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Despite growing enrollment of university students with disabilities, they have not achieved academic parity with their non-disabled peers. This study matched 71 first-year university students with disabilities and students without disabilities on three variables: high school average when admitted to university, gender, and program of study. Both groups of students were compared on three measures of academic performance: GPA, failed courses, and dropped courses after first year of university. The relationship between accommodations and academic performance was also analyzed for students with disabilities. Even when matched on admission average, gender, and program of study, students with disabilities had a significantly lower GPA and were more likely to fail courses in their first year than their peers without disabilities. While note-taking in the classroom was associated with being less likely to drop a course, it was also associated with poorer academic performance, as was using a calculator or alternate format during exams. The more accommodations students lost in the transition from high school, the worse they performed academically at university. Students who lost human assistant support in the classroom and the use of a computer or a memory aid during exams had a significantly lower GPA and were more likely to fail courses in their first year of university compared with students who did not lose these accommodations. These findings have implications for accessibility offices and universities in supporting the access needs and academic success of students with disabilities.

Although more students with disabilities are attending university than ever before, many still have difficulties with the transition from high school. Transition research has extensively examined the factors and barriers that support or hinder successful transitions for students with disabilities. However, there has been little explicit focus on the intersection of experiences with transition and academic accommodations on the overall experience of students with disabilities at university. This study interviewed six participants with various disabilities who transitioned directly from high school to university. Thematic analysis showed that: (a) first-year students are unprepared for the bureaucratic nature of the accommodation process, but ultimately find it fair and non-stigmatizing; (b) first-year students discover that they have to play a more active role in their accommodation planning but ultimately find that this role, and the accommodations they receive, positively supports their autonomy and disability identity at university; and (c) some university instructors exhibit significantly negative attitudes towards students requiring accommodations. These findings have practice implications for disability service professionals in universities supporting the transition needs of students with disabilities. [ABSTRACT FROM AUTHOR]

The inclusion of people with disabilities as a designated group for rights protection in the Canadian Charter of Rights and Freedoms was viewed as a triumph of disability advocacy in Canada. And yet, a number of commentators look back with disappointment over the 30 years since the Charter was passed. This paper employs an empirical approach to examine an important subset of cases invoking the Charter of Rights and Freedoms to promote disability rights. Specifically, it examines 14 cases heard by the Supreme Court of Canada to uncover the types of disability issues that have been addressed, and the approach of Supreme Court justices to these issues. In order to qualify for inclusion, cases had to have an appellant with a disability, and to directly address a disability discrimination issue. The current study shows a very limited impact of the Charter, despite expectations of a discernible shift in the position of people with disabilities within Canadian society. There is still no consistently applied "disability lens" in the policy environment, and there are relatively few tangible indicators of the kinds of considerations offered to other enumerated groups, such as Ministry or oversight committees dedicated to their issues. [ABSTRACT FROM AUTHOR]

Background. Breast cancer survivors continue to experience physical and psychosocial health care needs post-treatment. Primary care involvement is increasing as cancer centres move forward with earlier discharge of stable breast cancer survivors to primary care follow-up. Research suggests primary care providers (PCPs) are willing to provide survivorship care but many lack knowledge and confidence to provide evidence-based care. Although clinical practice guidelines (CPGs) exist for follow-up surveillance and certain aspects of survivorship care, no single comprehensive guideline addresses all significant breast cancer survivorship issues encountered in primary care. Purpose. The purpose of this research was to create a comprehensive clinical practice framework to guide the provision of breast cancer survivorship care in primary care settings. Methods. This study consisted of an extensive search, appraisal and synthesis of CPGs for posttreatment breast cancer care using a modified Delphi method. Breast cancer survivorship issues and relevant CPGs were mapped to four essential components of survivorship care to create a comprehensive clinical practice framework to guide provision of breast cancer survivorship care. Results. The completed framework consists of a one-page checklist outlining breast cancer survivorship issues relevant to primary care, a three-page summary of key recommendations and a one-page list of guideline sources. The framework and key guideline recommendations were verified by a panel of experts for comprehensiveness, importance and relevance to primary care. Conclusions. This framework may serve as a tool to remind PCPs about issues impacting breast cancer survivors, as well as the evidence-based recommendations and resources to provide the associated care. [ABSTRACT FROM AUTHOR]

