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Les systemes de sante ruraux du Canada sont debordes et manquent de personnel. Si la medecine generale en milieu rural est florissante dans certaines regions du pays, les donnees montrent [...]

The COVID-19 pandemic and associated restrictions have had a profound impact on the health of people in Canada. The unprecedented levels of stress, anxiety, and uncertainty led some people to [...], Background: The COVID-19 pandemic and related public health interventions have been associated with increased alcohol consumption. We sought to estimate excess mortality and hospitalizations attributable to alcohol use in Canada between April 2020 and December 2022. Methods: Using data from the Canadian Vital Statistics Database and hospital Discharge Abstract Database (Jan. 2016 to Dec. 2022), we analyzed monthly mortality and hospitalization rates for conditions fully attributable to alcohol use in people in Canada aged 15 years and older. We estimated excess rates during the study period of April 2020 to December 2022 by comparing observed rates to expected rates, modelled using the autoregressive integrated moving average method, accounting for trends, seasonality, autocorrelation, and pandemic waves. Results: Between April 2020 and December 2022, mortality fully attributable to alcohol in Canada increased by 17.6% (1600 excess deaths), and hospitalizations fully attributable to alcohol rose by 8.1% (7142 excess hospitalizations). Most increases occurred in the first 2 years, with deaths up about 24% and hospitalizations about 14%. Mortality rose by 55.4% in adults aged 25-44 years, 19.1% in those aged 45-64 years, and 2.6% in those aged 65 years and older, with similar increases among males (17.0%) and females (17.8%). Deaths rose by 11.7% in the highest income quintile, as compared with 17.0%-21.5% in the other quintiles. Excess hospitalizations were highest among people aged 15-24 years (20.3%) and 25-44 years (13.1%) and increased more for females (15.6%) than for males (5.7%). Regionally, mortality increased most in the Prairie provinces (Manitoba, Saskatchewan, and Alberta; 28.1%) and British Columbia (24.2%), whereas hospitalizations increased the most in the territories (Northwest Territories, Nunavut, and Yukon; 27.3%) and the Prairie provinces (14.6%). Alcoholic liver disease was the leading cause of excess mortality and hospitalizations, which increased by 22% and 23%, respectively. Interpretation: Mortality and hospitalizations fully attributable to alcohol increased substantially across different demographics and regions in Canada during the April 2020 to December 2022 period of the COVID-19 pandemic. A comprehensive approach to preventing and managing high-risk drinking, alcohol use disorder, and alcoholic liver disease in the aftermath of the pandemic should comprise both public health and clinical management interventions.

On January 5, 2025, President Biden signed into law the Social Security Fairness Act (H.R. 82) to increase Social Security benefits for retired public workers, their spouses, widows, and widowers [...], The impact of laws and policies that involve social determinants of health (SDOH), particularly among older, retired populations, needs to be considered as a public health intervention. The Social Security Fairness Act was signed into law in 2025, as a new amendment to the Social Security Act first introduced in 1935. The Social Security Fairness Act ends two provisions that have reduced benefits for spouses, widows, and widowers and for public service workers, which include teachers, fire fighters, police officers, nurses, and others who are receiving pensions from state or local government. Specifically, this new bill involves economic stability, which is considered an important SDOH for older adults. The purpose of the current article is to evaluate policy changes through the Social Security Fairness Act, including potential impact and benefits, limitations or unintended consequences, and implications and recommendations for future research, policy, and practice. Findings will help guide gerontological nurses and interprofessional researchers, clinicians, and educators promoting healthy aging. [Journal of Gerontological Nursing, 51(2), 7–12.]

Trauma is not something unfamiliar to those who work in emergency or first responder occupations. Indeed, it is common for those in the fire, EMS, police, emergency medical, and corrections [...]

TURNING DOWN A JOB was the best decision Kris Cameron ever made. He'd finally gotten an offer from a restaurant supply wholesaler in April 2023 after a long, frustrating search. [...]

The chasm between the principles upon which this Government was founded... and those which are daily practiced under the protection of the flag, yawns so wide and deep. --Mary Church [...]

January 6 Epiphany of the Lord Matthew 2:1-12 It was the first Christmas break of the COVID pandemic, and I was desperate for new distractions for my young children. Why [...]

Well-being, a state of mental and physical health, is largely shaped by the social, economic, and physical environments in which people live, work, and develop, often termed the social determinants [...], There is an increased need for mental health counselors (MHCs) to address social determinants of mental health (SDMH) in counseling practice. Using consensual qualitative research, we interviewed 12 MHCs and identified four key domains related to addressing SDMH: (1) competence, where participants reflected on their knowledge and skills within the Multicultural Social Justice Counseling Competencies (MSJCC) framework; (2) interventions and actions, where MHCs described their approaches to addressing SDMH; (3) challenges, where participants acknowledged the difficulties encountered in practice; and (4) counselor education, which provided insights related to training and professional development. These domains align with the MSJCC framework, emphasizing the importance of knowledge, skills, and action. Additionally, our findings resonate with existing research in healthcare disciplines, particidarly regarding the challenges of addressing SDMH in practice. Implications of our study include the need for ongoing professional development, culturally competent training, and systemic changes to better address SDMH in counseling practice.

Stroke is a leading cause of disability affecting approximately 795,000 adults per year in the United States and >93 million globally (Martin et al., 2024). The prevalence of stroke increases [...], Purpose Stroke family caregivers often struggle to provide care. The purpose of the current study was to determine: (a) ease or difficulty with caregiving tasks; (b) life changes because of providing care; and (c) relationship between caregiving tasks and life changes. Method A descriptive correlational design was used. Telephone interviews were conducted with 74 stroke caregivers. Tasks were measured using the Oberst Caregiving Burden Scale; life changes with the Bakas Caregiving Outcomes Scale. Results The most difficult tasks were managing survivor behaviors and the most negative life changes were lack of time for social activities. The easiest tasks were medical or nursing treatments, whereas the most positive life change was an improved relationship with the survivor. Tasks and life changes were different for each caregiver. Caregiver tasks and life changes were moderately correlated (r = 0.33, p < 0.01). Conclusion Caregiver tasks and life changes are important for designing strategies to support stroke caregivers. [Journal of Gerontological Nursing, xx(x), xx–xx.]

