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Copyright of Canadian Journal of Dental Hygiene is the property of Canadian Dental Hygienists Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Users' experiences in mental health assessment are multifaceted, including their emotional experiences. Yet, studies of mobile apps for psychiatric assessment have centered on diagnostic accuracy and perceived usability, with little consideration of the impact of user emotional experiences. In this study, we focused on users' perceived usability and emotions and compared the user experience of a paper-and-pencil and an app-based collection of mental health screening questionnaires: EarlyDetect. The System Usability Scale (SUS) and modality-directed emotion questionnaires were administered using paper-and-pencil or iPad. Modality was assigned pseudo-randomly on patients' first visit at a referral-based mental health clinic. We found that patients assigned to the iPad app reported a significantly higher SUS score than patients assigned to paper-and-pencil, qualified by a modality-by-gender interaction where modality effects were significant for men but not for women. Moreover, enjoyment was positively linked to perceived usability, whereas boredom, frustration, and anxiety were negatively linked to usability. Our findings illustrate the added value of studying user experience applied to psychiatric assessments, where both emotions and gender-specific user experience should be taken into consideration. We further discuss the implications for psychiatric assessments via app versus traditional data collection. [ABSTRACT FROM AUTHOR]

Purpose: HIV or AIDS remains invisible and dismissed by most South Asians living in Canada as HIV or AIDS issues are perceived as an offshoot of Western lifestyle linked with drug use and promiscuity. This paper aims to look into how people living with HIV or AIDS (PLWHA) cope with prejudice and stigma. Design/methodology/approach: To guide this research, a constructivist grounded theory approach was adopted as the theoretical and methodological framework. The authors reached the participants through a Toronto-based group that works with PLWHA. The authors chose their respondents in a snowball method and interviewed them both in person and online. Findings: This paper identifies how South Asian immigrants and refugees/refugees with HIV or AIDS claimants are vulnerable to discrimination in Canada due to the following factors, which include but are not limited to: a lack of information about HIV and AIDS incidence in the community; and the Canadian health system's inability to respond appropriately to the lack of information. Practical implications: HIV service engagements should take place within the context of a constellation of local traditions, or standardized expectations of patient engagement with HIV services can be counterproductive. Originality/value: It is critical that governmental action prioritizes increasing public understanding of stigma. To minimize the consequences of HIV-related discrimination and stigma, misconceptions about HIV transmission must be debunked. [ABSTRACT FROM AUTHOR]

The Internet of Things (IoT) is expanding rapidly and can potentially be a huge data source. This study aimed to close the knowledge gap about possible IoT applications in health care. English-language academic publications from the Web of Science (WoS) were used for the present study. Bibliometric networks were used to analyze pertinent publications to examine the connections between authors, nations, and affiliations. Papers on digital health care have been published in more than 1195 sources, among which the most popular was the Journal of Medical Internet Research. Six top institutions were from the Netherlands, making the Vrije Universiteit Amsterdam the most productive institution after Australia and England. This study provides an overview of IoT-related research conducted in digital health care, helping academic researchers, policymakers, and practitioners to better understand the development of digital health care research. [ABSTRACT FROM AUTHOR]

When governments acquire third-party social welfare services (SWS), they create institutions of acquisition. The rules and practices that governments adopt define who is able to participate, on what basis, and how prices are determined. This paper conceptualizes the institutions of SWS acquisition, their variations, and implications, in order to contribute to a deeper understanding of the link between contracting and nonprofit commercialisation. Institutions of SWS acquisition include rules of entry, participation, and assessment. Resulting acquisition regimes can be marketised to a greater or lesser extent, and this is influential through its effect on nonprofit competition. Drawing on interviews with public servants and nonprofit staff, the paper compares acquisition regimes for homelessness services in England, a regime that closely resembles a market, and Canada, a regime which is not marketised. In contrast to their non-marketised counterparts, this paper finds that marketised SWS acquisition regimes create incentives for participants to reduce prices by loss-leading or ratcheting down service quality. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to add to the research literature and begin to fill the gap in knowledge about shared parenting arrangements for women with young children and who have experienced domestic violence (DV), in three Canadian provinces; Alberta, Manitoba and Ontario. Method: This paper reports on the qualitative findings from a mixed methods study on shared parenting from women with children ages 4 and under. Twenty women participated in one-on-one individual interviews through electronic platform utilizing Zoom. Thematic analysis is used to analyze the data. Results: Despite efforts to not exclusively recruit women who had experienced domestic violence (DV) from their former partner, all participants identified as survivors of DV and ongoing survivors of DV, specifically, coercive controlling behaviours. Five themes describe the women's experiences of shared parenting with young children: 1) walking a tight-rope; 2) navigating post-separation relationships; 3) emotional realities of shared parenting; 4) shared parenting outcomes; and, 5) structural challenges. Conclusions: This paper not only adds to the significant and longstanding gap in knowledge directly from women with children ages 4 and under in shared parenting relationships, and who have experienced DV, and also helps to inform social service and legal actors. It is timely with the amendments to the Divorce Act in Canada which now includes DV as a factor in determining the best interests of the child. [ABSTRACT FROM AUTHOR]

Background: International and migrant students face specific challenges which may impact their mental health, well-being and academic outcomes, and these may be gendered experiences. The purpose of this scoping review was to map the literature on the challenges, coping responses and supportive interventions for international and migrant students in academic nursing programs in major host countries, with a gender lens. Methods: We searched 10 databases to identify literature reporting on the challenges, coping responses and/or supportive interventions for international and migrant nursing students in college or university programs in Canada, the United-States, Australia, New Zealand or a European country. We included peer-reviewed research (any design), discussion papers and literature reviews. English, French and Spanish publications were considered and no time restrictions were applied. Drawing from existing frameworks, we critically assessed each paper and extracted information with a gender lens. Results: One hundred fourteen publications were included. Overall the literature mostly focused on international students, and among migrants, migration history/status and length of time in country were not considered with regards to challenges, coping or interventions. Females and males, respectively, were included in 69 and 59% of studies with student participants, while those students who identify as other genders/sexual orientations were not named or identified in any of the research. Several papers suggest that foreign-born nursing students face challenges associated with different cultural roles, norms and expectations for men and women. Other challenges included perceived discrimination due to wearing a hijab and being a 'foreign-born male nurse', and in general nursing being viewed as a feminine, low-status profession. Only two strategies, accessing support from family and other student mothers, used by women to cope with challenges, were identified. Supportive interventions considering gender were limited; these included matching students with support services' personnel by sex, involving male family members in admission and orientation processes, and using patient simulation as a method to prepare students for care-provision of patients of the opposite-sex. Conclusion: Future work in nursing higher education, especially regarding supportive interventions, needs to address the intersections of gender, gender identity/sexual orientation and foreign-born status, and also consider the complexity of migrant students' contexts. [ABSTRACT FROM AUTHOR]

Introduction: This study presents a global research scenario in the broad domain of osteoarthritis (OA) research, using quantitative and qualitative publication and citation indicators. Methods: The study is based on 45,368 global publications, sourced from the Scopus bibliographical database, covering three decades (1994–2023). We studied the performance of the top 12 developed and top 12 developing countries. The key countries, organizations and authors at national and international levels were identified. The broad subject areas and key journals contributing to global OA research were delineated, besides identifying the broad characteristics of highly cited papers in the field. Results: The United States and China were the most productive countries, while the Netherlands and Canada made the largest citation impact. Harvard Medical School and the University of Sydney made the most contribution, while Boston University and Pfizer Inc., USA registered the highest citation impact. Hunter DJ and Guermazi A were the most productive authors, while Lohmander LS, and Hochberg MC registered the highest citation impact. Osteoarthritis and Cartilage (n = 4879) and Annals of the Rheumatic Diseases (n = 786) published the maximum papers, while Arthritis and Rheumatism and Nature Reviews Rheumatology registered the largest citation impact. The highly cited papers with 100 or more citations constituted 6.25% of the total publications. Conclusions: There has been a systematic growth of publications on OA. The research on OA was mainly done in developed countries, with the maximum publications coming from the United States of America, China and Canada. The most impactful publications on OA were from the Netherlands, Canada and the United States of America. [ABSTRACT FROM AUTHOR]

