Search

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]

Since the onset of the COVID-19 pandemic, community-dwelling people living with dementia and their family caregivers have experienced many challenges. The unanticipated consequences of public health measures have impacted these families in a myriad of ways. In this interpretive policy analysis, which used a longitudinal, qualitative methodology, we purposively recruited 12 families in British Columbia, Canada, to explore the impacts of pandemic public health measures over time. Semi-structured interviews were conducted every 3 months and participants completed diary entries. Twenty-eight interviews and 34 diary entries were thematically analyzed. The findings explore ways that families adopted and adapted to public health measures, loss of supports, both formal and informal, and the subsequent consequences for their mental and physical well-being. Within the ongoing context of the pandemic, as well as potential future wide-spread emergencies, it is imperative that programs and supports are restarted and maintained to avoid further harm to these families. [ABSTRACT FROM AUTHOR]

Objectives: Métis, with a population of close to 390,000 people, are a culturally distinct and constitutionally recognized Aboriginal group in Canada that suffers from poorer overall health than non-Aboriginal Canadians. One important predictor of good health is physical activity. Guided by frameworks based on social and Aboriginal-specific determinants, we investigated the correlates of leisure-time physical activity (LTPA) and active transportation (walking) among adult Métis, with a particular focus on how culturally specific variables were associated with these two types of activity. We also examined how demographic, geographic, socioeconomic and health-related factors were associated with physical activity. Design: We used data from Statistics Canada’s 2006 Aboriginal Peoples Survey and Métis Supplement to analyze the correlates of physical activity among Métis aged 20-64, using a series of logistic regression models. Results: Having attended a Métis cultural event in the past year was positively associated with LTPA, as was a high level of spirituality. Similarly, those who had attended a cultural event in the last year were more likely to report a high level of active transportation. Speaking an Aboriginal language and being a member of a Métis organization were not independently associated with the two types of physical activity. Self-perceived health, being male and household income were other correlates positively associated with LTPA, whereas age, body mass index and smoking were negatively associated with this type of activity. Active transportation was positively associated with self-perceived health and being female, while negatively associated with age and body mass index. Conclusions: The results of this study suggest that interventions aimed at increasing physical activity among adult Métis might be more successful if they are connected to cultural activities and spirituality. This research also suggests that demographic, socioeconomic and health-related factors are important considerations when designing initiatives to increase physical activity among adult Métis. [ABSTRACT FROM AUTHOR]

Background: Brain imaging is of limited diagnostic use in psychiatry owing to clinical heterogeneity and low sensitivity/specificity of between-group neuroimaging differences. Machine learning (ML) may better translate neuroimaging to the level of individual participants. Studying unaffected offspring of parents with bipolar disorders (BD) decreases clinical heterogeneity and thus increases sensitivity for detection of biomarkers. The present study used ML to identify individuals at genetic high risk (HR) for BD based on brain structure. Methods: We studied unaffected and affected relatives of BD probands recruited from 2 sites (Halifax, Canada, and Prague, Czech Republic). Each participant was individually matched by age and sex to controls without personal or family history of psychiatric disorders. We applied support vector machines (SVM) and Gaussian process classifiers (GPC) to structural MRI. Results: We included 45 unaffected and 36 affected relatives of BD probands matched by age and sex on an individual basis to healthy controls. The SVM of white matter distinguished unaffected HR from control participants (accuracy = 68.9%, p = 0.001), with similar accuracy for the GPC (65.6%, p = 0.002) or when analyzing data from each site separately. Differentiation of the more clinically heterogeneous affected familiar group from healthy controls was less accurate (accuracy = 59.7%, p = 0.05). Machine learning applied to grey matter did not distinguish either the unaffected HR or affected familial groups from controls. The regions that most contributed to between-group discrimination included white matter of the inferior/middle frontal gyrus, inferior/middle temporal gyrus and precuneus. Limitations: Although we recruited 126 participants, ML benefits from even larger samples. Conclusions: Machine learning applied to white but not grey matter distinguished unaffected participants at high and low genetic risk for BD based on regions previously implicated in the pathophysiology of BD. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of this study was to examine the correlates of current smoking among off-reserve First Nations and Métis adults, two Aboriginal Canadian groups that are at higher risk to smoke and more likely to suffer from chronic health conditions relative to their non-Aboriginal counterparts. A particular focus was on culturally specific factors and their associations with current smoking.Methods: We used data from Statistics Canada's, 2012 Aboriginal Peoples Survey to investigate the correlates of smoking among 12,720 First Nations and Métis adults. Sequential binary logistic regression models were estimated to examine associations between smoking and culturally specific, demographic, geographic, socioeconomic and health-related variables.Results: Overall, 39.4% were current smokers. Multivariate results found that those who had hunted, fished or trapped within the last year were more likely to be smokers. In addition, respondents who were exposed to an Aboriginal language at home or outside the home were more likely to be smokers. Current smoking was significantly associated with being aged 35 to 49 years, living in a small population center, low income, low education, unemployment, being unmarried, low ratings of self-perceived health, heavy drinking and low body mass index. Respondents aged 65 years and older and those living in British Columbia were less likely to smoke.Discussion: The results of this study suggest that it may be useful to consider cultural characteristics, particularly language in efforts to reduce the prevalence of manufactured tobacco use among First Nations and Métis adults. Interventions should also consider demographic, geographic and socioeconomic variables, in addition to co-occurring health-risk behaviors. [ABSTRACT FROM AUTHOR]