When we think of the damage caused by misinformation, we tend to think of false beliefs. Misinformation reduces acceptance of the reality of climate change, raises doubts about the safety [...]

In spring 2021, Jeff and Joan Beal moved from California to New York be closer to Joan's aging mother. They moved into a new home not far from Manhattan's Riverside [...]

In 20th century U.S. history, the Silent Generation is eclipsed by the Greatest Generation before it and the Baby Boomers that followed it. In fact, this group of people born [...]

The U.S. Department of Defense (DOD) is America's oldest and largest government agency. Boasting a budget of over $841 billion, it employs 3.4 million service members and civilians at nearly [...]

If you're sad,' French fashion designer Coco Chanel famously said, 'add more lipstick and attack.' The effect is less powerful, however, if your application is more Picasso than empowering. Painting [...]

When a child has disabilities, some families may feel helpless and rely on schools for support and guidance. Parental involvement is often linked to positive school outcomes for all students, [...]

The idea for training puppies from area animal shelters and rescues to assist veterans and first responders evolved when Laura Barker was visiting her veteran son Nick, while he was [...]

Family members like me, while well-intentioned, often struggle to fully comprehend the unique challenges and perspectives of a loved one with a disability. We may unintentionally make assumptions or offer [...]

French Receives Visionary Prize The Craig H. Neilsen Foundation has named Jennifer French, founder and executive director of the Neurotech Network, as the 2024 Craig H. Neilsen Visionary Prize award [...]

Author(s): Iva R Kalita [1]; Veena Kannusamy [2]; Fredrick Mouttapa [2]; Harsh V Singh (corresponding author) [1] The role played by vision centers (VCs) to achieve the Millennium Development Goals [...], Purpose: This study was conducted in continuation of Primary Eyecare in Paediatrics Population (PREPP-I) and was aimed to assess parents&apos; satisfaction with pediatric-eye-care services across six vision centers (VCs) of a tertiary eye hospital in Southern India. The barriers among the parents for not attending the base hospital (BH) when referred from these VCs were also evaluated. Methods: A standard-validated-satisfaction questionnaire (VSQ) was used to assess patient satisfaction. Responses were assessed on a 5-point Likert scale: 0 (very dissatisfied) to 4 (very satisfied) against each response. Responses were expressed as percentages with 0 (very dissatisfied) and 100% (very satisfied). Patients were referred with a form mentioning reasons for referral (urgent/non-urgent). All referrals were evaluated by the principal investigator. In case of failure to report, parents were enquired about the barrier based on the validated barrier questionnaire (VBQ) over a telephonic conversation. Results: All 250 patients of the PREPP-1 study were included in the satisfaction study. Different domains were evaluated using VSQ (accessibility of VC, waiting hours, financial aspects, spectacle dispensing service, and teleophthalmology). The overall satisfaction was 75%. The most common reason for dissatisfaction was the lack of meeting the ophthalmologist in person, followed by waiting time. 58 patients wanted to visit BH to consult a pediatric ophthalmologist in person (23%). For the barrier study, 14 out of 47 referrals did not report and were evaluated using VBQ (knowledge, physical, time, and financial barriers). The majority had a financial barrier (43%), followed by knowledge (28.6%) and time barrier (14%). Conclusion: PREPP-II demonstrated that 3/4[sup.th] of pediatric patients are happy to be treated at VC with teleophthalmology services. However, a significant percentage want to consult a specialist at BH. One-fourth of total referrals did not report to BH due to financial constraints and a lack of awareness of the child&apos;s condition. Keywords: Pediatric eye care service, pediatric eye diseases, pediatric ophthalmology, primary eye care, vision center, vision center study

Author(s): Ronak Asodariya [1]; Kavita R Bhatnagar (corresponding author) [2]; Manjari Tandon [1]; Kirti Jaisingh [1]; Jyoti Shakrawal [1]; Seema Meena [1]; Latika Pandey [1] The surge in viral infections, [...], Purpose: The study aims to systematically assess patient satisfaction concerning eye care services provided during and after the coronavirus disease 2019 (COVID-19) pandemic at a tertiary care academic institution. This work seeks to analyze the various dimensions influencing the holistic measure of overall patient contentment. Methods: A cohort of 2485 patients seeking physical consultation for ocular conditions at a tertiary care academic institution between April 2020 and December 2022 were recruited in a cross-sectional study. They were divided into two groups, viz. during the COVID period and post-COVID period. The primary focus was on evaluating overall satisfaction, measured through a validated patient satisfaction questionnaire (PSQ-18). Results: The study encompassed a total of 2485 participants, with 1242 individuals in the cohort during the COVID period and 1243 in the post-COVID phase. Within the COVID period subgroup, the mean age of male and female patients was 39.46 ± 19.31 and 39.58 ± 19.07 years, respectively. In the post-COVID subgroup, the mean age of male and female patients was 45.26 ± 19.38 and 45.36 ± 19.22 years, respectively. Examining the COVID subgroup, the highest satisfaction scores were observed in the domain of time spent with the doctor (3.3453 ± 0.59), followed by financial aspects (3.0816 ± 0.47), interpersonal manner (3.0589 ± 0.37), and accessibility and convenience (3.0585 ± 0.37). Notably, technical quality received the lowest satisfaction score (2.4763 ± 0.42). A statistically significant difference (P < 0.0001) was noted in the PSQ-18 scores between the two groups. In the post-COVID subgroup, patients expressed higher satisfaction with the technical quality of treatment, irrespective of the mode of management. However, financial satisfaction was better in the COVID group. Conclusion: Our study using the PSQ-18 questionnaire highlights significant variations in patient satisfaction with ophthalmology clinic services during and after the COVID era. Notably, time spent with the doctor scored the highest, emphasizing its positive impact. However, addressing concerns related to technical quality is crucial for overall improvement. Keywords: COVID, patient satisfaction, PSQ-18

