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Breast cancer treatment can affect estrogen levels leading to significant bone loss, osteoporosis, and risks for fracture. Although bone care guidelines are published, bone health interventions are often not routinely offered to at-risk individuals. This paper reports on the process of developing and implementing a nurse-led bilingual Breast and Bone Health Program (BBHP) in-person and online at a cancer centre in Montreal, Quebec (www.breastandbonehealth. ca, www.santeseinsetos.ca). The BBHP offers tailored bone health interventions (e.g., risk screening, information, rehabilitation, exercise prescriptions, nutritional counselling, and support for a health-promoting lifestyle). Over a two-year period, women treated for breast cancer (N = 430) took part in the program. Forty percent of surveyed participants (n = 97) initially reported being unaware that some breast cancer treatment could significantly affect bone health. Following the initial informational session with the BBHP nurse, self-reported bone health knowledge significantly increased, with 96% reporting sufficient information to manage their bone health. The BBHP offers both online and in-person risk assessment and bone health promotion activities and tools to both health care professionals and women with breast cancer. Herein, we review the background, BBHP development and implementation as well as preliminary program evaluation. [ABSTRACT FROM AUTHOR]

Background: Chronic conditions such as diabetes and chronic obstructive pulmonary disease (COPD) are common and burdensome diseases primarily managed in primary care. Yet, evidence points to suboptimal quality of care for these conditions in primary care settings. Quality improvement collaboratives (QICs) are organized, multifaceted interventions that can be effective in improving chronic disease care processes and outcomes. In Quebec, Canada, the Institut national d'excellence en santé et en services sociaux (INESSS) has developed a large-scale QIC province-wide program called COMPAS+ that aims to improve the prevention and management of chronic diseases in primary care. This paper describes the protocol for our study, which aims to evaluate implementation and impact of COMPAS+ QICs on the prevention and management of targeted chronic diseases like diabetes and COPD. Methods: This is a mixed-methods, integrated knowledge translation study. The quantitative component involves a controlled interrupted time series involving nine large integrated health centres in the province. Study sites will receive one of two interventions: the multifaceted COMPAS+ intervention (experimental condition) or a feedback only intervention (control condition). For the qualitative component, a multiple case study approach will be used to achieve an in-depth understanding of individual, team, organizational and contextual factors influencing implementation and effectiveness of the COMPAS+ QICs. Discussion: COMPAS+ is a QI program that is unique in Canada due to its integration within the governance of the Quebec healthcare system and its capacity to reach many primary care providers and people living with chronic diseases across the province. We anticipate that this study will address several important gaps in knowledge related to large-scale QIC projects and generate strong and useful evidence (e.g., on leadership, organizational capacity, patient involvement, and implementation) having the potential to influence the design and optimisation of future QICs in Canada and internationally. [ABSTRACT FROM AUTHOR]

To improve inclusion of persons with disabilities (PWD), it is important to create suitable physical and social environments. This can be done by improving awareness about disability, specifically for employees working in the service and cultural sectors. Virtual reality (VR) simulation can be advantageous by providing an engaging experience highlighting physical accessibility issues, as well as social interactions with virtual avatars. This study's objective was to validate the content of two disability awareness VR scenarios in museum employees and individuals with disabilities in terms of perceived usefulness. Five PWD and seven museum employees experienced two VR scenarios illustrating a museum visit for a person with low vision or using a wheelchair. The scenarios consisted of different scenes such as finding an accessible entrance and interacting with virtual employees. Participants were interviewed about their experience, with questions related to the realism of the scenarios and their perceived usefulness. Four main themes were identified specifically: emotions, experience, usefulness, and realism. Our scenarios were seen as useful in describing social and physical barriers experienced by PWD. VR can be a valid tool to promote disability awareness among employees in a sociocultural setting, representing a step towards the inclusion of PWD. [ABSTRACT FROM AUTHOR]

Understanding disability remains a challenge. Although the international community has largely embraced the idea that disability is the product of social and environmental practices, society still lacks good conceptual frameworks. In an era when the rights of persons with disabilities have been enshrined in international and national laws, such frameworks have become a necessity. Within the province of Quebec, Canada, the Disability Creation Process (DCP) model has served such a role. Furthermore, recent efforts to enrich the model enhance the applicability of this powerful tool to a broader range of contexts. As a result, the DCP model could be used more widely than it is today. In this paper we provide the foundations of the approach encapsulated by the model and explain how its usage guides policy development and service delivery within the province of Quebec. We also highlight its forward-looking capacities. [ABSTRACT FROM AUTHOR]