Abstract: This study describes the minimum incidence of pediatric complex regional pain syndrome (CRPS), clinical features, and treatments recommended by pediatricians and pain clinics in Canada. Participants in the Canadian Paediatric Surveillance Program reported new cases of CRPS aged 2 to 18 years monthly and completed a detailed case reporting questionnaire from September 2017 to August 2019. Descriptive analysis was completed, and the annual incidence of CRPS by sex and age groupings was estimated. A total of 198 cases were reported to the Canadian Paediatric Surveillance Program, and 168 (84.8%) met the case definition. The minimum Canadian incidence of CRPS is estimated at 1.14/100,000 (95% confidence interval 0.93-1.35/100,000) children per year. Incidence was highest among girls 12 years and older (3.10, 95% confidence interval 2.76-3.44/100,000). The mean age of CRPS diagnosis was 12.2 years (SD = 2.4), with the mean time from symptom onset to diagnosis of 5.6 months (SD = 9.9) and no known inciting event for 19.6% of cases. Most cases had lower limb involvement (79.8%). Nonsteroidal anti-inflammatory drugs (82.7%) and acetaminophen (66.0%) were prescribed more commonly than antiepileptic drugs (52.3%) and antidepressants (32.0%). Referrals most commonly included physical therapy (83.3%) and multidisciplinary pain clinics (72.6%); a small number of patients withdrew from treatment because of pain exacerbation (5.3%). Pain education was recommended for only 65.6% of cases. Treatment variability highlights the need for empiric data to support treatment of pediatric CRPS and development of treatment consensus guidelines. [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]

Context Checklists are commonly used in the assessment of procedural competence. However, on most checklists, high scores are often unable to rule out incompetence as the commission of a few serious procedural errors typically results in only a minimal reduction in performance score. We hypothesised that checklists constructed based on procedural errors may be better at identifying incompetence. Objectives This study sought to compare the efficacy of an error-focused checklist and a conventionally constructed checklist in identifying procedural incompetence. Methods We constructed a 15-item error-focused checklist for lumbar puncture ( LP) based on input from 13 experts in four Canadian academic centres, using a modified Delphi approach, over three rounds of survey. Ratings of 18 video-recorded performances of LP on simulators using the error-focused tool were compared with ratings obtained using a published conventional 21-item checklist. Competence/incompetence decisions were based on global assessment. Diagnostic accuracy was estimated using the area under the curve ( AUC) in receiver operating characteristic analyses. Results The accuracy of the conventional checklist in identifying incompetence was low ( AUC 0.11, 95% confidence interval [ CI] 0.00-0.28) in comparison with that of the error-focused checklist ( AUC 0.85, 95% CI 0.67-1.00). The internal consistency of the error-focused checklist was lower than that of the conventional checklist (α = 0.35 and α = 0.79, respectively). The inter-rater reliability of both tools was high (conventional checklist: intraclass correlation coefficient [ ICC] 0.99, 95% CI 0.98-1.00; error-focused checklist: ICC 0.92, 95% CI 0.68-0.98). Conclusions Despite higher internal consistency and inter-rater reliability, the conventional checklist was less accurate at identifying procedural incompetence. For assessments in which it is important to identify procedural incompetence, we recommend the use of an error-focused checklist. [ABSTRACT FROM AUTHOR]