The emergency department plays an important role in the diagnosis of cancer for many patients. Several large studies have identified several routes to cancer diagnosis, with the emergency department representing [...], Background: Although suspicions of cancer may be raised in patients who visit the emergency department, little is known about emergency department use before a cancer diagnosis. We sought to describe emergency department use among patients in Ontario within the 90 days before confirmed cancer diagnosis and to evaluate factors associated with this emergency department use. Methods: We conducted a retrospective, population-based study of patients aged 18 years or older who had a confirmed cancer diagnosis in Ontario from 2014 to 2021 using linked administrative databases. The primary outcome was any emergency department visit within 90 days before the cancer diagnosis date. We used multivariable logistic regression to evaluate factors associated with emergency department use, such as demographics (e.g., age, sex, rurality, Ontario Health region, indicators of marginalization), comorbidities, previous emergency department visits and hospital admissions, continuity of primary care, type of cancer, and year of cancer diagnosis. Results: We included 651 071 patients with cancer. Of these, 229 683 (35.3%) had an emergency department visit within 90 days before diagnosis, 51.4% of whom were admitted to hospital from the emergency department. Factors associated with increased odds of emergency department use before cancer diagnosis included rurality (odds ratio [OR] 1.15, 95% confidence interval [CI] 1.13-1.17), residence in northern Ontario (North East region OR 1.14, 95% CI 1.10-1.17 and North West region OR 1.27, 95% CI 1.21-1.32, v. Toronto region), and living in the most marginalized areas (material resources OR 1.37, 95% CI 1.35-1.40 and housing OR 1.09, 95% CI 1.06-1.11, v. least marginalized quintile). We observed significant variation in emergency department use by cancer type, with high odds of emergency department use among patients with intracranial, pancreatic, liver or gallbladder, or thoracic cancer. Interpretation: Emergency department use is common before cancer diagnosis, with about one-third of patients with cancer in Ontario using the emergency department before diagnosis. Understanding why patients visit the emergency department before cancer diagnosis is important, particularly for patients who live in rural or marginalized areas, or those who have specific cancer types.

The growing awareness and emphasis on social determinants of health (SDOH) represents a change in thinking in modern health care. SDOH are individual and community-level social and economic conditions affecting [...], Ambulatory care nurses are in an ideal position to gather social determinants of health (SODH) information from patients. Data on SDOH give nurses deeper insights into non-clinical factors affecting patient health, providing an opportunity for a more integrated approach to care. The challenge lies in turning this awareness into action. With increased visibility of issues like food insecurity, nurses seek practical solutions. Organizations may address this by partnering with food pantries or developing in-house programs, allowing staff to offer &apos;food prescriptions&apos; as direct interventions. This article explores the evolution of SDOH assessments and highlights evidence-based strategies from current literature to help outpatient health care providers effectively operationalize these assessments to tackle food insecurity. Keywords: Social determinants of health, SDOH, ambulatory care nurses, food insecurity, evidence-based strategies, food prescriptions.

Work-related stress is associated with burnout, job satisfaction, and physical and mental health outcomes. Long-term exposure to environmental and situational stressors can lead to work-related stress, resulting in emotional exhaustion, [...], Background: High levels of work-related stress have been reported among Chinese clinical nurses, mainly due to the extreme shortage of nursing staff and workplace violence, among other issues. One potential solution proposed to deal with mental health issues associated with stress is resilience development. However, until now, there has been limited research examining resilience amongst Chinese clinical nurses. Methods: In total, 2,504 clinical nurses in Chongqing, a Southwestern Chinese city, were interviewed to explore the characteristics of highly resilient clinical nurses. In a qualitative study, 15 clinical nurses were randomly recruited to participate in the interview based on a study of 99 clinical nurses who were identified as being highly resilient according to results of a larger survey design study. Data were collected through face-to-face, semi-structured, in-depth individual interviews and were analyzed using Colaizzi&apos;s phenomenological method. Results: Individual internal factors, social support, and work environment were identified as main themes of resilience. The characteristics of and skills for developing resilience should be incorporated into nursing education for both undergraduate and experienced nurses to help ameliorate the effects of workplace adversity, reducing the likelihood of nurses developing mental health problems. Conclusion: Individual internal factors, social support, and work environment help clinical nurses develop resilience and remain resilient. Keywords: Clinical nursing, phenomenology, resilience.

Nurses are essential for high-quality health care delivery across care settings. Yet their expertise often remains untapped or underutilized because state and federal regulations and institutional policies prevent many nurses [...], Despite recognized benefits, regulatory and institutional constraints hinder the full utilization of nurses in care delivery. Recent reforms demonstrate enhanced access and care quality with APRN full practice authority, yet persistent institutional barriers necessitate continued advocacy for advancing health equity. Keywords: Advanced practice registered nurse, APRN, full practice authority, health policy, access to care.