Simple Summary: The current approach to breast cancer screening, which is based on a person's age, overlooks individual-level differences in breast cancer risk. As a result, many people are over- or under-screened according to their actual risk of breast cancer. Risk-stratified breast screening may overcome the limitations of age-based screening, but there are still many knowledge gaps regarding how best to implement it in the population setting. This study will generate the first Canadian evidence on the adoption of breast cancer risk assessment in the population setting, to support the future implementation of risk-stratified breast cancer screening. This study demonstrated that, while risk assessment for risk-stratified screening at the population level is feasible, an equity lens must be considered in implementation to ensure cancer-screening disparities are not widened. Risk-stratified breast screening has been proposed as a strategy to overcome the limitations of age-based screening. A prospective cohort study was undertaken within the PERSPECTIVE I&I project, which will generate the first Canadian evidence on multifactorial breast cancer risk assessment in the population setting to inform the implementation of risk-stratified screening. Recruited females aged 40–69 unaffected by breast cancer, with a previous mammogram, underwent multifactorial breast cancer risk assessment. The adoption of multifactorial risk assessment, the effectiveness of methods for collecting risk factor information and the costs of risk assessment were examined. Associations between participant characteristics and study sites, as well as data collection methods, were assessed using logistic regression; all p-values are two-sided. Of the 4246 participants recruited, 88.4% completed a risk assessment, with 79.8%, 15.7% and 4.4% estimated at average, higher than average and high risk, respectively. The total per-participant cost for risk assessment was CAD 315. Participants who chose to provide risk factor information on paper/telephone (27.2%) vs. online were more likely to be older (p = 0.021), not born in Canada (p = 0.043), visible minorities (p = 0.01) and have a lower attained education (p < 0.0001) and perceived fair/poor health (p < 0.001). The 34.4% of participants requiring risk factor verification for missing/unusual values were more likely to be visible minorities (p = 0.009) and have a lower attained education (p ≤ 0.006). This study demonstrates the feasibility of risk assessment for risk-stratified screening at the population level. Implementation should incorporate an equity lens to ensure cancer-screening disparities are not widened. [ABSTRACT FROM AUTHOR]

Background: Mild cognitive impairment (MCI) is commonly defined as a transitional subclinical state between normal aging and dementia. A growing body of research indicates that health behaviors may play a protective role against cognitive decline and could potentially slow down the progression from MCI to dementia. The aim of this study is to conduct a bibliometric analysis of literature focusing on health behaviors and MCI to summarize the factors and evidence regarding the influence of health behaviors on MCI. Methods: The study performed a bibliometric analysis by retrieving publications from the Science Citation Index and Social Sciences Citation Index subdatabases within the Web of Science Core Collection. Utilizing VOSviewer and CiteSpace software, a total of 2,843 eligible articles underwent co-citation, cokeywords, and clustering analyses. This methodology aimed to investigate the current status, trends, major research questions, and potential future directions within the research domain. Results: The bibliometric analysis indicates that research on healthy behaviors in individuals with MCI originated in 2002 and experienced rapid growth in 2014, reflecting the increasing global interest in this area. The United States emerged as the primary contributor, accounting for more than one-third of the total scientific output with 982 articles. Journals that published the most articles on MCI-related health behaviors included "Journal of Alzheimer's Disease," "Neurobiology of Aging," "Frontiers in Aging Neuroscience," and other geriatricsrelated journals. High-impact papers identified by VOSviewer predominantly cover concepts related to MCI, such as diagnostic criteria, assessment, and multifactorial interventions. Co-occurrence keyword analysis highlights five research hotspots in health behavior associated with MCI: exercise, diet, risk factors and preventive measures for dementia, cognitive decline-related biomarkers, and clinical trials. Conclusion: This study provides a comprehensive review of literature on health behavior in individuals with MCI, emphasizing influential documents and journals. It outlines research trends and key focal points, offering valuable insights for researchers to comprehend significant contributions and steer future studies. [ABSTRACT FROM AUTHOR]

Despite the emerging body of literature on the benefits of youth peer support, there is also evidence that peer support can have unintended negative impacts on peers themselves. It is important to explore what aspects of the peer role contribute to these difficulties in order to mitigate risks. This paper uses a participatory approach to examine the unique attributes of youth peer practice and the related challenges. We conducted semi-structured interviews and focus groups with both peer and non-peer staff from a community-based youth mental health program that provides peer support services (N = 29). Thematic analyses were completed using QSR NVivo. Analyses capture the defining features and related challenges of the peer support role (self-disclosure, boundaries, role confusion and dynamic recovery), and risk factors that affect peers (stigma, exposure to harm and burnout). This paper contributes to the literature on peer support as well as youth participatory evaluation. The findings will be useful to support the development of improved organizational contexts for peer practice and more effective peer support programming. [ABSTRACT FROM AUTHOR]

Background: In 2016–17 an important consensus was established regarding the use of the diagnostic label 'developmental language disorder' (DLD) to describe children with a persistent language problem having a functional impact on communication or learning and in the absence of any other biomedical condition. Despite this consensus, past research has revealed ongoing uncertainty regarding when to use the DLD label among speech–language pathologists (SLPs). Aims: In response to this uncertainty, a survey of SLPs was conducted aimed at investigating which types of clinical language profiles, and specific assessment results, were viewed as warranting the diagnostic label DLD. Methods & Procedures: SLPs were presented with 10 childhood language profiles and assessment results. Participants reviewed each case and described if they felt a diagnosis of DLD was warranted, which presented symptoms were consistent/inconsistent with DLD and if further information/testing was desired. Additionally, participants provided details regarding their personal diagnostic processes. Outcomes & Results: Results indicated a general consensus among SLPs as to when the DLD label should be applied. However, free‐text responses demonstrated considerable variation between clinicians regarding symptoms of importance, points of contention/confusion in language profiles and minimal assessment results viewed as necessary in the diagnostic process. Conclusions & Implications: This detailed look at the assessment/diagnostic process for DLD provides valuable insight into how to build further practice consistency in the provision of the diagnostic label DLD, especially in cases of complex language profiles and assessment results. WHAT THIS PAPER ADDS: What is already known on this subject: The label DLD should be used as a diagnostic label to describe children with persistent language problems having a functional impact on communication or learning and in the absence of any biomedical condition. However, in current clinical practice, actual use of the label is inconsistent and SLPs face a number of challenges in diagnosing DLD. What this paper adds to the existing knowledge: This investigation provides clarity regarding which complexities in paediatric language profiles are most challenging for SLPs when determining if a child does/does not have DLD. Additionally, details regarding current assessment beliefs and practices are explored. What are the practical and clinical implications of this work?: By providing a detailed look at the diagnostic processes of practising SLPs, valuable insight is provided into how to build further practice consistency and confidence in the provision of the diagnostic label DLD, especially in cases of complex language profiles and assessment results. [ABSTRACT FROM AUTHOR]

Although women's representation in STEM fields and occupations has increased, science and math continue to be stereotyped as male domains. This paper links psychological and sociological explanations for gendered disparities in STEM by examining the relationship between the local "micro-situational" female learning environment and the gender gap in academic self-concept in math and science. We applied hybrid models to TIMSS 2015 data comprised of a pseudo-panel of repeated measures for individual student and peer achievement, academic self-concept, utility value, and interest-enjoyment value in math/science (at age 14). We analyzed data from three countries, including a subsample of students who were taught by the same teacher in both math and science, thus eliminating unobserved teacher heterogeneity. Results indicate that female peer climate in the classroom is important for understanding how girls' self-concept in math/science is formed, even though it was unrelated to the gender gap. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Advanced Nursing (John Wiley & Sons, Inc.) is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: A strong knowledge of mathematics, beginning at the elementary level, is critical for participation in today's complex world. The home may be one way to facilitate individualized mathematics instruction, given that children spend more time at home than in an academic institution. Therefore, researchers are interested to see whether the home numeracy environment (HNE) can provide a solid foundation for children's mathematics understanding. Further, children's digital mathematics exploration at home is increasingly common (e.g., using math apps). Objectives: The present study evaluates the digital home numeracy practice (DHNP) model and explores its effect on children's mathematics knowledge across five domains (numeration, number operation, pattern recognition, spatial sense, and applied problem‐solving). Methods: To conduct this study, 117 Canadian parents and their children from Grade 1 through 5 completed a DHNP survey and a range of in‐person mathematics measures. Results and Conclusions: The results identified significant relations between parents and children's implicit mathematics factors (e.g., math anxiety, motivation). Children's mathematics anxiety and parents' academic estimations and expectations for their children positively predicted children's mathematics knowledge. In terms of DHNP components, parental involvement in DHNP predicted children's numeration and applied problem‐solving knowledge. Implications: Taken together, the results detail the contribution of parental and child factors to children's mathematics knowledge and suggest that parents adjust their role in DHNP according to their children's mathematics ability. Lay Description: What is (not) known about the subject matter?: Research is less developed on the impact of home technology in the mathematics learning processExisting research did not use a multi‐measure approach to assess the relationships between a variety of home numeracy factors and fundamental mathematics concepts and processes What is the contribution of this paper?: The paper highlights the importance of considering different home related factors to understand the role of home numeracy practices in children's mathematics developmentIt provides a holistic view of digital home numeracy practice (DHNP) by examining several implicit and explicit components of home numeracy environmentChildren's mathematics anxiety predicts their mathematics knowledgeParental estimation and expectation about their children's mathematics performance predicts their mathematics knowledge across several domains whereas parental role on DHNP impacts children's numeration only What are the implications of the findings?: The findings provide an understanding of the significant value of including digital mathematics practices in the study of the home mathematics environmentThe outcome of the study provides guidance for educators and researchers to better understand and leverage DHNP, and its impact on children's mathematics educationFuture research should investigate to what extent digital features should be included in the DHNP model. This will provide insights into the impact of using well‐designed apps on children's mathematics learning [ABSTRACT FROM AUTHOR]