Fetal Alcohol Spectrum Disorder (FASD) is a leading cause of developmental disability in Canadian children. The majority of Canadians with FASD are not identified: FASD is diagnosed in less than 1% of Canadians, when it may occur in as high as 2-5% of the school-aged population. This discrepancy is due in part to a lack of harmonized policy and service coordination at national and provincial levels. Failure to provide appropriate interventions for individuals with FASD results in the development of debilitating secondary effects that impact individuals, families and communities. Ontario is the most populated Canadian province with an emerging provincial strategy for FASD that is challenged by additional barriers to effective service provision and utilization. The Eastern Ontario region represents a population of 3 million residents that are particularly under serviced. This environmental scan used formal and informal sources to explore, summarize, and map out current services for FASD in order to present a comprehensive review of service accessibility. The results inform residents, policymakers, service providers, and program developers on the scope and nature of services for FASD located in the Eastern Ontario region in 2012. [ABSTRACT FROM AUTHOR]

Study design:Cross-sectional, observational study.Objectives:To quantify, in adults with chronic spinal cord injury (SCI): (1) presence of metabolic syndrome versus the general North American population (GP) and (2) 10-year coronary heart disease (CHD) risk using Framingham risk scoring (FRS).Setting:Ontario, Canada.Methods:Fasting anthropometric and biochemical data were collected from 75 adults with chronic SCI. Metabolic syndrome was determined using four internationally recognized definitions and FRS using the most recent (2001) algorithm.Results:Prevalence of metabolic syndrome was up to 5.4 times lower in SCI participants compared to GP, and FRS categorized 3.1% of participants as being at high 10-year CHD risk. However, high-sensitivity C-reactive protein (CRP) values indicated 36.7% of participants as being at high CHD risk.Conclusion:Current metabolic syndrome definitions and FRS may underestimate true CHD risk in people with SCI. Tools that better identify CHD risk require validation in the SCI population. CRP may be a potential factor to consider in the development of SCI-specific screening tools.Spinal Cord (2008) 46, 608–615; doi:10.1038/sc.2008.21; published online 11 March 2008 [ABSTRACT FROM AUTHOR]

Study design:Cross-sectional.Objectives:In community-dwelling adults with chronic spinal cord injury (SCI), to (1) quantify C-reactive protein (CRP), a marker of inflammation and cardiovascular disease (CVD) risk; (2) determine factors associated with CRP.Setting:Hamilton, Ontario, Canada.Methods:We examined CVD risk factors in 69 participants. Measurements included length, weight, waist circumference, blood pressure, percent fat mass (bioelectrical impedance analysis) and fasting blood parameters (high-sensitivity CRP, lipids, insulin, glucose, insulin resistance by homeostasis model assessment (HOMA)).Results:Mean CRP of the group was 3.37±2.86 mg−l−1, consistent with the American Heart Association (AHA) definition of high risk of CVD. CRP was 74% higher in persons with tetraplegia (4.31±2.97) than those with paraplegia (2.47±2.47 mg l−1, P=0.002), consistent with high CVD risk. Participants with high CRP (3.1–9.9 mg l−1) had greater waist circumference, BMI, percent fat mass and HOMA values than those with lower CRP (3.0 mg l−1, all P<0.05). LogCRP was independently correlated with waist circumference (r=0.612), logTriglycerides (r=0.342), logInsulin (r=0.309) and logHOMA (r=0.316, all P<0.05). Only level of lesion and waist circumference remained significantly associated with logCRP when variables with significant bivariate correlations were included in multiple regression analysis.Conclusion:Mean CRP values in this sample of adults with chronic SCI were consistent with the AHA classification of high CVD risk, especially those of persons with tetraplegia. Level of lesion and waist circumference are independently associated with CRP in this population.Spinal Cord (2008) 46, 616–621; doi:10.1038/sc.2008.32; published online 15 April 2008 [ABSTRACT FROM AUTHOR]