Background Low English proficiency (LEP) is associated with untoward healthcare events. It is important for nurses to use effective communication resources, such as interpreter services. However, little research has been [...], This descriptive study explored U.S. nurses&apos; use of interpreter services when caring for patients with low English proficiency. Findings suggest there are opportunities for improvement. Keywords: communication, low English proficiency, language barriers, nursing, interpreters

Learning Outcome: After completing this education activity, the learner will be able to discuss the importance of family-focused nursing actions in providing end-of-life (EOL) care, and the need to incorporate [...], This scoping review explores family-focused end-of-life nursing actions for clinical nurses. This review examined literature from 2017 to 2022 and identified 47 nursing actions from categories like family communication, decision-making, and education. Keywords: hospice care, palliative care, family nursing, nursing actions, end of life, EOL

Loneliness remains a public health concern worldwide, affecting approximately one third of the world's population (Surkalim et al., 2022). Loneliness is defined as a subjective feeling as the result of [...], Purpose Despite advances in health care and increased life expectancy, many older adults are at high risk for poor health and loneliness. The current study examined loneliness and its association with health among Omani older adults (aged ≥60 years). Method This descriptive, correlational study used structured questionnaires to collect data from 113 Omani older adults. Results More than one half (67.3%) of participants felt moderate to severe loneliness. Hierarchical regression analyses revealed that being female, older age (≥85 years), living with non-family members, and being unemployed were significant predictors of loneliness. Loneliness was a significant predictor of poor mental health status when sociodemographic and environmental factors were controlled. Conclusion Findings indicate a significant number of Omani older adults are experiencing loneliness. We suggest that RNs specialize or practice in the care of older adults, and that researchers and policy makers take prompt action to address this urgent health issue before the occurrence of severe adverse health outcomes among this population. [Journal of Gerontological Nursing, xx(xx), xx–xx.]

For a decade, we've SEARCHED THE NATION FOR MEN WE ADMIRE--men who are PHYSICALLY STRONG, yes, but also MENTALLY RESILIENT, SOCIALLY CONNECTED, and ALL-AROUND GOOD GUYS. This year's finalists embody [...]

Although few yet see it coming, humans are about to enter a new era of history. Call it 'the age of depopulation.' For the first time since the Black Death [...]

Author(s): T. Subhashree (corresponding author) [1]; R. Yashoda [1]; Manjunath P. Puranik [1] Introduction Autism spectrum disorder (ASD) is a group of conditions with early childhood onset, affecting social and [...], Background: Autism is a neurodevelopmental disability that diminishes social interactions and communication. Maintaining good oral hygiene in them is a significant task. Objectives: The objective of this study was to evaluate the effectiveness of a toothbrushing visual pedagogy (TBVP) in improving brushing skills, oral hygiene, and gingival status among children with autism. Materials and Methods: This cluster randomized controlled trial was conducted among 200 children with autism, aged 6-17 years. TBVP and conventional oral hygiene instructions were administered as an intervention in the test group (TBVP). The control group (oral health education [OHE]) received conventional oral hygiene instructions. Assessment of toothbrushing skills, plaque, and gingival status were carried out at baseline, 30-, 60-, and 90-days. The data were analyzed using t-tests in SPSS version 26 software at P < 0.05. Results: At baseline, there was no significant difference between the groups in toothbrushing skills, plaque, and gingival scores. Postintervention, there was a significant improvement in the TBVP group compared to the OHE group. At 90 days, the mean toothbrushing scores of TBVP group were significantly higher (22.49 ± 6.70) than the OHE group (18.35 ± 6.82). Plaque scores were significantly lower (1.31 ± 0.48) in the TBVP group than the OHE group (1.47 ± 0.50). Gingival scores were significantly lower (1.38 ± 0.48) in the TBVP group than the OHE group (1.56 ± 0.51) (P < 0.05). Conclusion: The TBVP was effective in improving the toothbrushing skills, oral hygiene, and gingival health of the children with autism. Hence, it can be used for behavioural guidance in toothbrushing for these children to maintain their oral hygiene. Keywords: Autism, randomized controlled trial, toothbrushing, visual pedagogy

TABLE OF CONTENTS INTRODUCTION 105 I. BRITTANY AND HER BABY: PREGNANCY, 106 PUNISHMENT, AND THE RELENTLESS PURSUIT OF FREEDOM A. When the Punishment Does Not Fit the Crime: 106 Factoring [...], Incarceration of pregnant nonviolent offenders takes not only the pregnant mother captive but also her unborn child. Kept in unnecessary captivity, these innocent children may experience adverse childhood experiences ("ACES") or lifelong damage to their physical and mental health. The experiences may be the same for children born already to the mother, as they endure the suffering of parental separation during the mother&apos;s absence. In terms of racial health disparities, such captivity presents at least a triple threat--harm to the health of the mother, harm to the health of the unborn fetus, and harm to the health of children born already to the mother. Using the story of Brittany Martin, a pregnant, nonviolent social justice protestor sentenced to four years in prison, this Article makes the case that ending racial health disparities requires offering alternatives other than imprisonment for nonviolent offenders who are pregnant. By offering alternatives that support and keep the parent-child relationship intact, and that avoid what may be lifelong negative consequences of imprisonment, these alternatives help break the cycle of poorer health that unfairly plagues marginalized populations.

Author(s): Pragyat Thakur [1]; Aashita (corresponding author) [2]; Rajiv Sharma [2] INTRODUCTION Cancer remains one of the most dreaded diseases that instantly triggers a situation where anxiety, stress, and fear [...], Introduction: Caring for chronically ill patients is often an emotionally demanding task. Apart from physical, social, and economic burdens, inadequate information, preparation, and support for caregivers lead to significant distress, which is often underestimated. Objectives: This study aimed to estimate the prevalence and evaluate the factors contributing to stress in caregivers of terminally ill cancer patients and analyze the effects of such stress on the caregivers. Methods: Caregivers of 88 terminally ill patients admitted to our hospice facility between October 2019 and February 2020 were evaluated for stress using the Caregiver Strain Index (CSI) tool. Contributing factors and consequences of caregiver stress were analyzed using multivariate analysis. Results: A CSI score of ≥7 was present in 77.8 of caregivers, reflecting significant stress levels. Age more than 50, female sex, education status, financial constraints, physical strain, and emotional adjustments contributed significantly to overall caregiver stress, in multivariate analysis (P Conclusion: Caregiver stress is a significant problem, and the absence of support systems in developing countries further compounds their suffering. Methodical evaluation of stress and suitable coping strategies is the need of the hour. Keywords: Cancer, caregiver burden, Caregiver Strain Index, CSI, palliative care