Healthcare systems and health professionals are facing a litany of stressors that have been compounded by the pandemic, and consequently, this has further perpetuated suboptimal mental health and burnout in nursing. The purpose of this paper is to report select findings from a larger, national study exploring gendered experiences of mental health, leave of absence (LOA), and return to work from the perspectives of nurses and key stakeholders. Given the breadth of the data, this paper will focus exclusively on the qualitative results from 53 frontline Canadian nurses who were purposively recruited for their workplace insight. This paper focuses on the substantive theme of "Breaking Point," in which nurses articulated a multiplicity of stress points at the individual, organizational, and societal levels that amplified burnout and accelerated mental health LOA from the workplace. These findings exemplify the complexities that underlie nurses' mental health and burnout and highlight the urgent need for multipronged individual, organizational, and structural interventions. Robust and timely interventions are needed to restore the health of the nursing profession and sustain its future. [ABSTRACT FROM AUTHOR]

Agricultural injuries remain a major concern in North America, with a fatal injury rate of 19.5 deaths per 100,000 workers in the United States. Numerous research efforts have sought to compile and analyze records of agricultural-related injuries and fatalities at a national level, utilizing resources, ranging from newspaper clippings and hospital records to Emergency Medical System (EMS) data, death certifications, surveys, and other multiple sources. Despite these extensive efforts, a comprehensive understanding of injury trends over extended time periods and across diverse types of data sources remains elusive, primarily due to the duration of data collection and the focus on specific subsets. This systematic review, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, consolidates and analyzes agricultural injury surveillance data from 48 eligible papers published between 1985 and 2022 to offer a holistic understanding of trends and challenges. These papers, reporting an average of 25,000 injuries each, were analyzed by database source type, injury severity, nature of injury, body part, source of injury, event/exposure, and age. One key finding is that the top source of injury or event/exposure depends on the chosen surveillance system and injury severity, underscoring the need of diverse data sources for a nuanced understanding of agricultural injuries. This study provides policymakers, researchers, and practitioners with crucial insights to bolster the development and analysis of surveillance systems in agricultural safety. The overarching aim is to address the pressing issue of agricultural injuries, contributing to a safer work environment and ultimately enhancing the overall well-being of individuals engaged in agriculture. [ABSTRACT FROM AUTHOR]

Background: The risk of developing chronic postsurgical pain (CPSP) in youth is related to psychological factors, including preoperative anxiety, depression, patient/caregiver pain catastrophizing, and poor self-efficacy in managing pain. While interventions exist to address these factors, they are generally brief and educational in nature. The current paper details patient partner feedback on the development of a psychologist-delivered perioperative psychological program (PPP) designed to identify and target psychological risk factors for CPSP and improve self-efficacy in managing pain. Methods: Qualitative interviews were conducted with two patients and their caregivers to discuss their surgical and pain management experience and to advise on components of the PPP. Results: Reflexive thematic analysis of interviews generated the following themes, which were incorporated into the content and implementation of the PPP: caregiver involvement, psychological and physical strategies for pain management, biopsychosocial pain education, intervention structure, and supporting materials. Conclusions: The development of a novel psychologist-led PPP is a promising approach to mitigate mental health risks associated with pediatric CPSP and potentially boost postoperative outcomes and family wellbeing. Integrating patient partner feedback ensures that the PPP is relevant, acceptable, and aligned with the needs and preferences of the patients it is designed to serve. [ABSTRACT FROM AUTHOR]

Purpose: Due to ongoing inequities in the social determinants of health and systemic barriers, homelessness continues to be a significant concern that disproportionately impacts racialized communities. Despite constituting a small proportion of the population, Black individuals are over-represented among people experiencing homelessness in many Canadian cities. However, although Black homelessness in Canada is a pressing issue, it has received limited attention in the academic literature. The purpose of this paper is to examine the reported prevalence of Black homelessness across Canada. Design/methodology/approach: By consulting enumerations from 61 designated communities that participated in the 2018 Nationally Coordinated Point-in-Time Count and two regional repositories – one for homeless counts supported by the government of British Columbia and another from the Rural Development Network – this paper reports on the scale and scope of Black homelessness across Canada. Findings: Significantly, these reports demonstrate that Black people are over-represented among those experiencing homelessness compared to local and national populations. These enumerations also demonstrate significant gaps in the reporting of Black homelessness and inadequate nuance in data collection methods, which limit the ability of respondents to describe their identity beyond "Black." Originality/value: This research provides an unprecedented examination of Black homelessness across Canada and concludes with recommendations to expand knowledge on this important and under-researched issue, provide suggestions for future iterations of homeless enumerations and facilitate the development of inclusive housing policy. [ABSTRACT FROM AUTHOR]

Training staff and volunteers is an important aspect of successful program implementation. This paper follows Part A of an evaluation of the Special Olympics Canada (SOC) Coaching Young Athletes Training course. Consistent with Kirkpatrick's four-level model of training evaluation, Part A evaluated program leaders' reactions to (level 1) and immediate learning from (level 2) the training. This Part B paper covers "on the job" behavior (level 3). In-depth semi-structured interviews were conducted with youth program leaders (n = 11) from eight provinces. Overall, participants felt that more training related to working with children with autism and promoting positive athlete behavior was needed. The findings also lead us to suggest that program leaders need to develop a more fulsome understanding of how to foster skill mastery, including how to practice the same skill in many and varied ways. [ABSTRACT FROM AUTHOR]

Background: Discourse analysis has recently received much attention in the aphasia literature. Even if post‐stroke language recovery occurs throughout the longitudinal continuum of recovery, very few studies have documented discourse changes from the hyperacute to the chronic phases of recovery. Aims: To document a multilevel analysis of discourse changes from the hyperacute phase to the chronic phase of post‐stroke recovery using a series of single cases study designs. Methods & Procedures: Four people with mild to moderate post‐stroke aphasia underwent four assessments (hyperacute: 0–24 h; acute: 24–72 h; subacute: 7–14 days; and chronic: 6–12 months post‐onset). Three discourse tasks were performed at each time point: a picture description, a personal narrative and a story retelling. Multilevel changes in terms of macro‐ and microstructural aspects were analysed. The results of each discourse task were combined for each time point. Individual effect sizes were computed to evaluate the relative strength of changes in an early and a late recovery time frame. Outcomes & Results: Macrostructural results revealed improvements throughout the recovery continuum in terms of coherence and thematic efficiency. Also, the microstructural results demonstrated linguistic output improvement for three out of four participants. Namely, lexical diversity and the number of correct information units/min showed a greater gain in the early compared with the late recovery phase. Conclusions & Implications: This study highlights the importance of investigating all discourse processing levels as the longitudinal changes in discourse operate differently at each phase of recovery. Overall results support future longitudinal discourse investigation in people with post‐stroke aphasia. What This Paper Adds: What is already known on the subject: Multi‐level discourse analysis allows for in‐depth analysis of underlying discourse processes. To date, very little is known on the longitudinal discourse changes from aphasia onset through to the chronic stage of recovery. This study documents multi‐level discourse features in four people with mild to moderate aphasia in the hyperacute, acute, subacute and chronic stage of post‐stroke aphasia recovery. What this paper adds to existing knowledge: The study found that most discourse variables demonstrated improvement throughout time. Macrostructural variables of coherence and thematic units improved throughout the continuum whereas microstructural variables demonstrated greater gains in the early compared to the late period of recovery. What are the potential or actual clinical implications of this work?: This study suggests that multilevel discourse analysis will allow a better understanding of post‐stroke aphasia recovery, although more research is needed to determine the clinical utility of these findings. Future research may wish to investigate longitudinal discourse recovery in a larger sample of people with aphasia with heterogenous aphasia profiles and severities. [ABSTRACT FROM AUTHOR]

