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A cross-disciplinary rapid scoping review was carried out, generally following the PRISMA-SCR protocol to examine historical racial and caste-based discrimination as structural determinants of health disparities in the 21st century. We selected 48 peer-reviewed full-text articles available from the University of Memphis Libraries database search, focusing on three selected case-study countries: the United States (US), Canada, and Nepal. The authors read each article, extracted highlights, and tabulated the thematic contents on structural health disparities attributed to racism or casteism. The results link historical racism/casteism to health disparities occurring in Black and African American, Native American, and other ethnic groups in the US; in Indigenous peoples and other visible minorities in Canada; and in the Dalits of Nepal, a population racialized by caste, grounded on at least four foundational theories explaining structural determinants of health disparities. The evidence from the literature indicates that genetic variations and biological differences (e.g., disease prevalence) occur within and between races/castes for various reasons (e.g., random gene mutations, geographic isolation, and endogamy). However, historical races/castes as socio-cultural constructs have no inherently exclusive basis of biological differences. Disregarding genetic discrimination based on pseudo-scientific theories, genetic testing is a valuable scientific means to achieve the better health of the populations. Epigenetic changes (e.g., weathering—the early aging of racialized women) due to the DNA methylation of genes among racialized populations are markers of intergenerational trauma due to racial/caste discrimination. Likewise, chronic stresses resulting from intergenerational racial/caste discrimination cause an "allostatic load", characterized by an imbalance of neuronal and hormonal dysfunction, leading to occurrences of chronic diseases (e.g., hypertension, diabetes, and mental health) at disproportionate rates among racialized populations. Major areas identified for reparative policy changes and interventions for eliminating the health impacts of racism/casteism include areas of issues on health disparity research, organizational structures, programs and processes, racial justice in population health, cultural trauma, equitable healthcare system, and genetic discrimination. [ABSTRACT FROM AUTHOR]

The present study examined the differences in the food bank users' perceptions related to calcium nutrition across sex and employment status using a cross-sectional, prospective design at a large food bank in Canada. A total of 197 individuals participated for a response rate of 97%. A structured survey was developed and pilot tested before it was administered. Gender and employment status were the independent variables and calcium nutrition perceptions was the primary dependent variable. Chi-square analyses were conducted. Over 75% of participants perceived calcium to be important, but 47% believed they have insufficient intakes and over 15% admitted to being uncertain of their actual calcium needs. Food costs and not knowing food sources of calcium were indicated as the main determinant for choosing calcium rich foods. While the men surveyed were more likely to be "unsure of sources" of calcium, women were more concerned about the cost of calcium rich foods. Based on the results, it was recommended that nutrition education initiatives should inform food bank users of their calcium needs and economical ways to obtain an adequate calcium intake. (Contains 3 tables.)

Copyright of Leisure/Loisir: Journal of the Canadian Association for Leisure Studies is the property of Routledge 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.)

Social interaction and physical activity are critical components in supporting health among older adults, yet rates of activity are low in rural communities. There is significant merit in exploring the relationship between these interrelated concepts. A scoping review was conducted to synthesize existing literature. Search results identified 26 studies meeting inclusion criteria. Findings indicated that social interaction and physical activity were important for many older adults to maintain health; however, not all older adults preferred the social aspect of group-based exercise. Opportunities for physical activity and social interaction were limited based on geographical location and other socioeconomic factors. This was evident in rural communities where populations were lower and education and income levels varied. Differences on the defining role and meaning of physical activity also emerged. Increasing physical activity and social interaction must account for negative associations to address the lower rates of participation among rural older adults. [ABSTRACT FROM AUTHOR]