Introduction Overview of the Issue The maternal mortality ratio is defined by the World Health Organization as the death of a woman while pregnant or within 42 days of pregnancy [...], Patients with a high-risk pregnancy or who immediately give birth are often not provided access to acute care occupational and physical therapy during their hospital admission. The greatest potential for health care crises, including maternal mortality, occurs during the first 6 weeks after birth. Maternal mortality and morbidity, which continue to rise in the United States, are considered indicators of the overall population health of a country. It is estimated that over 80% of pregnancy-related deaths are preventable. The leading causes of death within the first 6 weeks after birth are hemorrhage, hypertensive disorders, and infection. Implicit biases about childbearing individuals who are perceived to be relatively young, independent, active, and healthy may unintentionally contribute to areas of substandard care that adversely impact maternal health outcomes. It is a professional and ethical imperative that health providers, including occupational and physical therapists, establish themselves as allies to patient groups at high risk for disparate treatment. The Acute Care OB Rehab Implicit Bias Self-Reflection Tool is an instrument designed for health providers to identify stereotypes that may contribute to inequitable access to rehabilitation in the hospital after birth. Including rehabilitation services for the perinatal population in the hospital setting can play a pivotal role in early detection of adverse events with activity that may directly impact the increasing maternal mortality rate in the United States. Keywords: Disparities, Maternal Health, Obstetrics Rehabilitation

Disparities in Rehabilitation Access: The Imperative for Change Globally, the enormous need for rehabilitative services is well-documented, with a recent study in the Lancet reporting that 1 in 3 patients [...], As the field evolves as a doctoring profession, the role and scope of physical therapist practice must also grow to meet important and urgent public health needs. Scalable, population-level interventions must be prioritized to the same degree as tailored, individual-level care. Drawing from public health frameworks, this perspective proposes an approach to population-level physical therapist care delivery that aims to mitigate disease and disability and improve health outcomes by expanding access, decreasing cost, and improving quality of care for those facing the greatest health disparities. Application of these frameworks prompts the development of novel approaches to rehabilitation service delivery to advance twin goals of promoting access to care and reducing health disparities. This paper describes how a population health framework and public health approach can be used to support necessary evolution and innovation within the field of physical therapy and to improve rehabilitation service delivery. Rapid developments in the digital and virtual health space have created a unique opportunity for physical therapists to lean into a new vision of their role as clinicians within the broader health ecosystem. This paper will provide clinicians with a broader perspective of physical therapist expertise and describe opportunities for the development and application of a physical therapist skill set toward driving population health outcomes. Real-world examples will guide clinicians to consider opportunities in their own practice for implementing this public health approach and potentially addressing various contributors to persistent health disparities. Keywords: Public Health, Health Services Accessibility, Rehabilitation, Technology

Introduction Chronic musculoskeletal pain conditions are among the greatest contributors to years lived with disability worldwide, and their impact has steadily increased since 1990. (1,2) Partaking in leisure time and [...], Objective. Self-efficacy for leisure-time or health-promoting physical activity (SEPA) is a psychosocial determinant of physical activity. The socioecological model can provide a robust perspective of SEPA. The objective of this study was to synthesize the evidence on multilevel correlates of SEPA among individuals with chronic musculoskeletal pain. The second aim examined the extentto which socioecological disparities are associated with SEPA among individuals with chronic musculoskeletal pain. Methods. An integrative review was conducted. Included studies needed to investigate the relationship between SEPA and socioecological factors at the interpersonal, institutional, community, and/or macrosystem level among adults with chronic musculoskeletal pain ([greater than or equal to]3 months). Searches in PubMed, EMBASE, PsycINFO, and CINAHL were performed (December 30, 2020, and October 12, 2022), yielding 4047 records after duplicates were removed. Two independent reviewers completed screening, full-text reviews, and data extraction. After title and abstract screening and full-text reviews, 17 studies were included. The constant comparison method included: data reduction, data display, data comparison, and conclusion drawing/verification. Quality of evidence was assessed using the Joanna Briggs Institute appraisal tools. Results. Five themes emerged with respect to relationships between SEPA and socioecological factors: social relations, social comparisons, patient-provider relationship, organizational resources, and accessibility to physical activity. Relationships between interpersonal factors and SEPA were most prominently studied. One study examined and addressed potential disparities in SEPA at the macrosystem level. Conclusion. A spectrum of relationships from supporting to straining SEPA were found at the interpersonal level. Relationships between institutional, community, and macrosystem factors and SEPA were comparably sparse. Gaps in the literature were identified regarding how health disparities present across the socioecological model with respect to SEPA. Impact. Clinicians can use this review to evaluate how SEPA can be supported or threatened by factors across the socioecological model. This may be a preliminary step towards examining and addressing health disparities in SEPA. Keywords: Musculoskeletal Pain, Physical Activity, Self-Efficacy, Socioecological

Introduction The pervasive inequities in health care experienced by historically marginalized groups are well documented. (2) The SARS-CoV-2 pandemic and recent social injustices have magnified the systemic racism and discrimination [...], The COVID-19 pandemic and recent incidents of social injustice exposed the systemic racism and discrimination in health care and clinical research that perpetuate systemic inequities. This perspective utilizes the acronym JEDI (justice, equity, diversity, and inclusion) as a vision for addressing inequities in physical therapy research. The need to go beyond diversity and focus on inclusion, equity, and justice is emphasized to achieve transformation within physical therapy research. The prevailing research paradigms are examined, acknowledging that research can perpetuate inequities and reinforcing the importance of integrating JEDI principles into the research process. The underrepresentation of diverse researchers in physical therapy is discussed, as well as the barriers faced by underrepresented researchers and research participants. Funding disparities are also highlighted, emphasizing the need for JEDI principles in research funding practices. How other health professions&apos; associations are addressing JEDI in research is also explored. The authors propose a framework for action, utilizing the concepts of the socioecological model to identify gaps in JEDI within physical therapy research at different levels of influence and conclude by emphasizing the importance of justice in dismantling inequitable systems and urge the physical therapy research community to become JEDI warriors to bring about transformative change. Impact. By championing cultures that value justice, equity, diversity, and inclusion, individuals within the physical therapy research community have the potential to ignite a powerful transformation in society. The authors envision a future where JEDI warriors emerge, embracing the spirit of "Do or do not. There is no try," to forge a research community that is inclusive for all. (1) Drawing inspiration from this mindset, this perspective seeks to empower individuals to harness the force of a JEDI warrior, fostering cultures that value justice, embrace inclusive methodologies, and ensure equitable access to resources and opportunities for researchers and participants. Keywords: Emancipatory Research, Funding Disparities, Qualitative Methods, Socioecological Framework