Despite increased access to and improvements in contraceptives, unintended pregnancy continues to be a problem globally and is associated with adverse outcomes for mothers and infants. This paper seeks to unravel the mediators of intended versus unintended pregnancies among Black women living with HIV. The paper draws on survey data from a broader multi-country mixed methods study that used a community-based participatory research approach to investigate the psychosocial experiences of Black mothers living with HIV. The study participants were Black mothers living with HIV drawn through venue-based sampling from Ottawa, Canada (n = 89), Port Harcourt, Nigeria (n = 400), and Miami, Florida, United States (n = 201). We used Hierarchical Binary Logistic Regression Modelling (HBLM) to estimate the independent associations of pregnancy intention (intended versus unintended) with blocks of predictor variables (sociodemographic, sociocultural, and psychosocial predictors) at alpha level of 0.5. Specifically, 44.2%, 67.3%, and 17.7% of the women had unintended pregnancies in Ottawa, Miami, and Port Harcourt, respectively. There were important results from the HBLM. The odds of intended relative to unintended pregnancies were (i) reduced in larger households (OR = 0.56, 95% CI = 0.36/0.87), but increased with employment (OR = 7.84, 95% CI = 1.52/40.54) and HIV knowledge (OR = 3.13, 95% CI = 1.42/6.90) in Ottawa; (ii) reduced with age (OR = 0.93, 95% CI = 0.88/0.98), but increased with marriage (OR = 2.90, 95% CI = 1.43/5.88) and social support (pregnancy (OR = 3.77, 95% CI = 1.98/7.19) in Port Harcourt; (iii) reduced with social support (OR = 0.95, 95% CI = 0.91/1.00) but increased with HIV status disclosure (OR = 1.73, 95% CI = 1.01/2.97) and the influence of specific referent (OR = 1.68, 95% CI = 1.13/2.52) in Miami-FL. The incidence of unintended pregnancy is more prevalent among Black women living with HIV in the North American cities relative to the African city. Also, unique combinations of sociodemographic, sociocultural, and psychosocial factors influence pregnancy intention in each city. This implies that policy and practices to address reproductive health needs of WLHIV must consider these contextual issues. [ABSTRACT FROM AUTHOR]

Background: The gender disparity in surgical disciplines, specifically in speakers across North American medical and surgical specialty conferences, has been highlighted in recent literature. Improving gender diversity at society meetings and panels may provide many benefits. Our aim was to determine the state of gender diversity amongst presenters and speakers at the annual Canadian Society of Otolaryngology-Head and Neck Surgery (CSO) meetings. Methods: Scientific programs for the CSO annual meetings from 2008 to 2020 were obtained from the national society website. Participant name, role, gender, location, and subspecialty topic were recorded for all roles other than poster presenter. Gender (male or female) was determined using an online search. The total number of opportunity spots and proportion of women was then calculated. Gender differences were analyzed using chi-square test and logistic regression with odds ratios. Four categories were analyzed: Society Leadership, Invited Speaker Opportunities, Workshop Composition (male-only panels or "manels", female-only panels, or with at least one female speaker), and Oral Paper Presenters (first authors). Results: There were 1874 leadership opportunity spots from 2008 to 2020, of which 18.6% were filled by women. Among elected leadership positions in the society, only 92 unique women filled 738 leadership opportunity spots. 13.2% of workshop chairs, 20.8% of panelists and 22.7% of paper session chairs were female. There was an overall increase in the proportion of leadership positions held by women, from 13.9% of leadership spots in 2008 to 30.1% in 2020. Of the 368 workshops, 61.1% were led by men only, 36.4% by at least 1 female surgeon, and 2.5% by women only. "Manels" have comprised at least 37.5% of workshops each year. Conclusions: The proportion of women in speaking roles at the annual CSO meetings has generally increased over time, particularly among panelists, leading to fewer male-only speaking panels. However, there has been a slower rate of growth in the proportion of unique women in speaker roles. There remains an opportunity to increase gender/sex diversity at the major Canadian otolaryngology meeting. [ABSTRACT FROM AUTHOR]

Background: Chronic rhinosinusitis with nasal polyposis (CRSwNP) often coexists with lower airway disease. With the overlap between upper and lower airway disease, optimal management of the upper airways is undertaken in conjunction with that of the lower airways. Biologic therapy with targeted activity within the Type 2 inflammatory pathway can improve the clinical signs and symptoms of both upper and lower airway diseases. Knowledge gaps nevertheless exist in how best to approach patient care as a whole. There have been sixteen randomized, double-blind, placebo-controlled trails performed for CRSwNP targeted components of the Type 2 inflammatory pathway, notably interleukin (IL)-4, IL-5 and IL-13, IL- 5R, IL-33, and immunoglobulin (Ig)E. This white paper considers the perspectives of experts in various disciplines such as rhinology, allergy, and respirology across Canada, all of whom have unique and valuable insights to contribute on how to best approach patients with upper airway disease from a multidisciplinary perspective. Methods: A Delphi Method process was utilized involving three rounds of questionnaires in which the first two were completed individually online and the third was discussed on a virtual platform with all the panelists. A national multidisciplinary expert panel of 34 certified specialists was created, composed of 16 rhinologists, 7 allergists, and 11 respirologists who evaluated the 20 original statements on a scale of 1–9 and provided comments. All ratings were quantitively reviewed by mean, median, mode, range, standard deviation and inter-rater reliability. Consensus was defined by relative interrater reliability measures—kappa coefficient (κ ) value > 0.61. Results: After three rounds, a total of 22 statements achieved consensus. This white paper only contains the final agreed upon statements and clear rationale and support for the statements regarding the use of biologics in patients with upper airway disease. Conclusion: This white paper provides guidance to Canadian physicians on the use of biologic therapy for the management of upper airway disease from a multidisciplinary perspective, but the medical and surgical regimen should ultimately be individualized to the patient. As more biologics become available and additional trials are published we will provide updated versions of this white paper every few years. [ABSTRACT FROM AUTHOR]

Background: There is a large body of research showing the negative impact of a total laryngectomy on the resultant voice signal across multiple outcomes (e.g., speech intelligibility/acceptability, listener comprehension, voice quality). However, there is limited information on the effects of laryngectomy on broader communication acts, particularly in the area of pragmatics, commonly referred to as the social use of language. Considering that individuals with a laryngectomy (IWL) frequently report reduced quality of life as well as reduced communicative competency, expanding the current research to include pragmatics is warranted. Aim: To explore the pragmatic changes in communication experienced by tracheoesophageal speakers. Methods & Procedures: The current study adapted an existing 17‐item measure to assess verbal, non‐verbal, paralinguistic and receptive communication competence via self‐report. This adapted measure was then distributed to 65 tracheoesophageal speakers (52 males, 13 females, mean age = 63.4 ± 8.5 years). Outcomes & Results: Both negative and positive pragmatic changes to communication were reported by participants secondary to laryngectomy. This included changes in verbal (negative –37.5%, positive –15.15%); non‐verbal (negative –9.54%, positive –35.45%; and paralinguistic acts (negative –29.55%, positive –34.09%). Changes to receptive communication were also noted (negative –14.78%, positive –43.19%). Conclusions & Implications: The overall results suggest that communication changes post‐laryngectomy exist well beyond the paralinguistic areas (e.g., intelligibility, voice quality) and that males and females may approach or respond to changes in communication differently. Results are discussed specific to clinical intervention and the importance of including assessment of pragmatic function post‐laryngectomy. WHat this paper adds: What is already known on this subject: While there is a large body of research on the changes to the speaker and listener following laryngectomy, there is minimal information on how the use of alaryngeal speech affects overall communication, specifically in the area of pragmatics or the social use of language. What this paper adds to existing knowledge: This study used an adapted version of the widely used Pragmatic Protocol to delineate changes in pragmatic components of communication for tracheoesophageal speakers. What are the potential or actual clinical implications of this work?: Clinically, this information can be used by healthcare professionals to educate and prepare IWL on potential changes in the underrecognized area of pragmatics. [ABSTRACT FROM AUTHOR]