Nova Scotia's Supportive Care Program (SCP) is an individualized funding program that provides funds for people living with dementia (PLWD) or acquired brain injuries to purchase basic home care services such as personal care, respite, cleaning and cooking. The SCP has the potential to address the Quintuple Aim of enhancing care experience, improving population health, reducing costs, improving provider experience and improving health equity, yet qualitative evidence is lacking. The aim of this study is to use participatory program evaluation methods to evaluate the SCP and consider how effective it is in addressing the Quintuple Aim. The study objectives and corresponding methods are to (1) Co-develop a SCP logic model to guide the evaluation through consultations with a diverse group of stakeholders including PLWD, caregivers, care providers, researchers, government representatives, and nongovernment organizations, with attention to gender; (2) Evaluate the SCP based on the outcomes and outputs identified in the logic model using focus groups with PLWD, caregivers and home care providers, and interviews with PLWD and their caregivers; and (3) Mobilize knowledge about the ways the SCP addresses the Quintuple Aim through integrated knowledge translation activities with public, policy and research audiences. By focusing on clinically and socially vulnerable populations of PLWD and caregivers, the proposed evaluation of the SCP offers a valuable case in assessing the effectiveness of individually-funded home care in addressing the Quintuple Aim including health equity within the context of dementia care. [ABSTRACT FROM AUTHOR]

Canada is a highly industrialized multicultural society with nearly 22 percent of its population made up of foreign-born individuals coming through the immigration process. Recent immigrants tend to experience a decline in their health status over time as their years in Canada increase. This phenomenon can be attributed to several factors, including reduced leisure time, changing active lifestyle, and adaptation to the new sociocultural environment. While a great deal of research has focused on children, there is paucity of research in this area among West Africans in Canada. Therefore, the purpose of this study was to gain a deeper understanding of the facilitators and barriers of active living among recently immigrated West African children living in Saskatchewan. Using purposive sampling, thirty-one interviews were conducted with children and their parents separately to reduce social desirability bias. Children between 10 and 17 years were interviewed in each family. A grounded theory methodological approach involving a constant comparative analytical process was utilized. The families identified some sociocultural facilitators and barriers to physical activity for their children. The facilitators included having an enabling environment in close proximity, parental role modeling, peer influence, and school influence. The barriers reported included the Saskatchewan weather, the neighborhood environment, societal norms such as bullying and discrimination, competing priorities for the parents, financial constraints, and the children's passive screen time. This study provides expanded understandings of physical activity among West African immigrant children, which has policy implications for active living in Canada. Physical activity appeared to take a secondary position in the lives of these families and could be significantly improved by reinforcing the facilitators and addressing the identified barriers. [ABSTRACT FROM AUTHOR]

Abstract Background The sole focus of models of insight on bio-medical perspectives to the complete exclusion of local, non-medical and cultural constructs mandates review. This study attempted to investigate the impact of insight, psychopathology, explanatory models of illness on outcome of first episode schizophrenia. Method Patients diagnosed to have DSM IV schizophrenia (n = 131) were assessed prospectively for insight, psychopathology, explanatory models of illness at baseline, 6, 12 and 60 months using standard instruments. Multiple linear and logistic regression and generalized estimating equations (GEE) were employed to assess predictors of outcome. Results We could follow up 95 (72.5%) patients. Sixty-five of these patients (68.4%) achieved remission. There was a negative relationship between psychosis rating and insight scores. Urban residence, fluctuating course of the initial illness, and improvement in global functioning at 6 months and lower psychosis rating at 12 months were significantly related to remission at 5 years. Insight scores, number of non-medical explanatory models and individual explanatory models held during the later course of the illness were significantly associated with outcome. Analysis of longitudinal data using GEE showed that women, rural residence, insight scores and number of non-medical explanatory models of illness held were significantly associated with BPRS scores during the study period. Conclusions Insight, the disease model and the number of non-medical model positively correlated with improvement in psychosis arguing for a complex interaction between the culture, context and illness variables. These finding argue that insight and explanatory models are secondary to psychopathology, course and outcome of the illness. The awareness of mental illness is a narrative act in which people make personal sense of the many challenges they face. The course and outcome of the illness, cultural context, acceptable cultural explanations and the prevalent social stigma interact to produce a complex and multifaceted understanding of the issues. This complexity calls for a nuanced framing of insight.

