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Homelessness is growing internationally, and resources to guide occupational therapy practice in this area are needed. To identify competencies needed for occupational therapists to support individuals during and following homelessness. We conducted a three-round Delphi study with occupational therapy practitioners and researchers with expertise in homelessness. Of 35 potential participants, n = 16 participated in Round I, n = 20 participated in Round II, and n = 18 participated in Round III. Participants included occupational therapists and researchers in Canada, United States, Brazil, UK, Ireland and New Zealand. Consensus was achieved on a total of 93 competencies in 10 categories after 15 were eliminated in Rounds II and III. The categories with the greatest number of competencies included occupational knowledge (n = 18), followed by psychosocial competencies (n = 16). This study represents the first to identify the competencies needed for occupational therapists working in the area of homelessness. Practitioners and educators are encouraged to view the identified competencies as a guide for the professional development of occupational therapists in this context. Stakeholders consulted for this study were able to communicate in English and situated in middle to high-income countries. As such, the competencies identified in this study only apply to these sociocultural contexts. [ABSTRACT FROM AUTHOR]

Although the value of family caregivers' involvement with relatives in long-term care (LTC) is well recognized, tensions remain regarding their role. Such tensions were exacerbated during the COVID-19 pandemic as strict public health measures restricted family access to LTC homes. Using interpretive description, we examined the impact of visitation restrictions on family caregivers' experiences caring for a relative in LTC between March 2020 and June 2021. In-depth interviews were conducted with 14 family caregivers (five spouses and nine adult daughters) and two key themes were identified. The first theme, "seeking to maintain relational continuity," illustrates how caregivers sought to sustain connections with residents prior to and during the pandemic. The second theme, "disrupted relational continuity," highlights the impact of severed relational connections on caregivers' sense of self and ongoing feelings of loss and anger. Findings call for a trauma-informed approach that recognizes the pervasiveness of trauma for family caregivers and the avoidance of re-traumatization. [ABSTRACT FROM AUTHOR]

Background: Compared with those with a higher socio-economic position (SEP), individuals with a lower SEP have higher cancer morbidity and mortality. However, the contribution of modifiable risk factors to these inequities is not known. This study aimed to quantify the mediating effects of modifiable risk factors to associations between SEP and cancer morbidity and mortality.Methods: This study used a prospective observational cohort design. We combined eight cycles of the Canadian Community Health Survey (2000/2001-2011) as baseline data to identify a cohort of adults (≥35 years) without cancer at the time of survey administration (n = 309 800). The cohort was linked to the Discharge Abstract Database and the Canadian Mortality Database for cancer morbidity and mortality ascertainment. Individuals were followed from the date they completed the Canadian Community Health Survey until 31 March 2013. Dates of individual first hospitalizations for cancer and deaths due to cancer were captured during this time period. SEP was operationalized using a latent variable combining measures of education and household income. Self-reported modifiable risk factors, including smoking, excess alcohol consumption, low fruit-and-vegetable intake, physical inactivity and obesity, were considered as potential mediators. Generalized structural equation modelling was used to estimate the mediating effects of modifiable risk factors in associations between low SEP and cancer morbidity and mortality in the total population and stratified by sex.Results: Modifiable risk factors together explained 45.6% of associations between low SEP and overall cancer morbidity and mortality. Smoking was the most important mediator in the total population and for males, accounting for 15.5% and 40.2% of the total effect, respectively. For females, obesity was the most important mediator.Conclusions: Modifiable risk factors are important mediators of socio-economic inequities in cancer morbidity and mortality. Nevertheless, more than half of the variance in these associations remained unexplained. Midstream interventions that target modifiable risk factors may help to alleviate inequities in cancer risk in the short term. However, ultimately, upstream interventions that target structural determinants of health are needed to reduce overall socio-economic inequities in cancer morbidity and mortality. [ABSTRACT FROM AUTHOR]

Background: Consistent assignment (CA) is the practice within long‐term care (LTC) by which care staff work with the same residents almost every shift for an indefinite period of time. CA is considered by many to be essential to person‐centred care. Objectives: This paper explores how staff assignment practices impact the caregiving experience from the perspectives of resident care aides (RCAs), residents and family members and, by doing so, describe the nuanced conditions under which CA may or may not be beneficial to all, and why. Methods: Data are drawn from 40 in‐depth interviews conducted as part of a larger institutional ethnography exploring the social organisation of care in three purposively selected LTC homes in Western Canada. Data analysis was based on the principles of constant comparison. Results: RCAs, residents and family members described the primary benefit of CA as being able to 'get to know' each other well and form meaningful relationships. However, the RCAs also indicated that CA can contribute to feelings of isolation, which has negative effects on worker comfort and satisfaction, care team dynamics and communication, and resident care. Conclusions: Management initiatives are needed to ensure that the implementation of CA does not result in the unintended consequences of decreasing RCAs' experience of teamwork, decreasing RCAs' exchange of individualised resident care information, or negatively impacting RCAs' ability and desire to care for each other as well as the residents. Implications for practice: The staffing practice of consistent assignment in long‐term care homes provides increased opportunities for the development of stronger staff‐resident and staff‐family member relationships. Findings from this study enable us to offer several, evidenced‐based recommendations for ensuring the successful implementation of consistent assignment, such that it may be beneficial to all. [ABSTRACT FROM AUTHOR]

Background: Adolescent cannabis use is perceived as a risky behavior, has been linked with many negative health outcomes, and is increasingly being connected with stigma.Methods: The purpose of this study is to investigate how cannabis use is associated with potentially stigmatizing markers of identity among adolescents two waves of a repeat cross-sectional survey (2015 N = 12,110; 2017 N = 15,191) of high schools students in seven Canadian provinces. Students were asked about ever use of cannabis, as well as "stigma markers", including their current living arrangement, mother's education, and ethnicity. Multivariable logistic regression models were used to examine associations between cannabis use and stigma markers.Results: After adjusting models for grade, gender, and province of residence, students who did not live with their mothers had higher odds of cannabis use relative to students living with their mothers [OR = 1.94, 95% CI 1.62-2.31]. Low maternal education was also significantly associated with cannabis use, as was ethnicity (students who identified as Indigenous had 3.38 (95% CI 2.29-4.99) times higher odds of using cannabis compared to students who identified as "white" in 2017). Findings related to attending school in a rural (vs. urban) area (2015 OR = 1.33 95% CI 0.99-1.78; 2017 OR = 1.44 95% CI 0.9 to -2.15) and low SES (2015 OR = 0.99, 95% 0.98-1.00; 2017 OR = 1.00, 95% CI 0.98-1.01) were more marginal.Conclusions: Future research should explore cannabis initiation experiences among vulnerable groups to better understand potential stigma triggers. [ABSTRACT FROM AUTHOR]