Background: Online knowledge translation (KT) approaches are becoming increasingly prevalent within healthcare due to their accessibility and facilitation of international support networks. Online platforms enable timely and far‐reaching dissemination of current evidence and best‐practice recommendations. Although there is potential to improve the uptake of rehabilitation guidelines, it is essential to consider the acceptability of online approaches to healthcare professionals to ensure their successful integration within everyday clinical settings. Aims: To establish the prospective acceptability of a theoretically informed online intervention for speech pathologists, Aphasia Nexus: Connecting Evidence to Practice, that aims to facilitate the implementation of aphasia best practice. Methods & Procedures: A mixed‐methods multinational electronic survey based on the Theoretical Framework of Acceptability (TFA) completed by aphasia researchers and clinicians. Outcomes & Results: A total of 43 participants completed the survey with 91% (n = 39) indicating that they would use Aphasia Nexus. Understanding the intervention and how it works (intervention coherence as per the TFA) was the key factor influencing the likelihood of integration within everyday clinical practice. Participants identified potential areas where the intervention could influence service change and also recommended further design and content changes to improve the intervention. Conclusions & Implications: Aphasia Nexus is an acceptable platform for further feasibility testing in the form of a pilot trial within an Australian‐based health service. The study progresses the theory of TFA as it was a valuable framework facilitating the identification of prominent factors influencing acceptability. The study also informs further intervention refinements in preparation for the next stage of research. WHAT THIS PAPER ADDS: What is already known on the subject: Online strategies have the potential to enhance KT and promote the uptake of rehabilitation guidelines. An online intervention, however, can only be effective if implemented well. For this reason, it is essential to establish the acceptability of online interventions to the intended recipients and therefore increase the likelihood of successful implementation. What this paper adds to existing knowledge: This study used a theoretically based framework to establish the acceptability of an online implementation intervention, Aphasia Nexus, to multinational aphasia clinicians and researchers. It demonstrated the value in identifying the prominent factors influencing acceptability to inform further intervention refinements and warrant continuing research. What are the potential or actual clinical implications of this work?: Speech pathologists should use online platforms to drive the implementation of best practice on an international scale. It is important for clinicians to have an in‐depth understanding of online interventions and how they work to enhance their successful uptake into routine clinical practice. Aphasia Nexus is an acceptable online platform for implementing best practice in aphasia. [ABSTRACT FROM AUTHOR]

Accessible Summary: What Is Known on the Subject?: Economic and educational opportunities are usually the principal driving forces for migration.There is a large body of quantitative research studies, mainly from the U.K., supporting the high prevalence of psychiatric disorders, mainly psychotic disorders, in Afro‐Caribbean immigrants which increases across generations.The process of migration and acculturation can present significant risk factors for psychiatric disorders in immigrants.Research involving members of the Black community is generally conducted with the perception that Blacks are a homogenous group, ignoring the cultural and ethnic differences among the subgroups. What the Paper Adds to Existing Knowledge?: It provides a broadened understanding of the experiences, thoughts and feelings of Afro‐Caribbean immigrants, and the factors within the processes of migration and acculturation that negatively impacts their mental health.It provides context to the volume of quantitative studies indicating a high prevalence of psychiatric disorders, particularly psychotic disorders, in Afro‐Caribbean immigrants and their offspring. What Are the Implications for Practice?: Nurses conducting mental health evaluations and assessments for members of the Black community should be culturally competent. Cultural competence entails an understanding of cultural beliefs, race, ethnicity and values. Additionally, knowledge of the effects of migration and acculturation as mental health risks is also important to improve mental health outcomes.Cultural competence will help reduce health disparities by increasing trust in the health care system and providers, not only for Afro‐Caribbean immigrants, but all immigrant groups. Introduction: There is evidence to support migration as a significant risk factor for psychiatric disorders in immigrants. Unfortunately, as an immigrant group, little is known about the mental health of Afro‐Caribbean immigrants and the factors that threaten their mental health. Aim: To explore the perceived effects of migration on the mental health of Afro‐Caribbean immigrants. Methods: A qualitative narrative synthesis was employed to interpretively integrate 13 primary qualitative research findings. Eleven of the primary studies were conducted in the U.K., one in the U.S. and one in Canada. Results: The themes gleaned: (1) experiences of racism, (2) generational conflicts, (3) feelings of powerlessness, (4) limited socioeconomic resources, (5) unfulfilled expectations, (6) fragmented family and community and (7) ignoring cultural/ethnic identity. Discussion: The findings broadened the understanding and experiences of Afro‐Caribbean immigrants and their mental health vulnerabilities as they navigate through migration and acculturation. Implications for Practice: Addressing the mental health of Afro‐Caribbeans will require health care providers to: (1) be cognizant of their immigrant status; (2) understand how migration and acculturation influence the mental health of immigrants; (3) be aware of the ethnocultural differences among Black subgroups. [ABSTRACT FROM AUTHOR]

Objective: Dental regulatory bodies aim to ensure the health and safety of dentists, dental staff patients and the public. An important responsibility during a pandemic is to communicate risk and guidelines for patient care. Limited data exist on the perceptions and experiences of dentists navigating new guidelines for mitigating risk in dental care during the pandemic. The objective of this study was to use a qualitative approach to explore how dentists in Canada experienced and perceived their regulatory bodies' communication about COVID‐19 risks and guidelines during the pandemic. Methods: Participants were Canadian dentists (N = 644) recruited through the email roster of nine provincial dental associations or regulatory bodies. This qualitative analysis was nested within a prospective longitudinal cohort study in which data were collected using online questionnaires at regular intervals from August 2020 to November 2021. To address the objective reported in this paper, a conventional qualitative content analysis method was applied to responses to three open‐ended questions included in the final questionnaire. Results: Participants encountered challenges and frustrations amid the COVID‐19 pandemic, grappling with diverse regulations and communications from dental bodies. While some bodies offered helpful guidance, many participants felt the need for improved communication on guidelines. Dentists urged for expedited, clearer and more frequent updates, expressing difficulty in navigating overwhelming information. Negative views emerged on the vague and unclear communication of COVID‐19 guidelines, contributing to confusion and frustration among participants. Conclusion: As COVID‐19 persists and in planning for future pandemics, these experiential findings will help guide regulatory bodies in providing clear, timely and practical guidelines to protect the health and safety of dentists, dental staff, patients and the public. [ABSTRACT FROM AUTHOR]

Purpose: Over the years, many upstream health policies have sought to reduce smoking across populations. While smoking has been substantially reduced, the effects of these policies on education-smoking gradient remain unclear. The present paper compares the education-smoking gradient among the Generation X and the millennials, who grew up with different types of upstream policies. Design/methodology/approach: The study relies on regression analysis. The data are from the Canadian Tobacco, Alcohol and Drugs Survey of 2017, with the sample restricted to those born between 1965 and 1995. Findings: At the zero-order, the education-smoking gradient has not significantly flattened from Generation X to millennials. And, accounting for the channels of impact of education on smoking does not substantially change this pattern. Social implications: The implications for health inequalities associated with socioeconomic status, and tobacco consumption reduction policies, are discussed. Originality/value: This paper is the first study of the kind using Canadian data. [ABSTRACT FROM AUTHOR]

Background: Recent evidence suggests that biologic therapy with targeted activity within the Type 2 inflammatory pathway can improve the clinical signs and symptoms of chronic rhinosinusitis with nasal polyposis (CRSwNP). There remains a population in CRSwNP that despite medical therapy and endoscopic sinus surgery have persistent signs and symptoms of disease. Therefore, biologics, monoclonal antibody agents, could be beneficial therapeutic treatments for these patients. There have been eight randomized, double-blind, placebo-controlled trails performed for CRSwNP targeted components of the Type 2 inflammatory pathway, notably interleukin (IL)-4, IL-5 and IL-13, IL-5R, IL-33, and immunoglobulin (Ig)E. However, there are no formal recommendations for the optimal use of biologics in managing Chronic Rhinosinusitis (CRS) within the Canadian health care environment. Methods: A Delphi Method process was utilized involving three rounds of questionnaires in which the first two were completed individually online and the third was discussed on a virtual platform with all the panelists. 17 fellowship trained rhinologists across Canada evaluated the 28 original statements on a scale of 1–10 and provided comments. A rating within 1–3 indicated disagreement, 8–10 demonstrated agreement and 4–7 represented being neutral towards a statement. All ratings were quantitively reviewed by mean, median, mode, range and standard deviation. Consensus was defined by removing the highest and lowest of the scores and using the "3 point relaxed system". Results: After three rounds, a total of 11 statements achieved consensus. This white paper only contains the final agreed upon statements and clear rationale and support for the statements regarding the use of biologics in patients with CRS. Conclusion: This white paper provides guidance to Canadian physicians on the use of biologic therapy for the management of patients with CRS, but the medical and surgical regimen should ultimately be individualized to the patient. As more biologics become available and additional trials are published we will provide updated versions of this white paper every few years. [ABSTRACT FROM AUTHOR]