The Virtual Learning Program was developed to provide isolated English-speaking older adults in Quebec access to Cummings Centre programming through live webcasting and videos on demand. The objectives of the program were to: increase social engagement and reduce the risk for mental health issues associated with chronic illness and caregiving; and provide opportunities for lifelong learning including access to health promotion and prevention information in English. This paper presents a practice perspective of the innovative and successful use of digital technology to reach and engage older adults experiencing social isolation. Preliminary results show that the program is simple, provides opportunities for lifelong learning, and has the potential to reduce social isolation. Program challenges and suggestions for therapeutic recreation practice will be discussed. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Community Mental Health is the property of Canadian Periodical for Community Studies 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.)

Purpose - Formal recognition of the human rights of people living with mental health problems has greatly progressed. We must ask ourselves, however, to what extent the formal recognition of these rights has transformed the culture of psychiatric care and improved their quality of life. Gaining Autonomy & Medication Management (GAM) is an approach that strives to empower service users and providers and promotes the exercise of users' rights by transforming their relationship with the central component of psychiatric treatment in community services: psychopharmacology. The purpose of this paper is to show how GAM highlights the issues surrounding the establishment of a culture of rights. Design/methodology/approach - For this analysis qualitative data were collected in Brazil and in Quebec, Canada, through over 100 interviews done with people living with mental health issues and practitioners who participated in the different GAM implementation projects. Findings - Issues, challenges and obstacles facing the instauration of a human rights culture in mental health services are presented. The profound changes that the understanding and exercise of users' rights bring to the lives of individuals are supported by excerpts illustrating recurring issues, situations and common experiences that appear in the various contexts of the two different countries. Research limitations/implications - This is not a parallel study taking place into two countries. The methodologies used were different, and as a consequence the comparative power can be limited. However, the results reveal striking similarities. Originality/value - There is scant research on human rights in mental health services in the community, and the issues surrounding the prescribing and follow-up of pharmacological treatment. The joint analysis of the researches in Brazil and in Canada, identified common challenges which are intertwined with the dominant approach of biomedical psychiatry. [ABSTRACT FROM AUTHOR]

Copyright of International Journal of Integrated Care (IJIC) is the property of Ubiquity 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.)

This article presents a preliminary evaluation of training sessions promoting a systemic approach to violent radicalization (VR) offered to first-line health and education professionals in Quebec. We describe the rationale and content for the training program, its general principles and implementation modalities. The mixed-method evaluation indicated that the participants felt the training increased their level of confidence in dealing with VR in their work. It appeared that training also shifted participants' attitudes significantly on four items with decreases: (1) worry about the extent of VR of young people in Quebec; (2) belief that VR should automatically be reported to the police; (3) thinking that Islam favors VR; and (4) assumption that enhanced security measures would have a deterrent effect on VR. The conclusion discusses the challenges associated with violent radicalization training programs, emphasizing the delicate ethical and political questions related to the provision of training on this socially divisive topic. [ABSTRACT FROM AUTHOR]

BACKGROUND: Workplace interventions are recommended for workers with common mental disorders, but knowledge of their action mechanisms and operationalization remains limited. The Therapeutic Return-to-Work Program, developed for workers with musculoskeletal disorders, is recommended for common mental disorders. OBJECTIVE: Our objective was to adapt this program's logic models to common mental disorders. METHODS: A program logic analysis was conducted using a literature review and a two-phase group consensus method. We submitted a preliminary adapted version of the program's logic models and two questionnaires to health professional experts who participated in two group sessions, ultimately to produce the final version of the models. RESULTS: We consulted 86 publications. The health professional experts (N = 7) had overall mean agreement scores of respectively 4.10/5 and 3.89/5 for questions on the program's theoretical and operational models. The final version of the logic models adapted for common mental disorders included four specific and 15 intermediate objectives, three main components, one optional component, four key processes, and 44 tasks. CONCLUSION: The adapted logic models for the Therapeutic Return-to-Work Program show the relevance of the original objectives and components for common mental disorders. The next step will involve evaluating its feasibility with other stakeholders (insurers, employers, unions, workers). [ABSTRACT FROM AUTHOR]