Abstract Background The study examined the effects of dietary fasting on physical balance among young healthy women. Methods This study undertaken involving 22 young healthy women (age = 22 ± 1.5) using a within subject counterbalanced 2-week crossover study design. Participants were asked to refrain from consuming any food or beverage for 12 hours prior to the fasting trial and to maintain their regular diet for the non-fasting trial. Measures included: a background questionnaire, 24-hour dietary recall, and functional reach and timed single-limb stances. Results Fasting resulted in significant declines in functional reach (p < 0.01), and ability to balance in a single limb stance with eyes open, on both the dominant and non-dominant legs (p < 0.01 and p < 0.01, respectively), and with eyes closed on the dominant leg (p < 0.01). Conclusions The findings have implications for athletic performance in younger individuals as well as emphasizing the need for health education for young women to avoid skipping meals.

Copyright of Applied Physiology, Nutrition & Metabolism is the property of Canadian Science Publishing 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: Musculoskeletal pain alters physiological function, which may be evidenced as early as middle age. Previous research has concluded that middle-aged adults are a high-risk group for musculoskeletal pain and report functional limitations similar to older adults. However, few studies have examined the relationships between musculoskeletal pain and physical function, using objective performance measures in a sample of racially and socioeconomically diverse adults. Thus, this study examined musculoskeletal pain in relation to physical function in middle-aged (30-64 years) White and Black adults and investigated whether the relationship varied by sociodemographic characteristics.Methods: This cross-sectional examination incorporated data from the Healthy Aging in Neighborhoods of Diversity across the Life-Span Study. Participants (n = 875) completed measures of musculoskeletal pain and objective measures of physical performance (ie, lower and upper body strength, balance, and gait abnormalities). Physical performance measures were standardized to derive a global measure of physical function as the dependent variable.Results: Approximately, 59% of participants identified at least 1 pain sites (n = 518). Multivariable regression analyses identified significant relationships between greater musculoskeletal pain and poorer physical function (β = -0.07, p = .031), in mid midlife (β = -0.04, p = .041; age 40-54) and late midlife (β = -0.05, p = .027; age 55-64).Conclusions: This study observed that musculoskeletal pain was associated with poorer physical function within a diverse group of middle-aged adults. Future research should longitudinally explore whether chronic musculoskeletal pain identified at younger ages is associated with greater risk for functional limitation and dependence in later life. [ABSTRACT FROM AUTHOR]

Existing cognitive health literature focuses predominately on understanding the pathology and clinical treatment of older adults with dementia rather than cognitive health promotion and preventative activities. In addition, most of the work in the area remains urban-centric with little focus on cognitive health in rural communities. This study examined rural seniors' perspectives of activities that they identified as supporting their cognitive health. Using community-based research and an ethnographic methodology, participant observation and semi-structured interviews were conducted with 42 older adults in rural Saskatchewan, Canada. Participants discussed a variety of activities that they viewed as supporting their cognitive health. In particular, cognitive health promotion was identified as being strongly linked to keeping one's brain active, thinking positively, mingling with others, and managing daily affairs. This study's findings suggest that there is a need to move beyond focusing solely on clinical interventions to including older adults' perspectives of preventative activities and cognitive health promotion. [ABSTRACT FROM AUTHOR]

Although rural seniors are important users of health-care services, their perspectives and input remain largely absent from health programs and policies. This article explores rural seniors' perspectives to support their engagement in patient-oriented research. Guided by lay theory and cultural schema theory, participant observation, concept maps, and semi-structured interviews were conducted with 42 rural seniors in Saskatchewan, Canada. Three themes were identified: community outreach through trust and partnership-building; using flexible data collection methods such as moving to open-ended interviews rather than closed-ended surveys; and developing community-relevant dissemination strategies such as local newspaper articles, posters, and community workshops. In moving forward, collaborative research with seniors is essential to improving health programs and policies for older adults in rural communities and beyond. [ABSTRACT FROM AUTHOR]