Background: The purpose of this paper is to provide a preliminary evaluation of treatment outcomes, retention and client satisfaction following a 12-week combined cognitive behavioural therapy (CBT) and motivational enhancement therapy (MET) group treatment for cannabis use disorder (CUD) delivered in an outpatient setting. Implementation of the program is also described. Methods: A retrospective observational cohort study was conducted using data collected from medical records and self-report assessments. Participants were treatment-seeking cannabis users at the Centre for Addiction and Mental Health, Toronto. Cannabis use, cannabis-related problems, craving, withdrawal symptoms, self-efficacy for remaining abstinent, depression and anxiety were assessed pre- and post-treatment. Treatment retention was calculated by inspecting clinic attendance records, and client satisfaction was evaluated using an anonymous feedback survey. Potential predictors of treatment outcomes and retention were investigated in exploratory analyses. Results: Cannabis use was lower and days of abstinence higher post-treatment (vs pre-treatment). Post-treatment improvements in cannabis-related problems, craving, withdrawal symptoms, self-efficacy and mood were also observed. Completion of group treatment (⩾75% of sessions attended) was 57% and moderate levels of treatment satisfaction were reported. Conclusions: This study provides preliminary evidence that a 12-week combined CBT and MET treatment for cannabis use disorder delivered in a novel group setting improves cannabis use outcomes. Potential predictors of reduced cannabis use and retention were identified. Future controlled studies are warranted, and strategies for increasing retention should be explored. [ABSTRACT FROM AUTHOR]

What is known on the subject: Supported housing approaches that include case management and increased opportunities for independence and personal autonomy for people who are living with severe and persistent mental illness (SPMI) have been found to help reduce hospitalizations and use of the emergency department.What is not fully clear is if these types of supported housing arrangements also influence the use of primary health care and other specialist services. What the paper adds to existing knowledge: This study uncovered that individuals experiencing SPMI who lived in supported housing used more primary health care and specialist physician services, in the year following transition to this housing arrangement. What are the implications for practice: The findings of this study suggest that supported housing arrangements for people experiencing SPMI may help in improving the personalization of health services for individual residents, including increasing access to both primary health care and specialist services.This is important for nursing practice, as the findings of the study show that supported housing arrangements for people experiencing SPMI may assist in better supporting their complex health care needs. Introduction: Supported housing for people who are living with severe and persistent mental illness (SPMI) has been found to help reduce hospitalizations and use of the emergency department. What is not fully clear is if these types of supported housing arrangements also influence the use of primary health care and other specialist services. Aim/Question: The aim of this study was to compare the use of health services use of individuals with SPMI, before and after transition to the new supported housing program. Method: Using health care administrative databases, a pre‐post cohort study was conducted examining the health system use of residents who transitioned from custodial to supported housing arrangements between 2017 and 2019. Results: Individuals with SPMI used more primary health care and specialist physician services after transition to the supported housing model. Discussion: The results suggest that a supported housing model may be associated with increased usage of outpatient person‐centred health services in people experiencing SPMI. Implications for Practice: The findings of this study suggest that supported housing arrangements for people experiencing SPMI may help in improving the personalization of health services for individual. This is important for nursing practice, as the findings of the study show that supported housing arrangements may assist in better supporting complex health care needs of individuals. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Occupational Therapy is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

For many novice teachers, their first year on the job can be a roller coaster experience of 'ups' and 'downs' as they transition from their teacher education programs to teaching in real classrooms. While to 'ups' are always good to experience, the 'downs' can be so traumatic that novice teachers can feel so stressed that their teaching is adversely impacted and burned out to the point that they consider resigning for the profession. For the most part, however, the language teaching profession has not addressed this aspect of a novice ESL (English as a second language) teacher well-being in terms of their personal and emotional investment as they transition from trainee to novice teacher in their first year. This paper attempts to shed light on the emotional experiences of three female novice ESL teachers in a university language school in Canada as they reflected during regular group discussions and journal writing during their first semester (12 weeks) as novice ESL teachers. The results reveal that the group discussions and journal writing provided a platform for the teachers to articulate their mostly negative emotions with three most frequently expressed: frustration, anger and boredom. [ABSTRACT FROM AUTHOR]

Introduction: The COVID‐19 pandemic has had an impact on all aspects of the health system. Little is known about how the activities and experiences of patient, family and caregiver partners, as a large group across a variety of settings within the health system, changed due to the substantial health system shifts catalysed by the pandemic. This paper reports on the results of a survey that included questions about this topic. Methods: Canadian patient, family and caregiver partners were invited to participate in an online anonymous survey in the Fall of 2020. A virtual snowballing approach to recruitment was used. Survey invitations were shared on social media and emailed to health system and governmental organizations with the request that they share the survey with patient partners. This paper focuses on responses to two questions related to patient partner experiences during the COVID‐19 pandemic. Results: The COVID‐19 questions were completed by 533 respondents. Over three quarters of respondents (77.9%, n = 415) indicated their patient engagement activities had been impacted by COVID‐19. The majority (62.5%, n = 230) experienced at least a temporary or partial reduction in their patient engagement activities. Some respondents did see increases in their patient engagement activities (11.4%, n = 42). Many respondents provided insights into their experience with virtual platforms for engagement (n = 194), most expressed negative or mixed experiences with this shift. Conclusions: This study provides a snapshot of Canadian patient, family and caregiver partners' perspectives on the impact of COVID‐19 on their engagement activities. Understanding how engagement unfolded during a crisis is critical for our future planning if patient engagement is to be fully integrated into the health system. Identifying how patient partners were engaged and not engaged during this time period, as well as the benefits and challenges of virtual engagement opportunities, offers instructive lessons for sustaining patient engagement, including the supports needed to engage with a more diverse set of patient, family and caregiver partners. Patient Contribution: Patient partners were important members of the Canadian Patient Partner Study research team. They were engaged from the outset, participating in all stages of the research project. Additional patient partners were engaged to develop and pilot test the survey, and all survey respondents were patient, family or caregiver partners. The manuscript is coauthored by two patient partners. [ABSTRACT FROM AUTHOR]

This paper investigates how to best compare algorithms for predicting chronic homelessness for the purpose of identifying good candidates for housing programs. Predictive methods can rapidly refer potentially chronic shelter users to housing but also sometimes incorrectly identify individuals who will not become chronic (false positives). We use shelter access histories to demonstrate that these false positives are often still good candidates for housing. Using this approach, we compare a simple threshold method for predicting chronic homelessness to the more complex logistic regression and neural network algorithms. While traditional binary classification performance metrics show that the machine learning algorithms perform better than the threshold technique, an examination of the shelter access histories of the cohorts identified by the three algorithms show that they select groups with very similar characteristics. This has important implications for resource constrained not-for-profit organizations since the threshold technique can be implemented using much simpler information technology infrastructure than the machine learning algorithms. [ABSTRACT FROM AUTHOR]

Copyright of Physiotherapy Canada is the property of University of Toronto Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Social Frailty is a significant public health concern affecting the elderly, particularly with the global population aging rapidly. Older adults with social frailty are at significantly higher risk of adverse outcomes such as disability, cognitive impairment, depression, and even death. In recent years, there have been more and more studies on social frailty, but no bibliometrics has been used to analyze and understand the general situation in this field. Therefore, by using CiteSpace, VOSviewer, and Bilioshiny software programs, this study aims to analyze the general situation of the research on social frailties of the older adults and determine the research trends and hot spots. Methods: A bibliometric analysis was conducted by searching relevant literature on the social frailty of the older adults from 2003 to 2022 in the Web of Science core database, using visualization software to map publication volume, country and author cooperation networks, keyword co-occurrences, and word emergence. Results: We analyzed 415 articles from 2003 to 2022. Brazil has the highest number of articles in the field of social frailty of the older adults, and the United States has the highest number of cooperative publications. Andrew MK, from Canada, is the most published and co-cited author, with primary research interests in geriatric assessment, epidemiology, and public health. "Social Vulnerability," "Health," "Frailty," "Mortality," and "Older Adult" are among the research hotspots in this field. "Dementia," "Alzheimer's disease," "Population," and "Covid-19" are emerging research trends in social frailty among the older adults. Conclusion: This scientometric study maps the research hotspots and trends for the past 20 years in social frailty among the older adults. Our findings will enable researchers to better understand trends in this field and find suitable directions and partners for future research. [ABSTRACT FROM AUTHOR]