Background: Access to health care is vital to the health and well-being of people with chronic conditions like multiple sclerosis (MS). Access is often measured using service utilization as a proxy. Utilization measures may fail to capture the complexities of the experiences of accessing care that populations with chronic illness face. The Candidacy Framework offers an alternative to utilization measures, by examining the dynamic process a patient must engage in, with the health care system and all components of it, to negotiate their eligibility for care, which is described as one's candidacy. The process of accessing care is examined form the perspective of vulnerable populations and considers the impact of social patterning and health system environments on this process. Objectives: To investigate access to health care for the management of MS, in a Canadian context, from the perspective of persons with MS. Methods: The study design was informed by an interpretive descriptive methodology. Forty-eight individuals with MS living across 7 communities in Ontario were recruited primarily through the MS Society of Canada to participate in 1 of 5 focus groups or 10 individual telephone interviews. The sessions were digitally recorded and transcribed. The transcriptions were then analyzed using constant comparative methods. Additionally, the data was re-interpreted in light of the Candidacy Framework to determine its alignment to this framework. Results: All dimensions of the Candidacy Framework were relevant to the experiences of persons with MS. However, the framework failed to account for important aspects of the participants lifelong experience of accessing care. Importantly, participants discussed the process of engaging in help-seeking which was informed by past experiences of seeking and receiving health care services, as well as the accumulated knowledge of living with MS. The most commonly reported past experiences were those regarding instances of patient-centered care, where negative experiences were described when this approach to care was not taken. Past negative experiences oftentimes made persons with MS hesitant to seek further care. Conclusions: The Candidacy Framework alone does not account for the lifelong interaction with health care that individuals with chronic illnesses such as MS face. To capture the full experience of access the framework should consider 3 main extensions: 1) The addition of recursivity, which captures the reciprocal nature of interacting with the health care system; 2) inclusion of help-seeking behavior and related decision making; and 3) inclusion of the concepts of patient-centered care. [ABSTRACT FROM AUTHOR]

Background: Current Canadian literature demonstrates that persons with multiple sclerosis (MS) are high users of health care services, yet still have multiple unmet needs and low satisfaction with health care services. International studies showing similar results suggest this may be related to issues in access to health care. Objectives: We aimed to 1) describe the health care service use of Canadians with MS in managing their condition; 2) identify the most pressing concerns Canadians with MS have in relation to accessing care to manage their MS. Methods: The aims were addressed using an online cross-sectional survey guided by Concerns Report Methodology. Inclusion criteria were: older than 18 years, a Canadian citizen, and self-reported diagnosis of MS. Data were collected about health care service use and the importance and satisfaction with access to health care service in the community. Data were analyzed using descriptive statistics. Access concerns were prioritized by calculating a Needs Index (NI). Results: To date, 211 persons with MS have completed the survey. Participants were predominantly female (86%), with a mean (SD) age of 46.4 (11.7), living with relapsing remitting MS (77%) for a mean (SD) of 10.4 (8.9) years. Just over half of the participants were still working (57%), with varying levels of disability ranging from 0-7 on the Patient-Determined Disease Steps (median: 2). Preliminary findings indicate that nearly all participants had a regular neurologist (97%), many of whom practice in an MS clinic (83%). Most individuals also had a general practitioner (96%). Participants on average visited their neurologist 1.5 times a year (SD: 0.7) and their general practitioner 4.6 times (SD: 2.3) a year. The highest concerns among participants regarding their access to care were: 1) affordability of complementary care (example: massage therapy, yoga, naturopathic care) (NI: 33.8) and physiotherapy and occupational therapy (NI: 29.7), both aimed at improving wellness; 2) availability of health care providers with MS-related knowledge in their communities to guide their care plan (NI: 33.7); and 3) communication between health care providers to ensure coordination of care (NI: 29.2). Conclusions: Preliminary findings suggest that for persons with MS, merely having regular neurologists and general practitioners is not considered satisfactory access to care. Persons with MS identified concerns regarding the availability of affordable health care services aimed at maintaining wellness. They also had concerns regarding the availability of community providers with sufficient MS-related knowledge to guide their referrals and care plans. Targeting policy reform promoting the coverage of health care services aimed at preventative and maintenance care may be a critical step in improving care for this population. [ABSTRACT FROM AUTHOR]