The proportion of older adults is increasing around the world and most wish to live in their home until they die. To achieve this, many will require services in the home to remain living independently. To maintain function (ie, strength, balance, and endurance), physical activity needs to be undertaken on a regular basis, and is essential as a person ages. Unfortunately, as people age there is a tendency to reduce activity levels, which often leads to loss of function and frailty, and the need for home care services. This updated systematic review includes a mix of study methodologies and meta-analysis, and investigated the effectiveness of physical activity/exercise interventions for older adults receiving home care services. Eighteen studies including ten randomized controlled trials meeting the selection criteria were identified. Many of the studies were multi-factorial interventions with the majority reporting aims beyond solely trying to improve the physical function of home care clients. The meta-analysis showed limited evidence for effectiveness of physical activity for older adults receiving home care services. Future exercise/physical activity studies working with home care populations should consider focusing solely on physical improvements, and need to include a process evaluation of the intervention to gain a better understanding of the association between adherence to the exercise program and other factors influencing effectiveness. [ABSTRACT FROM AUTHOR]

Objective: To examine the relationship between dietary service staff and dietary deficiency citations in nursing homes (NHs). Method: 2007-2011 Online Survey and Certification and Reporting data for 14,881 freestanding NHs were used to examine the relationship between dietary service staff and the probability of receiving a dietary service–related deficiency citation. An unconditional logit model with random effects was employed. Results: Findings suggest that higher staffing levels for dietitians (odds ratio [OR] =.955; p <.01), dietary service personnel (OR =.996; p <.01), and certified nursing assistants (CNAs; OR =.981; p <.05) decrease the likelihood of receiving a dietary service deficiency citation. Conclusion: Higher levels of dietary service and CNA staffing levels have the potential to improve the quality of nutritional care in NHs. Findings help substantiate the Centers for Medicare and Medicaid Services' proposed rules for more stringent Food and Nutrition Services in the NH setting and signify the need for further research relative to the impact of dietary service staff on nutritional and clinical outcomes. [ABSTRACT FROM AUTHOR]

In the context of an aging population, both the need for home care services and its complexity of care have increased in many high-income countries. Yet, the definition of what constitutes complex care is largely elusive. This systematic review examined the conceptual definition of complex care within the home care environment using several social and health science databases for research published from 2000 to 2017. Of the 25 articles and reports identified, only 16 addressed complex care specifically and included older adults, aging, and/or home care. The results showed that complex care for older adults is primarily defined from a biomedical approach focusing on chronic disease and management and less commonly from the perspective of the social determinants of health. Future studies should consider the importance of the continuum of care needs from both the biomedical and the social determinants to adequately plan and provide care for older adults. [ABSTRACT FROM AUTHOR]

The older adult population in Canada is growing, creating a greater demand for long-term care (LTC) facilities. Seniors living in LTC are more vulnerable to malnutrition, making it important to implement nutrition screening tools on a routine basis. The purpose of this study was to explore the practices of Registered Dietitians (RDs) related to nutritional screening, nutritional assessment, and follow-ups conducted within LTC facilities. This study also explored possible barriers hindering the application of these practices. Nine RDs from two health regions in Southern Saskatchewan completed a phone interview to address nutrition care practices/policies and barriers in LTC facilities. Results showed a considerable amount of variability in nutrition care practices for screening and assessment with lack of time identified as the greatest barrier. These findings highlight the importance of having consistent policies and a sufficient amount of RDs available in LTC facilities to provide the expected level of nutrition care for residents. [ABSTRACT FROM AUTHOR]

This qualitative study examined the falls and fall-related injury experiences of community-dwelling rural seniors. 42 senior men and women living in two rural areas in Saskatchewan, Canada were recruited, and in-depth interviews were conducted. Analysis revealed three main themes among responses: nature of falls and injuries, causes of falls and injuries, and consequences of falls and injuries. Men and women expressed a fear of falling, which led to activity limitations; however, women were more reflective on their potential to fall and showed an increased level of preparedness compared to men. The causes of falls included activities at the time of a fall, functional limitations, chronic diseases, and personal factors such as type shoes worn. While men and women downplayed the seriousness of their falls or injuries, indicating a level of hardiness, this trend was stronger among men. None of the participants discussed the role of health care professionals or the health care system in relation to fall risk and ways of preventing falls, despite reporting adaptations to prevent and deal with consequences of falls. Overall, these findings may allude to the scarcity of health care services provided in rural communities, highlighting a need to focus on falls prevention for community-dwelling rural seniors. [ABSTRACT FROM AUTHOR]