Background: Performance reporting in primary health care in Canada is challenging because of the dearth of concise and synthesized information. The paucity of information occurs, in part, because the majority of primary health care in Canada is delivered through a multitude of privately owned small businesses with no mechanism or incentives to provide information about their performance. The purpose of this paper is to report the methods used to recruit family physicians and their patients across 10 provinces to provide self-reported information about primary care and how this information could be used in recruitment and data collection for future large scale pan-Canadian and other cross-country studies. Methods: Canada participated in an international large scale study-the QUALICO-PC (Quality and Costs of Primary Care) study. A set of four surveys, designed to collect in-depth information regarding primary care activities was collected from: practices, providers, and patients (experiences and values). Invitations (telephone, electronic or mailed) were sent to family physicians. Eligible participants were sent a package of surveys. Provincial teams kept records on the number of: invitation emails/letters sent, physicians who registered, practices that were sent surveys, and practices returning completed surveys. Response and cooperation rates were calculated. Results: Invitations to participate were sent to approximately 23,000 family physicians across Canada. A total of 792 physicians and 8,332 patients from 772 primary care practices completed the surveys, including 1,160 participants completing a Patient Values survey and 7,172 participants completing a Patient Experience survey. Overall, the response rate was very low ranging from 2% (British Columbia) to 21% (Nova Scotia). However, the participation rate was high, ranging from 72% (Ontario) to 100% (New Brunswick/Prince Edward Island and Newfoundland & Labrador). Conclusions: The difficulties obtaining acceptable response rates by family physicians for survey participation is a universal challenge. This response rate for the QUALICO-PC arm in Canada was similar to rates found in other countries such as Australia and New Zealand. Even though most family physicians operate as self-employed small businesses, they could be supported to routinely submit data through a collective effort and provincial mandate. The groundwork in setting up pan-Canadian collaboration in primary care has been established through this study. [ABSTRACT FROM AUTHOR]

Background: The quality of medical student and resident clinical evaluation reports submitted by rotation supervisors is a concern. The effectiveness of faculty development (FD) interventions in changing report quality is uncertain. Aims: This study assessed whether faculty could be trained to complete higher quality reports. Method: A 3-h interactive program designed to improve evaluation report quality, previously developed and tested locally, was offered at three different Canadian medical schools. To assess for a change in report quality, three reports completed by each supervisor prior to the workshop and all reports completed for 6 months following the workshop were evaluated by three blinded, independent raters using the Completed Clinical Evaluation Report Rating (CCERR): a validated scale that assesses report quality. Results: A total of 22 supervisors from multiple specialties participated. The mean CCERR score for reports completed after the workshop was significantly higher (21.74 ± 4.91 versus 18.90 ± 5.00, p = 0.02). Conclusions: This study demonstrates that this FD workshop had a positive impact upon the quality of the participants' evaluation reports suggesting that faculty have the potential to be trained with regards to trainee assessment. This adds to the literature which suggests that FD is an important component in improving assessment quality. [ABSTRACT FROM AUTHOR]

Traditional funding programs for fisheries, aquaculture, and aquatic research provide short-term support for an individual or small research team to test a specific hypothesis, often having only limited spatial applicability. To tackle more complex issues existing at larger spatial scales (national or continental), other approaches are necessary. In Canada, the Natural Sciences and Engineering Research Council has developed the Strategic Network Grants (SNGs) program that enables multi-institutional teams of academics (typically 10 to 20 co-principal investigators) to work with industry and government partners on large-scale, multidisciplinary research projects in targeted research areas. The network model is intended to create unique training opportunities and enable researchers to study problems at spatial and temporal scales that could not be addressed with traditional funding. Currently, six of the 30-plus SNGs in Canada are focused on fisheries, aquaculture, and aquatic sciences issues, namely, impacts of hydropower on fish and fish habitat, capture fisheries, integrated multitrophic aquaculture, healthy oceans, and the spatial ecology of aquatic vertebrates in coastal waters. Here we introduce five case studies that will examine the motivation, scientific research objectives, and operation of networks in detail. In addition, we explore the perceived benefits and challenges with the research network-funding model with specific reference to the advancement of large-scale studies in fisheries, aquaculture, and aquatic sciences. [ABSTRACT FROM PUBLISHER]

Few cross-cultural studies have assessed psychopathy and none have included a sample from non-western countries. This study investigated the factor structure of the Psychopathy Checklist: Screening Version (PCL:SV) in an Iranian sample, and compared the results with a western sample. Three hundred fifty-one Iranian prisoners were compared with 405 participants of the standardization sample of the PCL:SV. Confirmatory factor analysis and item response theory method were used for data analysis. The Iranian data fitted well with the hierarchical three-factor model of psychopathy and neither two- nor four-factor models showed an adequate fit. Differential item functioning existed across samples, with discriminatory power of factor 1 (arrogant and deceitful interpersonal style) being lower in the Iranian sample that for factor 2 (deficient emotional experience) being greater in the Iranian sample than the standardization sample. Deficient emotional experience might be the most significant factor in diagnosing psychopathy, regardless of the studied culture. Other factors appear to be relatively culture-specific. [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]