Search

Objective: To examine experiences of anti-Indigenous racism in a Canadian medical school and inform the development of critical and action-oriented Indigenous health education necessary to pave the way for reconciliation within health systems. Design: A qualitative study conducted within a constructivist paradigm which involved: (1) semi-structured interviews with students, faculty and staff at a Canadian medical school; and (2) consensus-building/collaborative analytical sessions with an Indigenous advisory group and a non-Indigenous working group. Setting: Twenty-three semi-structured interviews were completed with students, staff and faculty working across a Canadian medical school. Results: Inductive coding generated 211 codes that were grouped into seven overarching thematic domains. By engaging in an iterative dialogue with the advisory and working groups, we deductively aligned the thematic analysis with faculty-level and institution-level Indigenous education strategies to ensure local relevance. Self-reflective statements were developed with the advisory group to guide areas for action and resulted in 18 statements with five-point Likert-type-style response options. Conclusion: The results of this study suggest that promoting self-reflexivity in health professional education can prompts educators to engage with Indigenous health curriculum and pedagogy; mentorship and role modelling; and accountability. Critically evaluating systemic injustices at an individual level enables educators to resist systemic oppression and create change in the spaces where they work.

Background: A strengths-based lens is essential for the pursuit of health equity among Indigenous populations. However, health professionals are often taught and supported in practice via deficit-based approaches that perpetuate inequity for Indigenous peoples. Deficit narratives in healthcare and health education are reproduced through practices and policies that ignore Indigenous strengths, disregard human rights, and reproduce structural inequalities. When strengths are recognised it is possible to build capacities and address challenges, while not losing sight of the structural factors impacting Indigenous peoples' health. Objective: In this paper, we examine Indigenous strengths-based approaches to policy and practice in healthcare and health professions education when delivered alongside teachings shared by Elders from the Cree, Blackfoot and Métis Nations of Alberta, Canada. Method: Literature and Elders' teachings were used to shift strengths-based approaches from Western descriptions of what might be done, to concrete actions aligned with Indigenous ways. Results: Four pointers for future action adopting a strengths-based approach are identified--enacting gifts: focusing on positive attributes; upholding relationality: centring good relationships; honouring legacy: restoring self-determination; and reconciling truth: attending to structural determinants of health. Conclusion: Identified directions and actionable strategies offer a promising means to advance Indigenous health equity through strengths-based actions that change existing narratives and advance health equity.

Background: To gain culturally appropriate awareness of First Nations, Inuit and/or Métis Health, research suggests that programs focus on sending more trainees to First Nations, Inuit and/or Métis communities Working within this context provides experiences and knowledge that build upon classroom education and support trainees' acquisition of skills to engage in culturally safe healthcare provision. This study examines residents' and faculty members' perceptions of how residency training programs can optimize First Nations, Inuit and/or Métis health training and support residents in gaining the knowledge, skills, and experiences for working in and with First Nations, Inuit and/or Métis communities. Methods: A qualitative approach was used, guided by a relational lens for collecting data and a constructivist grounded theory for data interpretation. Theoretical sampling was used to recruit 35 participants from three main study sites across two western Canadian provinces. Recruitment, data collection, and analysis using constructivist grounded theory occurred concurrently to ensure appropriate depth of exploration. Results: Our data analysis revealed five themes: Five themes were generated: Complexity of voluntourism as a concept; Diversity of knowledge representation required for developing curriculum; Effective models of care for First Nations, Inuit and/or Métis health; Essential traits that residents should have for working in First Nations, Inuit and/or Métis communities; and Building relationships and trust by engaging the community. Conclusions: First Nations, Inuit and/or Métis Health should be prioritized within Canadian postgraduate medical education. Equipping trainees to provide holistic care, immersing in and learning from First Nations, Inuit and/or Métis communities is essential for developing the next generation of clinicians and preceptors. We present educational recommendations for residency programs to optimize First Nations, Inuit and/or Métis health educational experiences and provide residents with skills to provide effective and culturally safe care. [ABSTRACT FROM AUTHOR]