The aim was to determine the prevalence of work-related musculoskeletal disorders (WMSDs) and health profile among urban versus rural continuing care aides (CCAs) in Canada. This cross-sectional study of 42 urban and rural CCAs assessed WMSDs and health profiles using the Nordic Musculoskeletal Questionnaire (NMQ), Cornell Musculoskeletal Discomfort Questionnaire (CMDQ), and a health background questionnaire. CCAs were generally unhealthy, with rural CCAs somewhat healthier. Greatest WMSD complaint was reported at the neck. Urban CCAs were more likely to report foot complaints (p < .05). No other statistically significant differences were found. Back and shoulder scores were correlated with poorer nutrition status, higher body mass index, and more years worked. Workplace wellness programs should address the health issues faced by CCAs through active surveillance and practical interventions to improve CCAs’ health status, prevent and manage WMSDs, and lost workdays. [ABSTRACT FROM AUTHOR]

The article discusses an attempted study on the impact psychopathology, explanatory models of illness and clinical outcome on insight over the long-term course of first-episode schizophrenia in Vellore, India. Topics discussed include the study conducted in the Department of Psychiatry, Christian Medical College, Vellore, Tamil Nadu, India and an urgent need to develop and refine instruments that can capture diverse beliefs on mental illness and elicit local explanatory models of illness.

To date, initiatives to support healthy aging in place have focused primarily on the views of policy makers, researchers, and health professionals. This article explored the meanings, experiences, and perceptions of healthy aging in place among rural older adults. Guided by a community-based participatory research approach, this study sheds light on the perspectives of rural seniors themselves. Through semistructured interviews with 40 rural older adults, the study found that rural older adults' conceptualization of healthy aging in place consisted of factors that policy makers and health professionals would not necessarily consider. In contrast to biomedical approaches, the rural older adults situated healthy aging in place within a more holistic context of health, ranging from social interaction to maintaining an optimistic mental outlook. If policy makers and researchers are to develop more effective interventions that support rural healthy aging in place, then the importance of rural older adults' perspectives, experiences, and input must be recognized. [ABSTRACT FROM PUBLISHER]

This study examines the interventions that enable rural seniors to remain within their homes and communities as they age. Through semi-structured interviews with 40 rural seniors, the findings reveal a number of actions that facilitate rural aging. This study has important implications for a range of stakeholders from policy makers to community leaders by identifying policy, community, and kin-level interventions that support rural healthy aging in place. In identifying interventions that support rural seniors’ needs, this study provides a fundamental basis to better allocate resources, plan programs, and develop policies that reflect the needs of an aging population. [ABSTRACT FROM AUTHOR]

This study was performed to compare the effects of creatine supplementation (CR) before vs. after supervised resistance training (RT) in healthy older adults. Participants were randomized to one of two groups: CR-Before (0.1g•kg−1creatine before + 0.1g•kg−1placebo [rice flour] after RT,n = 11) or CR-After (placebo before + creatine after RT,n = 11). Resistance training (RT) was performed 3 days/week, on nonconsecutive days, for 12 weeks. Prior to and following the study, measures were taken for body composition, maximum strength, muscle protein catabolism, and kidney function. Over the 12-week training period, both groups experienced a significant increase in whole-body lean tissue mass, limb muscle thickness, and upper and lower body strength and a decrease in muscle protein catabolism (p < 0.001), with no differences between groups. There was no change in kidney function over time. Changes in muscle mass or strength are similar when creatine is ingested before or after supervised resistance training in older adults. [ABSTRACT FROM PUBLISHER]