Introduction Inequity in physical therapy takes many forms, from disparities in health care access, quality, and outcomes to unequal access to professional education programs to limited diversity of program directors, [...], Objective. Discussions of the root causes of health disparities and educational inequities often neglect to identify racism as a primary factor. Researchers must take a systems perspective to identify the effects of racism and other forms of systemic oppression on health. It is unclear to what extent this perspective exists in the physical therapy research literature. We conducted a scoping review to quantify and describe the volume of research in physical therapy pertaining to diversity, equity, and inclusion specifically examining race and/or ethnicity and references racism or antiracism. Methods. A systematic search of PubMed and Scopus databases for articles published between 1997 and 2021 was conducted. Articles were screened to ensure they were focused exclusively or primarily on physical therapy and used diversity, equity, and inclusion terms in the context of personal identity factors. This resulted in 158 relevant articles. Each was tagged with an article type and personal identity factor focus. Results. A majority of the included articles were descriptive/observational in nature. The included articles explored various personal identity factors, with race and ethnicity being the most common focus followed by culture, disability, and socioeconomic status. A small proportion of articles explicitly discussed racism or antiracism. Conclusion. These findings highlight the need in physical therapy research for greater attention to racism as a fundamental cause of health disparities and educational inequities. Addressing this gap is crucial for promoting diversity, equity, and inclusion within the field and ultimately achieving optimal health outcomes for marginalized populations. Impact. Including consideration of racism and otherforms of systemic oppression in the motivation, design, and interpretation of research in physical therapy will help to make more visible the root causes of inequity and improve our ability to develop effective, multi-level interventions. Keywords: Culture, Ethnic Groups, Health Services Accessibility, Peer Review: Research, Physical Therapists, Professional Issues, Public Health, Social Responsibility, Socioeconomic Factors

Author(s): Kimia Belafkih [1]; Manon Simonin [2]; Claudia Sarubbi [1]; Anne-Sophie Gauthier [1]; Lauriana Solecki (corresponding author) [1,3] A surgical intervention to remove an eyeball is a significant life event [...], Purpose: To describe the early health-related quality of life (HRQoL) of patients who have undergone an eye removal surgery. Methods: A descriptive monocentric study was conducted. Patients with a surgical indication of eye amputation were enrolled. Three standardized surveys were given to each patient 1-3 months after the surgery. The following standardized questionnaires were used: National Eye Institute Visual Function Questionnaire 25 (NEI VFQ-25) (range: 0-100), Short Form-36 (SF-36) (range: 0-100), and Perceived Stress Scale (PSS-10) (range: 0-40). Results: Between January 2021 and January 2022, in the Ophthalmology Department of the University Hospital of Besançon (France), 20 patients who were going to undergo an eye removal surgery were included. The population comprised a majority of men (12 men vs. 8 women) with a mean age of 70 (±16.2) years. The underlying conditions leading to the eye amputation were varied: three infections (15%), three retinal detachments (15%), three chronic uveitis (15%), 11 traumas (55%), three tumors (15%), and five chronic high intraocular pressures (25%). The surgical procedure consisted of an evisceration in 15 cases (75%) or an enucleation in five cases (25%). On average, the composite NEI VFQ-25 scored 68.7 (±22.4). Regarding the SF-36 score, the physical composite score was 63.1 (±15.4), and the mental composite score was 64.7 (±14.4). The overall PSS-10 score was 12.3 (±8.7). Conclusion: The patients who had undergone an eye amputation had an early reduction in their HRQoL in all its domains, especially in the vision, mental, and physical specific quality of life. These patients need personalized preparation before the surgery. These findings need to be assessed in the long term. Keywords: Enucleation, evisceration, eye amputation, NEI VFQ-25 score, PSS score, quality of life, SF-36 score

In her new book, Year 2000: The Inside Story of Y2K Panic and the Greatest Cooperative Effort Ever, risk management expert Nancy P. James writes, 'Year 2000, like COVID-19, was [...]

In June 2016 JD Vance published his memoir, Hillbilly Elegy, and appointed himself explainer-in-chief of America's white working class. Vance, who grew up in the rust belt city of Middletown, [...]

NCPD 1.3 contact hours/CEPTCs Chronic kidney disease (CKD) is a prevalent, burdensome, and progressive condition that contributes to substantial morbidity, mortality, and health care costs worldwide (Carney, 2020; Centers for [...], Older age is linked with poorer self-care in the chronic kidney disease (CKD) setting. Informal health supporters (family members and friends) are critical sources of self-care support, but much remains unclear about the characteristics and implications of received support among this patient population. We examined how received self-care support (amount and type) related to positive (CKD management self-efficacy) and negative (depressive symptoms) psychosocial health correlates of self-care in 536 adults aged 65 years and older with non-dialysis-dependent CKD. Participants who received a greater amount of support reported less CKD management self-efficacy and more depressive symptoms. We did not observe associations between self-care support type and psychosocial health. Further research is needed to clarify our findings, especially studies that investigate causality and contextual influences. Keywords: Amount and type of older adults, pre-dialysis, family, friends, self-management self-efficacy, depressive symptoms.