Background: Little research has focused on implementation of electronic Patient Reported Outcomes (e-PROs) for meaningful use in patient management in 'real-world' oncology practices. Our quality improvement collaborative used multi-faceted implementation strategies including audit and feedback, disease-site champions and practice coaching, core training of clinicians in a person-centered clinical method for use of e-PROs in shared treatment planning and patient activation, ongoing educational outreach and shared collaborative learnings to facilitate integration of e-PROs data in multi-sites in Ontario and Quebec, Canada for personalized management of generic and targeted symptoms of pain, fatigue, and emotional distress (depression, anxiety). Patients and methods: We used a mixed-methods (qualitative and quantitative data) program evaluation design to assess process/implementation outcomes including e-PROs completion rates, acceptability/use from the perspective of patients/clinicians, and patient experience (surveys, qualitative focus groups). We secondarily explored impact on symptom severity, patient activation and healthcare utilization (Ontario sites only) comparing a pre/post population cohort not exposed/exposed to our implementation intervention using Mann Whitney U tests. We hypothesized that the iPEHOC intervention would result in a reduction in symptom severity, healthcare utilization, and higher patient activation. We also identified key implementation strategies that sites perceived as most valuable to uptake and any barriers. Results: Over 6000 patients completed e-PROs, with sites reaching 51%–95% population completion rates depending on initial readiness. e-PROs were acceptable to patients for communicating symptoms (76%) and by clinicians for treatment planning (80%). Patient experience was better than the provincial average. Compared to the pre-population, we observed a significant reduction in levels of anxiety (p = 0.008), higher levels of patient activation (p = 0.045), and reduced hospitalization rates (12.3% not exposed vs 10.1% exposed, p = 0.034). A pre/post population trend towards significance for reduced emergency department visit rates (14.8% not exposed vs 12.8% exposed, p = 0.081) was also noted. Conclusion: This large-scale pragmatic quality improvement project demonstrates the impact of implementation strategies and a collaborative improvement approach on acceptability of using PROs in clinical practice and their potential for reducing anxiety and healthcare utilization; and improving patient experience and patient activation when implemented in 'real-world' multi-site oncology practices. [ABSTRACT FROM AUTHOR]

Background: The PR1MaC study was conducted to evaluate the integration of Chronic Disease Prevention and Management services into primary care practices and was reported effective. The aim of this study was to further explore the effects of the PR1MaC intervention on patients and their family. Methods: We conducted a qualitative study embedded in a randomized controlled trial. The trial was implemented in eight primary health care practices in the Saguenay region, Quebec, Canada. The interdisciplinary patient-centred team-based intervention included self-management support and a motivational approach. We conducted focus groups and semi-directed individual interviews with patients, family members and healthcare professionals. Results: Perceived positive effects can be grouped into six major themes: awareness, improved knowledge, improved motivation and empowerment, adoption of healthy behaviours, improvement of health status and improvement of quality of life. On the negative side, some participants reported lack of sustainability of newly acquired benefits in the months following the intervention. Conclusions: Integrating chronic disease prevention and management services into primary care settings had impacts on patients and their family members. These findings are consistent with findings that were reported in the quantitative study. Further studies should address longterm sustainabilility in terms of benefits for the patients. Trial registration: ClinicalTrials.gov, no.: NCT01319656. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Oncology Nursing Journal is the property of Pappin Communications 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: Kahnawà:ke is a Kanien'kehá:ka (Mohawk) community in Quebec, Canada. In 1997, the community-controlled Kateri Memorial Hospital Centre in partnership with the Kahnawake Education Center, and the Kahnawake Schools Diabetes Prevention Project (KSDPP) developed an elementary school diabetes prevention health education program, aimed to increase knowledge of Type 2 diabetes, healthy eating and active lifestyles. Long-term goals for KSDPP community and school interventions are to decrease obesity and diabetes.Objectives: To evaluate the Kateri Memorial Hospital Centre Health Education Program for Diabetes Prevention (HEP) and use key principles of knowledge translation to promote understanding of results to upgrade HEP content and improve delivery.Methods: A KSDPP community-based participatory research team used mixed methods for evaluation, combining a cross-sectional survey for 23 teachers with interviews of two elementary school principals and three culturally appropriate Indigenous talking circles with HEP authors, teachers and parents. Questionnaire results were presented as descriptive statistics. The thematic textual analysis identified emerging themes from talking circles and interviews.Results: Facilitators of HEP delivery were an acknowledgement of its importance; appreciation of prepared lesson plans for teachers; and KSDPP's strong community presence. Barriers included reduced administrative support and instructional time due to competing academic demands; the need for increased Kanien'kehá:ka cultural content; and outdated resource materials. Recommendations included increasing teacher training, Kanien'kehá:ka cultural content and administrative support.Conclusion: Community researchers undertook detailed knowledge translation activities of facilitators, barriers and recommendations with hospital and education centre administrators and Kahnawà:ke community to maximize uptake of findings before external dissemination of results. [ABSTRACT FROM AUTHOR]