Background: The integration of Primary Care (PC) into broader health systems has been a goal in jurisdictions around the world. Efforts to achieve integration at the meso-level have drawn particular attention, but there are few actionable recommendations for how to enact a 'pro-integration culture' amongst government and PC governance bodies. This paper describes pragmatic integration activity undertaken by meso-level participants in Alberta, Canada, and suggests ways this activity may be generalizable to other health systems. Methods: 11 semi-structured interviews with nine key informants from meso-level organizations were selected from a larger qualitative study examining healthcare policy development and implementation during the COVID-19 pandemic. Selected interviews focused on participants' experiences and efforts to 'do' integration as they responded to Alberta's first wave of the Omicron variant in September 2021. An interpretive descriptive approach was used to identify repeating cycles in the integration context, and pragmatic integration activities. Results: As Omicron arrived in Alberta, integration and relations between meso-level PC and central health system participants were tense, but efforts to improve the situation were successfully made. In this context of cycling relationships, staffing changes made in reaction to exogenous shocks and political pressures were clear influences on integration. However, participants also engaged in specific behaviours that advanced a pro-integration culture. They did so by: signaling value through staffing and resource choices; speaking and enacting personal and group commitments to collaboration; persevering; and practicing bi-directional communication through formal and informal channels. Conclusions: Achieving PC integration involves not just the reactive work of responding to exogenous factors, but also the proactive work of enacting cultural, relationship, and communication behaviors. These behaviors may support integration regardless of the shocks, staff turnover, and relational freeze-thaw cycles experienced by any health system. [ABSTRACT FROM AUTHOR]

Recovery Colleges are strength-based mental health and well-being learning centers driven by peer support and principles of adult education. This paper examines the outcome of a hospital-based Recovery College in Canada on participants' self-reported well-being, recovery, loneliness, and self-esteem. Using a retrospective pre- and postsurvey design and standardized scales, we collected self-reported data from 32 Recovery College students. The majority (88%) of participants were female and 78% of participants reported to struggle with maintaining positive mental health. Recovery College participation had a significant impact on self-reported connection, mental wellbeing, self-esteem, and personal mental health recovery. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to explore users' perceptions of whether the Leadership Development Impact Assessment (LDI) Toolkit is valid, reliable, simple to use and cost-effective as a guide to its quality improvement. Design/methodology/approach: The Canadian Health Leadership Network codesigned and codeveloped the LDI Toolkit as a theory-driven and evidence-informed resource that aims to assist health-care organizational development practitioners to evaluate various programs at five levels of impact: reaction, learning, application, impact and return on investment (ROI) and intangible benefits. A comparative evaluative case study was conducted using online questionnaires and semistructured telephone interviews with three health organizations where robust leadership development programs were in place. A total of seven leadership consultants and specialists participated from three Canadian provinces. Data were analyzed sequentially in two stages involving descriptive statistical analysis augmented with a qualitative content analysis of key themes. Findings: Users perceived the toolkit as cost-effective in terms of direct costs, indirect costs and intangibles; they found it easy-to-use in terms of clarity, logic and structure, ease of navigation with a coherent layout; and they assessed the sources of the evidence-informed tools and guides as appropriate. Users rated the toolkit highly on their perceptions of its validity and reliability. The analysis also informed the refinement of the toolkit. Originality/value: The refined LDI Toolkit is a comprehensive online collection of various tools to support health organizations to evaluate the leadership development investments effectively and efficiently at five impact levels including ROI. [ABSTRACT FROM AUTHOR]

There is limited evidence on the strategies, resources, and tools shown to improve winter mobility and community participation. This paper describes a multifaceted approach taken to develop an mHealth application that provides information, resources, and strategies to facilitate winter mobility for mobility device users, service providers, community organisations, and researchers. The study was conducted in three phases: (1) A scoping review of peer-reviewed and grey literature was completed to identify literature that reported on tools, strategies, resources, and recommendations used to promote winter mobility; (2) Online asynchronous focus groups were conducted to identify the type of content that mobility device users wanted to include in the web-based application; and (3) A prototype mHealth application was developed based on the findings from the previous phases. Using a rapid prototyping process that included stakeholder review through an online survey, four cycles of application design and development were undertaken. The scoping review identified 23 peer-reviewed studies and limited grey literature on winter mobility strategies, resources and recommendations. Twenty-four participants from across Canada engaged in one of five focus groups. Focus group analysis led to the development of the content categories for the mHealth application. The initial prototype application developed was reviewed by; 27 mobility device users, 16 health care providers, and seven consumer organisation representatives identified areas of strength and further refinement in regard to application design. The approach used in this study provided a method to develop an application based on the ideas, needs, and interests of a variety of stakeholders. Once fully developed, the application has the potential to fill the gaps related to the lack of a unified collection of winter mobility strategies and resources, and open the dialogue on methods to improve winter participation among mobility device users. Despite winter conditions being a common challenge among mobility device users, there is an absence of an organised approach towards helping individuals manage their winter mobility needs. As the development and usage of mHealth applications continues to increase, it is valuable to use methods of designing applications based on the ideas, needs, and interests of a variety of stakeholders. Development of a framework for collating information on winter mobility strategies and resources is the first step towards launching an mHealth application. [ABSTRACT FROM AUTHOR]

Background: Under dentistry's social contract with the public, dental professionals have a social responsibility to address the oral health needs of the population at large. However, dental education places little emphasis on such moral commitments. By ascertaining dental students' stance regarding these notions, we may be able to inform changes in dental education. This paper thus explores dental students' comprehension of dentistry's social contract using the concepts of moral inclusion, moral community and empathy. Methods: A cross-sectional online survey collected information from undergraduate dental students at the Faculty of Dentistry, University of Toronto (N = 430). Moral inclusion was assessed through the breadth of students' moral community by computing a "moral inclusion score" (MIS) from Likert scale responses to statements that asked students about their duty of care for different population groups, wherein a higher MIS indicated a broader moral community and in turn greater moral inclusiveness. Empathy was assessed using Likert scale responses to statements that gauged the extent to which students understood the effect of social determinants on people's health. Association of the MIS with environmental, institutional and student-related factors was also investigated using non-parametric tests and linear regression. Results: The survey yielded a response rate of 51.4% (n = 221). Overall, students in this sample were morally inclusive and displayed empathy. Regression results showed that the MIS was most strongly associated with choosing a small town/rural area as a future practice location (β = 4.76, 95% CI: 0.52, 9.01) and viewing patients as consumers (β = -3.71, 95%CI: -7.13, -0.29). Conclusion: Students in this sample made morally inclusive choices, which implied that they had a basic understanding of the obligations under dentistry's social contract. Improving knowledge and experience with regards to addressing the social and economic determinants of oral health and access to oral health care may positively influence students' perceptions of their professional duties under the social contract. [ABSTRACT FROM AUTHOR]