NCPD 1.3 contact hours/CEPTCs In October 2022, the National Academy of Medicine (NAM, 2024) released the National Plan for Health Workforce Well-Being, acknowledging the burnout epidemic spreading among the U.S. [...], Nurse well-being is critical for safe and efficient health care delivery, particularly in complex and demanding specialties like nephrology. However, levels of burnout are rising and may relate to a largely unexplored phenomenon: loneliness. This study investigated the phenomenon of nurse loneliness as a potential factor in burnout. A mixed-methods approach was used to investigate burnout and loneliness in a national sample of nephrology nurses. Together with workforce demographics, burnout and loneliness were measured, prevalence was estimated, and correlations were examined. Interpretive descriptive inquiry and analysis was used to develop a richer understanding of nurse loneliness in the context of burnout. In the study population (n = 217), rates of burnout were low, but positively correlated with loneliness. Qualitative interviews reveal that organizational and systemic pressures, recognition and peer support, work environment and demands, and physical and emotional well-being are components of the experience of current nephrology nurses related to loneliness and burnout. Keywords: Well-being, loneliness, burnout, workforce.

Medical leaves of absence occur because of physical issues, psychological disorders, and work-related accidents. Light duty nursing refers to the modification of job responsibilities to accommodate nurses with health conditions [...], Medical leave of absences occur due to physical, psychological, and work-related issues. It is imperative for nurse leaders to understand the impact of these situations on a nursing team from organizational and relational perspectives, and to address this issue by understanding the complexity of the transitional work process and improve this process. There may be opportunities to reintegrate nursing staff into areas with staffing challenges, increasing productivity and staff engagement, while ensuring cost avoidance. Keywords: Medical leave of absence, nurse leaders, productivity, staff engagement, cost avoidance, employee job satisfaction.

Introduction One in 4 Americans have a disability. (1) Of people with disabilities who are employed, only 8% work in health care, (2) yet in a 2022 survey from an [...], People with disabilities are considered a historically marginalized population that experiences significant health disparities resulting from the unequal distribution of resources as evidenced in the social determinants of health. Health professions education presents an opportunity to explore the policy, systems, and environmental changes that are needed to improve social conditions and address known disparities for people with disabilities. Evidence suggests that inclusion of learners with diverse lived experiences, including students with disabilities, strengthens our understanding of the influence of social determinants on health and our ability to address known barriers. Unfortunately, people with disabilities and other minoritized individuals are grossly underrepresented in physical therapy. It is imperative that doctor of physical therapy (DPT) education more intentionally promotes the full inclusion of students with disabilities to improve representation and to better support the complex needs of this population. In this perspective, we describe key social determinants of health for people with disabilities, offer strategies for increasing representation and inclusion of students with disabilities in DPT education, and summarize how the inclusion of students with disabilities in DPT education can enhance our understanding of and ability to address social barriers for this population. Keywords: Disability, Physical Therapy Education, Social Determinants of Health, Social Responsibility, Students With Disabilities

Introduction 'Gulf-sized race-based gaps exist with respect to the health, wealth, and well-being of American citizens. They were created in the distant past, but have indisputably been passed down to [...], Patient history assists clinicians in determining the most appropriate tests to identify the symptoms&apos; source and select appropriate interventions. Therefore, a subjective history is an essential component of patient management. When physical therapist practitioners transition into academia, they must understand how the history of the education system may affect learners. Health disparities are related to the lack of workforce diversity and skills in cultural responsiveness, and the education system is critical in addressing the impact of future providers on health disparities. Developing a doctor of physical therapy program to address health disparities requires an analysis of the historical context of the US educational and health care systems, along with traditional components of physical therapist education. This country&apos;s education system was built upon a 2-tiered system, where minoritized individuals struggled to overcome barriers imposed by legislation and societal beliefs. Jim Crow laws continued this unequal access to education, and the recent Supreme Court ruling to deny race-based affirmative action continues these inequities. This historical context informed the construction of the College of Saint Mary Doctor of Physical Therapy Program. The program&apos;s mission led to using less traditional educational approaches; thus, the pillars of practice took form. The 5 pillars evolved to include social determinants, inclusive faculty and student recruitment and retention practices, equitable grading, culturally responsive pedagogy, and community development. The purpose of this paper is to present a historical overview of the US education system and its influence on physical therapist education. Furthermore, it will illustrate how this historical context inspired the 5 Pillars of Community Practice from College of Saint Mary and discuss the challenges and interventions related to these pillars. There are tremendous disparities in educational outcomes and patient services in the United States. Disparities are most significant in those with historically marginalized identities. If those disparities are to improve, a change is required in the people providing care to patients. The best way to accomplish this is by transforming how future providers are educated. Keywords: Education: Faculty, Health Disparities, History of Education, Supreme Court

Introduction The United States trails behind other high-income countries on many health care outcomes. Specifically, the United States ranks last among high-income countries when it comes to affordability and access [...], The purpose of this perspective is to discuss the imperative for curricular change that focuses on the utilization of structural competency to promote excellence in physical therapist professional education, transform society, and achieve health equity. Pedagogy centered around biomedical and social determinants of health (SDOH) models are limited in that they lack self-reflexivity, encode social identities like race and gender as risk factors for poor health, fail to examine structural causes of health inequity, conflate SDOH and the structural forces that shape their unequal distribution, and overlook instances of injustice. Promoting health equity will require structural competency, an approach that considers drivers of health beyond the individual and their conditions of daily living (ie, SDOH). Utilizing this approach in physical therapist professional education will help learners understand the evolving needs of society in a deeper, more holistic way: one that considers structural determinants of health as the primary drivers of health equity and inequity. Impact. This paper provides a perspective on how physical therapist professional education can promote health equity for all by embracing an equity-focused, structurally competent pedagogy/approach. Keywords: Health Equity, Political Determinants of Health, Structural Competency, Social Determinants of Health, Structural Determinants of Health