The article discusses issues related to understanding challenges faced by youths in care at the edge of their transition to adulthood. It is noted that transition to adulthood appears to be different and more challenging for youths under state care and in out-of-home care facilities. It is noted that pre-transition to adulthood was studied on the basis of dependent variables including professional activity and housing plan.

The aim of this study was to explore the bidirectional relationship between youth behaviours, more specifically opposition and aggression, and the types of interventions used by staff within a child welfare residential setting. Intervention forms were completed by staff after their interventions with youth. A total of 278 micro-interactions between staff and youth were coded from 84 forms. Generalised estimating equations were conducted controlling for past aggression during the intervention. Reminding youth of rules and using constraining methods were the interventions used with greater frequency when youth were oppositional or aggressive. These two interventions were also found to increase the odds of opposition and aggression among youth. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the association between employees' perceptions of their exposure to an organizational-level occupational health intervention and its psychosocial outcomes. Participants were employees of an insurance firm (N = 1084) in Quebec, Canada. The intervention was designed to reduce adverse psychosocial work factors (high psychological demands, low decision latitude, low social support and low rewards). Departmental managers were responsible for implementing changes to reduce exposure to these factors. Employees' perceptions of exposure to the intervention and its impact on their work were measured in 2007 through questionnaires. Psychological demands, decision latitude, social support and rewards measured in 2005 and 2007 were used to assess outcomes. Employees who perceived that they had been exposed to the intervention changes showed more improvement in outcomes than those who did not perceive changes. The greatest differences in outcomes were found in those participants who perceived that workplace changes had improved their work situation as compared to those who perceived the changes as neutral or negative. The results suggest that measurement of employee-perceived impact of each intervention change on their work situation may be even more important than actual exposure, and should be included in the measurement of exposure to organization-level interventions. [ABSTRACT FROM AUTHOR]

Introduction: In the Province of Quebec, Canada, it is estimated that only about one-third of working-age adults with visual impairments are part of the workforce, despite ongoing efforts of rehabilitation and government agencies to integrate these individuals. The present article describes the development and adaptation of a pre-employment program specifically designed for English-speaking visually impaired persons in Quebec. Methods: Based on a model program introduced at the University of Texas in the United States, and further developed with the Royal National Institute of Blind People in the United Kingdom, the MAB-Mackay Rehabilitation Centre (MMRC) adapted the training materials for its pre-employment program to the local requirements. Its effectiveness was appraised using posttraining employment status as well as responses by participants, using the Canadian National Institute for the Blind (CNIB) Tool to Assess Preparedness for Employment (TAPE) measure of employment readiness. Results: Of the eight participants who completed the four-week program, five had found employment and, of those, four had maintained employment within the eight-month follow-up period (one full-time, three part-time). Further, two of those employed part-time also returned to school part-time. An additional two participants chose to continue their education in order to improve their employability. Scores on the CNIB TAPE subscale of communication showed statistically significant post-training improvement (p = .01) that was maintained after eight months. A statistical trend indicated improvement on the technology subscale following participation in training (p = .10). Discussion: MMRC's pre-employment training program was developed to address the need for a structured employment preparation program that was integrated with the available rehabilitation services for English-speaking visually impaired individuals in a predominantly French-speaking environment. Implications for practitioners: The multidisciplinary nature of this approach facilitated a common language and shared perspective for practitioners across disciplines that are involved in preparing clients for the job market. [ABSTRACT FROM AUTHOR]

