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidance. The articles identified through an extensive search using PubMed and UpToDate from 1999 to 2016.Improved self-management will increase compliance, promote patient quality-of-life, advance clinical outcomes, reduce hospital re-admission and will decrease hospitalization costs.

The Immigration and Refugee Protection Act (IRPA) in Canada has set the stage for inclusive policy. Health literacy, language spoken, and gender are among the selected differential resettlement determinants of refugees’ access to health resources and opportunities. Gender-based analysis (GBA) is a priority for IRPA for promoting inclusive settlement policies. However, these legislative structures do not reflect language and health literacy as important intersections for immigrant integration. The objective of this chapter is to demonstrate that intersectionality as a policy tool can help structural and political processes to promote social justice and integration commitments to settlement and health care policy.