Objectives: Mild behavioral impairment (MBI) is a dementia risk indicator in older adults characterized by later‐life emergent and persistent neuropsychiatric symptoms. Quality of life (QoL) is a multi‐dimensional concept encompassing physical, spiritual, and emotional well‐being. QoL aims to measure and quantify perceptions of individual health, well‐being, standard of living, personal fulfillment, and satisfaction. As MBI symptoms may arise from early‐stage neurodegenerative disease, MBI may contribute to declining QoL before dementia onset. In this study, we investigated the relationship between symptoms of MBI and QoL in older adults. Methods: The sample comprised 1107 individuals aged ≥ 50 years from the Canadian Platform for Research Online to Investigate Health, Quality of Life, Cognition, Behavior, Function, and Caregiving in Aging (CAN‐PROTECT). Multivariable linear regressions were used to model the associations between MBI symptom severity (exposure), measured using the MBI Checklist (MBI‐C), and QoL (outcome) assessed by the EuroQol‐5D (EQ‐5D, higher score = poorer QoL) and the novel Quality of Life and Function Five Domain Scale (QFS‐5) (QFS‐5, lower score = poorer QoL). Covariates were age, sex, cognition, education, ethnocultural origin, marital status, employment status, high blood pressure, heart disease, and diabetes. Moderation analysis explored potential sex differences. A sensitivity analysis was performed removing anxiety/depression items from the EQ‐5D score. Results: Across the sample (mean age = 64.4 ± 7.2, 79.4% female) every 1‐point increase in MBI‐C score was associated with a 0.06‐point standard deviation (SD) increase in EQ‐5D score (95% confidence interval (CI): 0.05–0.06, p < 0.001) and 0.08 SD decrease in QFS‐5 score (95% CI: −0.09 to −0.08, p < 0.001). Neither association depended on sex (p = 0.59 and p = 0.41, respectively). The association remained significant after removing anxiety/depression items from the EQ‐5D score (β = 0.04, 95% CI: 0.03– 0.04, p < 0.001). Conclusions: The study shows that MBI is associated with poorer QoL, independent of sex, on two QoL scales. We addressed depression/anxiety items in the EQ‐5D as a potential confounder for the observed MBI‐QoL association by conducting a sensitivity analysis that excluded those items from the EQ‐5D total score and by employing a novel measure of QoL (QFS‐5) that excludes psychiatric symptoms from measurement of QoL. Associations of MBI with the novel QFS‐5 were similar to associations between MBI and the EQ‐5D. Finding interventions to reduce the burden of MBI symptoms might improve quality of life. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Changes to the brain due to Alzheimer's disease and other age‐related neuropathologies may present with cognitive and behavioral symptoms, even during preclinical and prodromal stages. While cognitive reserve is known to mitigate cognitive decline in the preclinical stages of Alzheimer's disease, links between cognitive reserve and behavioral symptoms remain unclear. This study investigates the relationship between cognitive reserve and mild behavioral impairment (MBI), a neurodegenerative behavioral prodrome. METHODS: We analyzed cross‐sectional data from 1204 participants in the Canadian Platform for Research Online to Investigate Health, Quality of Life, Cognition, Behavior, Function, and Caregiving in Aging (CAN‐PROTECT) study. A cognitive reserve score (CRS) was generated based on education, occupation, and personal cognitive reserve proxies. MBI presence (MBI+) and MBI global and domain symptom severity were evaluated using the self‐reported MBI Checklist. Initial analyses examined the convergent validity of the CRS through associations with objective neuropsychological test performance and self‐reported cognitive symptoms (Everyday Cognition [ECog‐II] scale). Models were also fitted to assess MBI status and severity as functions of the CRS. RESULTS: Higher CRS was associated with better neuropsychological test scores, lower odds of subjective cognitive decline (OR = 0.86, 95% CI: [0.76, 0.98], p =.03), and lower ECog‐II total score. Likewise, higher CRS was associated with lower odds of MBI+ (OR = 0.81, 95% CI: [0.71, 0.93], p =.003), and lower MBI symptom severity globally, and in impulse dyscontrol and social inappropriateness domains. DISCUSSION: We provide preliminary evidence that engagement in activities known to preserve cognitive function in aging and disease may also preserve behavioral function. Future research should disentangle possible pathways through which cognitive reserve may preserve both cognition and behavior, explore common etiologies for these symptoms, and observe outcomes longitudinally to better understand these relationships. Highlights: Education, occupation, and personal activities are cognitive reserve proxies.Cognitive reserve is linked to lower subjective cognitive decline in older persons.Cognitive reserve is linked to lower mild behavioral impairment odds and severity. [ABSTRACT FROM AUTHOR]

Shared governance has emerged as an incrementally inclusive modification to common Western forms of governance, which are often top-down, bureaucratic, and individualistic in nature. Anti-oppressive movements call for structural changes which necessarily involve examining where and how decisions are made in post-secondary institutions. This systematic literature review synthesizes scholarship on shared governance in post-secondary settings. This research is guided by the Joanna Briggs Institute (JBI) guidelines for conducting systematic reviews, a priori protocol to steer the research process, and the PRISMA guidelines for reporting systematic reviews. A review of 48 empirical papers published in peer-reviewed journals resulted in five main themes for shared governance in higher education: potentially interested parties; characteristics of governing leaders; principles and values of shared governance; processes of shared governance; and models of shared governance. We also identified gaps in the shared governance literature: underrepresentation of community (Indigenous and non-Indigenous) as well as Indigenous and diverse ways of knowing, and lack of attention to the diverse identities within the interested parties. We proceed to propose inclusive governance as a more appropriate term than shared governance. [ABSTRACT FROM AUTHOR]

Physical inactivity in mid-life is a modifiable risk factor for dementia. Mild behavioral impairment (MBI) is a marker of potential neurodegenerative disease. We investigated the association between physical activity and MBI. Baseline data from the Canadian Platform for Research Online to Investigate Health, Quality of Life, Cognition, Behaviour, Function, and Caregiving in Aging (CAN-PROTECT) were used. Four categories of weekly physical activity (cardiovascular, mind-body, strength training, and physical labour) were derived from the Community Healthy Activities Model Program for Seniors questionnaire. MBI was measured using the MBI-Checklist. Multivariable negative binomial regressions modelled the association between the standardized physical activity duration and MBI severity, adjusted for age, sex, education, marital status, ethno cultural origin, occupation, hypertension, dyslipidemia, mobility, and body mass index. Every 1 SD increase in cardiovascular activity was associated with 8.42% lower MBI severity. In contrast, every 1 SD increase in physical labor duration was associated with 5.64% greater MBI severity. These associations were neither moderated by the frequency engaging in each physical activity nor by sex. Cardiovascular physical activity in older persons may reduce levels of non-cognitive dementia markers like MBI, comparable to effects seen in cognition, potentially modulating dementia risk. [ABSTRACT FROM AUTHOR]

Addresses the status of technology in elementary social studies. Reviews research on technology and elementary social studies, explores various examples of practice, discusses how preservice social studies methods textbooks treat the issue of using technology, and identifies beliefs held by elementary social studies teachers. (CMK)