Obstacles to assistive device outcome measurement include a lack of consensus about which outcomes should be evaluated. This article reports a case study of the use of a structured consensus-building approach called Technique for Research of Information by Animation of a Group of Experts (TRIAGE) to develop agreement among key professional team members with regard to outcome measurement. We also describe the changes in key professional team members' perspectives on outcome measurement over time. Initially, participants expressed preferences for the measurement of about 33 different outcomes. Subsequent discussions and the TRIAGE process led to the choice of the five most important outcomes. Our case study provides evidence that professional team consensus could successfully be reached through the individual reflections and group sharing proposed by the TRIAGE technique. Future research directions include the development of strategies to give prominence to the opinions of individuals who use augmentative and alternative communication (AAC) in the identification of important outcomes, and for aggregating and interpreting data gathered at local, regional, or national levels. [ABSTRACT FROM AUTHOR]

This study assesses the Urban Breakaway Project, a collaborative project offering a structured vacation in the countryside of the province of Quebec intended for homeless (or street) youths. The objective of this study was to document participants' perspectives regarding this project by examining their satisfaction, intention to change following their stay and perceived improvement with respect to their life situation. Another goal of this research was to investigate the relationship between satisfaction level and perceived improvement of participants. One hundred and seven individuals participated in the study, during Urban Breakaway's first year of operation. Satisfaction with the project, assessed with the global Client Satisfaction Questionnaire-3 score, revealed a positive relationship with global scores of perceived improvement, as measured by the Perceived Improvement Questionnaire [PIQ; r = 0.37 (67), 95% CI (0.15; 0.56)]. Regarding intention to change, the data indicated that 95% of participants had moderate-to-definite intentions to do something to change their lives. Participants reported an improvement for most items covered by the PIQ. They experienced the greatest changes in relation to mood, leisure, appetite, physical condition and self-esteem. Results indicate that the Urban Breakaway Project reaches not only street youths but also an older homeless population. Participants, regardless of their age, were found to be very satisfied with services obtained, and their satisfaction was significantly correlated with the perceived improvement in their situation. Qualitative data indicate that characteristics of the programme, such as the countryside setting, the focus on basic needs, the climate and the opportunity for socialisation, peer support (or belonging) and personal growth were appreciated. [ABSTRACT FROM AUTHOR]

Participants in the ESPACE sexual abuse prevention workshop were in grades 1 through 4 and attended three Montreal, Canada, public schools in low socioeconomic areas. The sample was culturally diverse, with half born outside of Canada. An evaluation was conducted to explore the effects associated with participating in the workshop and the effects of booster sessions conducted two years later. Outcomes included knowledge gained, the ability to offer behavioral responses to abusive situations, peer victimization, sense of safety, empathy, self-efficacy, and support. Results revealed that participants in this sample obtained low scores on measures of sexual abuse knowledge and that short booster sessions that elicit children's recall of the learned material might produce greater improvements. [ABSTRACT FROM PUBLISHER]

Background: Limited studies exist on successful interventions for patients with multimorbidity. Even more limited is the knowledge on how socioeconomic factors have an impact on these interventions. The objective of this study was to analyze the effect of a multidisciplinary self-management intervention among patients with multimorbidity and the impact of socioeconomic factors on the results. Methods: Secondary data analysis limited to multimorbid patients from of a pragmatic randomized trial evaluating an intervention that included patients (18 to 75 yrs.) from eight primary care practices in Quebec, Canada. The intervention included self-management support and patient-centred motivational approaches. Self-management was evaluated using the Health Education Impact Questionnaire (heiQ) which measures eight different domains. Changes in heiQ were analyzed following the three-month intervention with univariate and multivariate logistic regressions. Results: Participants with three or more chronic conditions (n = 281), randomized to intervention or control groups, were included in this analysis. The effect of the intervention on the likelihood of an improvement in self-management was significant in six heiQ domains in the univariate analysis (Odd ratio; 95% CI): Health-directed behaviour (2.03; 1.16–3.55), Emotional well-being (1.97; 1.05–3.68), Self-monitoring and insight (2.35; 1.02–5.40), Constructive attitudes and approaches (2.91; 1.45–5.84), Skill and technique acquisition (1.96; 1.13–3.39), and Health services navigation (2.52; 1.21–5.21). After controlling for age and gender the results remained essentially the same. After additional adjustments for family income, education and self-perceived financial status, the likelihood of an improvement was no longer significant in the domains Emotional well-being and Self-monitoring and insight. Conclusions: The intervention produced significant improvements in multimorbid patients for most domains of self-management. Socioeconomic factors had a minor impact on the results. Trial registration: ClinicalTrials.gov Identifier: NCT01319656 [ABSTRACT FROM AUTHOR]