Objectives: Individuals with spinal cord injury deal with multiple health complications that require them to use many medications. The purpose of this paper was to find the most common potentially harmful drug-drug interactions (DDIs) in therapeutic regimens of persons with spinal cord injury, and the risk factors associated with it. We further highlight the relevance of each of the DDIs specific to spinal cord injury population., Design: Observational design and cross-sectional analysis., Setting: Community; Canada., Participants: Individuals with spinal cord injury ( n  = 108)., Main Outcome Measures/analysis: The main outcome was the presence of one or more potential DDIs that can lead to an adverse outcome. All the reported drugs were classified as per the World Health Organization's Anatomical Therapeutic Chemical Classification system. Twenty potential DDIs were selected for the analysis based on the most common medications prescribed to people with spinal cord injury and severity of clinical consequences. The medication lists of study participants were analyzed for selected DDIs., Results: Among the 20 potential DDIs analyzed in our sample, the top 3 prevalent DDIs were Opioids + Skeletal Muscle Relaxants, Opioids + Gabapentinoids, and Benzodiazepines + ≥ 2 other central nervous system (CNS)-active drugs. Of the total sample of 108 respondents, 31 participants (29%) were identified with having at least one potential DDI. The risk of having a potential DDI was highly associated with polypharmacy, though no associations were found between the presence of a drug interaction and age, sex, level of injury, time since injury, or cause of injury among the study sample., Conclusion: Almost three out of ten individuals with spinal cord injury were at risk of having a potentially harmful drug interaction. Clinical and communication tools are needed that facilitate identification and elimination of harmful drug combinations in the therapeutic regimens of patients with spinal cord injury.

Objective: To describe the implementation of key best practice guideline recommendations for posttreatment breast cancer survivorship care by primary care providers (PCPs)., Design: Descriptive cross-sectional survey., Setting: Southeastern Ontario., Participants: Eighty-two PCPs: 62 family physicians (FPs) and 20 primary health care nurse practitioners (PHCNPs)., Main Outcome Measures: Twenty-one “need-to-know” breast cancer survivorship care guideline recommendations rated by participants as “implemented routinely,” “aware of guideline recommendation but not implemented routinely,” or “not aware of guideline recommendation.”, Results: Overall, FPs and PHCNPs in our sample reported similar practice patterns in terms of implementation of breast cancer survivorship guideline recommendations. The PCPs reported routinely implementing approximately half (46.4%, 9.7 of 21) of the key guideline recommendations with breast cancer survivors in their practices. Implementation rates were higher for recommendations related to prevention and surveillance aspects of survivorship care, such as mammography and weight management. Knowledge and practice gaps were highest for recommendations related to screening for and management of long-term effects such as fatigue and distress. There were only a few minor differences reported between FPs and PHCNPs., Conclusion: There are knowledge and practice gaps related to implementation of the key guideline recommendations for breast cancer survivorship care in the primary care setting that could be targeted for improvement through educational or other interventions.

Objective: To present the results of a pilot study of an innovative methodology for translating best evidence about spinal cord injury (SCI) for family practice., Design: Review of Canadian and international peer-reviewed literature to develop SCI Actionable Nuggets, and a mixed qualitative-quantitative evaluation to determine Nuggets' effect on physician knowledge of and attitudes toward patients with SCI, as well as practice accessibility., Setting: Ontario, Newfoundland, and Australia., Participants: Forty-nine primary care physicians., Methods: Twenty Actionable Nuggets (pertaining to key health issues associated with long-term SCI) were developed. Nugget postcards were mailed weekly for 20 weeks to participating physicians. Prior knowledge of SCI was self-rated by participants; they also completed an online posttest to assess the information they gained from the Nugget postcards. Participants' opinions about practice accessibility and accommodations for patients with SCI, as well as the acceptability and usefulness of Nuggets, were assessed in interviews., Main Findings: With Actionable Nuggets, participants' knowledge of the health needs of patients with SCI improved, as knowledge increased from a self-rating of fair (58%) to very good (75%) based on posttest quiz results. The mean overall score for accessibility and accommodations in physicians' practices was 72%. Participants' awareness of the need for screening and disease prevention among this population also increased. The usefulness and acceptability of SCI Nugget postcards were rated as excellent., Conclusion: Actionable Nuggets are a knowledge translation tool designed to provide family physicians with concise, practical information about the most prevalent and pressing primary care needs of patients with SCI. This evidence-based resource has been shown to be an excellent fit with information consumption processes in primary care. They were updated and adapted for distribution by the Canadian Medical Association to approximately 50,000 primary care physicians in Canada, in both English and French.