Background: Adequate housing is a basic human right. The many millions of people experiencing homelessness (PEH) have a lower life expectancy and more physical and mental health problems. Practical and effective interventions to provide appropriate housing are a public health priority. Objectives: To summarise the best available evidence relating to the components of case‐management interventions for PEH via a mixed methods review that explored both the effectiveness of interventions and factors that may influence its impact. Search Methods: We searched 10 bibliographic databases from 1990 to March 2021. We also included studies from Campbell Collaboration Evidence and Gap Maps and searched 28 web sites. Reference lists of included papers and systematic reviews were examined and experts contacted for additional studies. Selection Criteria: We included all randomised and non‐randomised study designs exploring case management interventions where a comparison group was used. The primary outcome of interest was homelessness. Secondary outcomes included health, wellbeing, employment and costs. We also included all studies where data were collected on views and experiences that may impact on implementation. Data Collection and Analysis: We assessed risk of bias using tools developed by the Campbell Collaboration. We conducted meta‐analyses of the intervention studies where possible and carried out a framework synthesis of a set of implementation studies identified by purposive sampling to represent the most 'rich' and 'thick' data. Main Results: We included 64 intervention studies and 41 implementation studies. The evidence base was dominated by studies from the USA and Canada. Participants were largely (though not exclusively) people who were literally homeless, that is, living on the streets or in shelters, and who had additional support needs. Many studies were assessed as having a medium or high risk of bias. However, there was some consistency in outcomes across studies that improved confidence in the main findings. Case Management and Housing Outcomes: Case management of any description was superior to usual care for homelessness outcomes (standardised mean difference [SMD] = −0.51 [95% confidence interval [CI]: −0.71, −0.30]; p < 0.01). For studies included in the meta‐analyses, Housing First had the largest observed impact, followed by Assertive Community Treatment, Critical Time Intervention and Intensive Case Management. The only statistically significant difference was between Housing First and Intensive Case Management (SMD = −0.6 [–1.1, −0.1]; p = 0.03) at ≥12 months. There was not enough evidence to compare the above approaches with standard case management within the meta‐analyses. A narrative comparison across all studies was inconclusive, though suggestive of a trend in favour of more intensive approaches. Case Management and Mental Health Outcomes: The overall evidence suggested that case management of any description was not more or less effective compared to usual care for an individual's mental health (SMD = 0.02 [−0.15, 0.18]; p = 0.817). Case Management and Other Outcomes: Based on meta‐analyses, case management was superior to usual care for capability and wellbeing outcomes up to 1 year (an improvement of around one‐third of an SMD; p < 0.01) but was not statistically significantly different for substance use outcomes, physical health, and employment. Case Management Components: For homelessness outcomes, there was a non‐significant trend for benefits to be greater in the medium term (≤3 years) compared to long term (>3 years) (SMD = −0.64 [−1.04, −0.24] vs. −0.27 [−0.53, 0]; p = 0.16) and for in‐person meetings in comparison to mixed (in‐person and remote) approaches (SMD = −0.73 [−1.25,−0.21]) versus −0.26 [−0.5,−0.02]; p = 0.13). There was no evidence from meta‐analyses to suggest that an individual case manager led to better outcomes then a team, and interventions with no dedicated case manager may have better outcomes than those with a named case manager (SMD = −0.36 [−0.55, −0.18] vs. −1.00 [−2.00, 0.00]; p = 0.02). There was not enough evidence from meta‐analysis to assess whether the case manager should have a professional qualification, or if frequency of contact, case manager availability or conditionality (barriers due to conditions attached to service provision) influenced outcomes. However, the main theme from implementation studies concerned barriers where conditions were attached to services. Characteristics of Persons Experiencing Homelessness: No conclusions could be drawn from meta‐analysis other than a trend for greater reductions in homelessness for persons with high complexity of need (two or more support needs in addition to homelessness) as compared to those with medium complexity of need (one additional support need); effect sizes were SMD = −0.61 [−0.91, −0.31] versus −0.36 [−0.68, −0.05]; p = 0.3. The Broader Context of Delivery of Case Management Programmes: Other major themes from the implementation studies included the importance of interagency partnership; provision for non‐housing support and training needs of PEH (such as independent living skills), intensive community support following the move to new housing; emotional support and training needs of case managers; and an emphasis on housing safety, security and choice. Cost Effectiveness: The 12 studies with cost data provided contrasting results and no clear conclusions. Some case management costs may be largely off‐set by reductions in the use of other services. Cost estimates from three North American studies were $45–52 for each additional day housed. Authors' Conclusions: Case management interventions improve housing outcomes for PEH with one or more additional support needs, with more intense interventions leading to greater benefits. Those with greater support needs may gain greater benefit. There is also evidence for improvements to capabilities and wellbeing. Current approaches do not appear to lead to mental health benefits. In terms of case management components, there is evidence in support of a team approach and in‐person meetings and, from the implementation evidence, that conditions associated with service provision should be minimised. The approach within Housing First could explain the finding that overall benefits may be greater than for other types of case management. Four of its principles were identified as key themes within the implementation studies: No conditionality, offer choice, provide an individualised approach and support community building. Recommendations for further research include an expansion of the research base outside North America and further exploration of case management components and intervention cost‐effectiveness. [ABSTRACT FROM AUTHOR]

Parenting education interventions and parenting programs are important for health promotion efforts among children and families; however, the majority of parenting programs are directed towards and attended by mothers. This is problematic because research has consistently demonstrated that fathers' active participation in the family can have a positive influence on mothers' well-being, children's self-esteem, success in school, and interpersonal relationships. In this paper, using an intersectional poststructuralist framework, document analysis, and Bacchi and Goodwin's "What's the problem represented to be" approach (WPR), we analyzed the program policies of 12 organizations that provide family-centred services in the Downtown Eastside of Vancouver, British Columbia, Canada. We identified the following three discourses: organizations strive to be client-centred and provide choices; organizations want to empower their participants; and women need safe place to raise their families. Our analysis revealed that fathers are absent or represented as problems in program policies, and that this has consequences for not only fathers but also mothers and children. Highlights: Dominant discourses of gender are upheld through the exclusion of fathers in program policies. The exclusion of fathers in policies produces them as either absent/problematic and can adversely affect families. Organizations uphold damaging discourses of masculinity that can undermine efforts to prioritize the needs of mothers. Changing language in policies may help family-centred organizations shift services and better support families. [ABSTRACT FROM AUTHOR]

Background: Computer‐based assessment allows for the monitoring of reader behaviour. The identification of patterns in this behaviour can provide insights that may be useful in informing educational interventions. Objectives: Our study aims to explore what different patterns of reading activity exist, and investigates their interpretation and consistency across different task sets (units), countries, and languages. Three patterns were expected: on‐task, exploring and disengaged. Methods: Using log data from the PISA 2012 digital reading assessment (9226 students from seven countries), we conducted hierarchical cluster analyses with typical process indicators of digital reading assessments. We identified different patterns and explored whether they remained consistent across different units. To validate the interpretation of the identified patterns, we examined their relationship to performance and student characteristics (gender, socio‐economic status, print reading skills). Results and Conclusions: The results indicate a small number of transnational clusters, with unit‐specific differences. Cluster interpretation is supported by associations with student characteristics—for example, students with low print reading skills were more likely to show a disengaged pattern than proficient readers. Exploring behaviour tended to be exhibited only once across the three units: It occurred in the first unit for proficient readers and in later units for less skilled readers. Major Takeaways: Behavioural patterns can be identified in digital reading tasks that may prove useful for educational monitoring and intervention. Although task situations are designed to evoke certain behaviours, the interpretation of observed behavioural patterns requires validation based on task requirements, assessment context and relationships to other available information. Lay Description: What is already known about the subject matter?: Students differ in how they read, comprehend and use digital information.Indicators from process data provide insight about how students engage with digital reading tasks. What does this paper add to the subject matter?: Based on multiple process indicators, a small number of clusters indicating different behavioural activity can be distinguished.These clusters can be described as on‐task, passive, hasty, exploring, disengaged, persistent and lost interest.A meaningful interpretation of the clusters must consider the requirements of the underlying tasks. Implications for practice and/or policy: Knowledge of how students engage with digital resources may provide useful feedback for teachers to guide students' learning or intervene when they struggle.Educational monitoring: The high comparability of country‐specific results suggests an invariant set of solution strategies in the digital reading assessment. [ABSTRACT FROM AUTHOR]

Compared to research conducted with nondisabled samples, little is known about the relation between mental health and physical activity (PA) in individuals with a spinal cord injury (SCI). Despite this population being more at risk of experiencing anxiety and depression and less likely to engage in PA, few studies have investigated other factors that may impact this association in this population such as anxiety sensitivity (AS). AS is a fear of physiological arousal sensations, and importantly has been shown to be negatively associated with PA in people without disabilities. It is unknown if the changes to how one experiences physiological sensations after a SCI impacts the relation between AS and PA. Objective: This study investigated which forms of PA are predicted by anxiety and depression and whether AS is predictive of PA in this population. Research Method: 98 participants with a SCI (both paraplegia and tetraplegia) completed an online questionnaire that had measures of PA, AS, and anxiety and depression. Results: It was found that symptoms of anxiety were significantly associated with mild-intensity PA. Interestingly AS was positively associated with moderate-intensity PA. Conclusions: The results of this study show that the relation between mental health and PA in this sample may not mirror what has been found in people without disabilities. More research is needed to replicate these findings as well as to investigate other potential mechanisms that may be relevant for people with a SCI. Impact and Implications: The results of this paper provide important insights into the association between physical activity and mental health for people with a spinal cord injury (SCI). The results of this paper suggest that research looking at this association in people who do not have disabilities may not be generalizable to people with a SCI. [ABSTRACT FROM AUTHOR]

Annual turnover of home care workers represents a huge loss of revenue and is a key source of inefficiency in the home health care industry. In this article, we propose a data-driven approach to monitor employee churn and to capture the evolution of employee intent to leave. Unlike most papers in the literature, we use machine learning techniques to analyze over 2 million visits in the US, Canada, and Australia between 2016 and 2019. Results show that the gap between the number of hours worked and in the contract is the most important factor to predict employee intent to leave, which means an employee should be given as many hours as requested in the contract to improve retention. Secondary results show that having diverse shift lengths and continuity in services and patients seem to be associated with less turnover. [ABSTRACT FROM AUTHOR]