Purpose: To examine the key determinants that support healthy aging in rural communities. Sample: Forty- two participants aged 65 and older were recruited from two rural communities in Saskatchewan, Canada. Methods: Using an ethnographic methodological approach, data was collected through semi-structured interviews, field notes and participant observation notes. Cantor's (1989) Social Care Model was used as the theoretical framework for exploring the supports that facilitate rural healthy aging. Findings: Healthy aging among rural seniors extends significantly beyond access to physicians and formal health care. Eight key themes related to healthy aging were identified: housing; transportation; healthcare; finances; care giving; falls; rural communities; and support systems. Conclusions: While there is evidence of poor health among rural seniors, little research has examined healthy aging or the determinants that facilitate healthy aging in rural communities. In addressing rural seniors' health needs, this study provides a fundamental basis for developing effective interventions and innovative public policy options to support rural healthy aging. [ABSTRACT FROM AUTHOR]

Background: Transcultural studies have found lack of insight to be an almost invariable feature of acute and chronic schizophrenia, but its influence on prognosis is unclear.Aims: To investigate the relationship between insight, psychopathology and outcome of first-episode schizophrenia in Vellore, India.Method: Patients with a DSM-IV diagnosis of schizophrenia (n = 131) were assessed prospectively at baseline and at 6-month and 12-month follow-up. Demographic and clinical measures included insight, psychopathology, duration of untreated psychosis (DUP) and social functioning. Linear and logistic regression was used to measure predictors of outcome.Results: Follow-up data were available for 115 patients at 1 year. All achieved remission, half of them with and half without residual symptoms. Changes in psychopathology and insight during the first 6 months and DUP strongly predicted outcome (relapse or functional impairment), controlling for baseline measures.Conclusions: Outcome of schizophrenia in this setting is driven by early symptomatic improvement and is relatively favourable, in line with other studies from low- and middle-income countries. Early improvement in insight might be a useful clinical guide to future outcome. Reduction of DUP should be a target for intervention. [ABSTRACT FROM AUTHOR]

Background: The study examined the effects of dietary fasting on physical balance among young healthy women. Methods: This study undertaken involving 22 young healthy women (age = 22 ± 1.5) using a within subject counterbalanced 2-week crossover study design. Participants were asked to refrain from consuming any food or beverage for 12 hours prior to the fasting trial and to maintain their regular diet for the non-fasting trial. Measures included: a background questionnaire, 24-hour dietary recall, and functional reach and timed single-limb stances. Results: Fasting resulted in significant declines in functional reach (p < 0.01), and ability to balance in a single limb stance with eyes open, on both the dominant and non-dominant legs (p < 0.01 and p < 0.01, respectively), and with eyes closed on the dominant leg (p < 0.01). Conclusions: The findings have implications for athletic performance in younger individuals as well as emphasizing the need for health education for young women to avoid skipping meals. [ABSTRACT FROM AUTHOR]

The article discusses how the Canadian government can help reduce health disparities. Five recommendations are presented. They include establishing a national population health framework, an integrated population health-information infrastructure, and a plan to assess population health initiatives. Education and training that help implement strategies for societal action on the determinants of health are also recommended. The availability of data sources for tracking health status is addressed. The need for further assessment and research is mentioned. The authors believe national action along with recommendations from the World Health Organization Commission on the Social Determinants of Health will reduce health inequalities.

Background: Lack of insight has been observed in people with schizophrenia across cultures but assessment of insight must take into account prevailing illness models.Aims: To determine whether culturally specific and Western biomedical interpretations of insight and psychosis can be reconciled.Method: Patients with schizophrenia (n=131) were assessed during their first contact with psychiatric services in Vellore, South India. Patients' explanatory models, psychopathology and insight were investigated using a standard schedule translated into Tamil.Results: Supernatural explanations of symptoms were frequent. Some insight dimensions were weakly associated (inversely) with severity of symptoms whereas preserved insight was associated with anxiety, help-seeking and perception of change. Willingness to attribute symptoms to disease, in others and in one's self, but not to supernatural forces was strongly associated with insight.Conclusions: The relationship between insight, awareness of illness and other clinical variables is similar in South India to elsewhere. However, the assessment of insight might have failed to capture locally accepted explanatory frameworks. An inclusive conceptual model which emphasises help-seeking is recommended. [ABSTRACT FROM AUTHOR]