Introduction 'Real education means to inspire people to live more abundantly, to learn to begin with life as they find it and make it better...' --Carter G. Woodson In 1933, [...], Physical therapists should be able to screen patients for social determinants that impact health and refer to community resources as appropriate. To make appropriate referrals, physical therapists must equip themselves with skills to connect patients and clients to community resources outside the walls of their respective institutions, starting with developing these practices in physical therapist education programs. Experienced community builders recommend a community development approach where residents initiate and agree upon decisions, and outside stakeholders work as partners to elevate the community. The community should be supported to determine the desired outcomes in ways that enhance equity, inclusion, and social justice. Communities play a substantial role in health outcomes. Studies indicate that 85% of one&apos;s health is connected to community and economic resources, while only 15% is affected by medical interventions. Connected communities are potent tools to enhance health. Connected communities are places where residents nurture neighborhood relationships that enable them to work together to create a good life supporting their collective well-being. The community-builder approach recenters people and their communities as fundamental health leaders; institutions can use their resources to elevate communities by relocating authority back to communities. Communities have assets and resources largely unrecognized, disconnected, and not mobilized by residents. Institutions are positioned to support citizens and their associations in discovering, connecting, and mobilizing these assets. This asset-based community development approach focuses on 5 principles: place-based, citizen-led, relationship-oriented, asset-based, and inclusion-focused. This perspective paper will describe ways institutions can elevate communities; the benefits of community development practices in physical therapist education programs; and explore examples of community partnerships and best practices to develop equitable alliances with residents in the community. Impact. A large part of one&apos;s health is directly related to where one lives. Physical therapists and physical therapist assistants can play a vital role in improving the health of society by engaging in their local communities through community development. Community development is a practice where community members and outside stakeholders, such as physical therapists, come together to meet the needs of a community. Keywords: Community Development, Community Engagement, Outreach

Introduction The lack of representation of the general population in physical therapy education and practice has been unresolved for decades. (1,2) Issues reported by the Institute of Medicine (2) concerning [...], The push for holistic admissions practices in physical therapy education has evoked concerns that learners who are culturally and linguistically diverse might be less qualified than the predominant demographic traditionally admitted into programs. The implications are that culturally and linguistically diverse learners struggle academically and experience challenges passing the National Physical Therapy Examination. However, as the academic preparedness of learners is discussed, rarely does the conversation include the capabilities of faculty to teach these learners. As cohorts continue to include learners from a greater variety of backgrounds and identities, the largely homogenous professorate, with more than 80% identifying as White, might need training in culturally responsive pedagogy to best serve learners from all backgrounds and identities. Educators often use a "one-size-fits-all" approach in which learners are expected to use the same resources and pace for assignments, readings, and assessments, regardless of their learning strengths or academic preparation. That approach fails to empower educators to design curricula and instruction to position all learners to excel in the classroom. This Perspective explores strategies to support all learners through three dimensions of culturally responsive pedagogy: institutional, personal, and instructional. To truly transform society, we must first transform physical therapy education. Culturally responsive pedagogy advances and supports all student achievement by recognizing, fostering, and using their strengths in the learning environment. Keywords: Culturally Awareness, DEI, Diversity, Pedagogy, Teaching

Introduction: Disability, Health Disparities, and Lack of Disability Competence Disability is a ubiquitous human experience. About 1 in 4 Americans report having a disability, belonging to what is the largest [...], Americans with disabilities represent the largest historically underserved and marginalized health disparity population in the United States. This perspective piece will raise the awareness of physical therapist faculty and clinicians on gaps in health care provider knowledge about disability and provide actionable strategies, frameworks, and resources available to improve disability competence to make changes in clinical education and practice. In this perspective piece, 3 contributions are made. First, health disparities experienced by Americans with disabilities as a result of health care providers&apos; biased assumptions about disability and lack of disability competence are described through an in-depth illustration of lived experiences of people with disabilities. Second, a discussion of disability competence in physical therapist education is provided. Finally, critical and evidence-based insights and actionable frameworks and resources to address disability competence training gaps and to promote anti-ableist practice are provided. Keywords: Disability, Education: Competency-Based, Health Disparities

Introduction Physical therapists are increasingly called to examine how social determinants of health (SDOH) influence physical therapist practice, advocacy, research, and education. (1-3) As an organizing paradigm, an SDOH framework [...], Objective. The aim of this study was to explore the instruction of social determinants of health (SDOH) for people with disabilities (PWD) in doctor of physical therapy (DPT) education programs. Methods. A sequential mixed methods study informed by a five-member disability community advisory panel was conducted. Qualitative semi-structured interviews with educators (n = 10) across 4 DPT programs in the Midwest were conducted and analyzed thematically. The qualitative findings formed the basis of the quantitative phase. An online survey was conducted with faculty of DPT programs in the United States (n = 254) with the most knowledge of instruction of SDOH and health equity for PWD (n = 74; 29% response rate). Quantitative data were analyzed with descriptive statistics and triangulated with qualitative data. Results. SDOH for PWD is an emerging component of instruction in DPT curricula. Five themes included: emerging instruction of SDOH for PWD; conceptual frameworks informing instruction; instructional strategies; barriers to integration of SDOH for PWD; and facilitators to integration of SDOH for PWD. Quantitative analysis revealed that 71 respondents (95.9%) included disability in health equity discussions primarily focused on health care access. Limited time (n = 49; 66.2%) was the most frequently reported barrier, and educator interest in disability health equity was the most frequently reported facilitator (n = 62; 83.7%) to inclusion of the SDOH for PWD in health equity discussions. Conclusion. Opportunities exist in DPT curricula to build on instructional strategies, integrate SDOH frameworks, and amplify facilitators to integration of SDOH for PWD. Impact. To meet the needs of the 67 million Americans living with disabilities, students must have the knowledge and skills to address the complex needs of this historically marginalized population. Understanding the DPT education landscape around SDOH for PWD can guide DPT educators to more fully prepare their students to recognize and ameliorate health disparities faced by PWD. Keywords: Disability, Disabled Persons, Education: Physical Therapist Students, Social Responsibility