• Canada
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From 1967 until 2020, [Community] has had 85 million litres of pulp and paper mill effluent dumped every day into an estuary that borders the community. Despite long-term concerns about cancer in the community, a federal government appointed Joint Environmental Health Monitoring Committee, mandated to oversee the health of the community, has never addressed [Community] concerns. In this study we accessed the 2013 Canadian Cancer Registry microfile data, and using the standard geographical classification code, accessed the cancer data for [Community], and provided comparable data for all Nova Scotia First Nations, as well as the county, provincial, and national population level data. We determined that digestive organ cancers, respiratory organ cancers, male genital organ cancers, and urinary tract cancers are higher in [Community] than at all comparable levels. Female breast and genital organ cancers are lowest in [Community] than at all other comparable levels. We note the limitation of this study as not being able to capture cancer data for off-reserve members at the time of diagnosis and the lapse in availability of up-to-date CCR data. This study demonstrates that cancer data can be compiled for First Nation communities using the standard geographic code, and although not a comprehensive count of all diagnoses for the registered members of [Community], it is the first study to provide data for those who lived in [Community] at the time of diagnosis. Moreover, it highlights the lack of capacity (or will) by Joint Environmental Health Monitoring Committee to uphold their fiduciary duty.

Abstract Objective Performance measurement and reporting is proliferating in all sectors of the healthcare system, including primary care, despite a dearth of evidence on how the public uses reports on primary care performance. We explored how the public might use this information, to guide the development of effective reporting systems for primary care. Methods We conducted six full‐day deliberative dialogue sessions with a purposive sample of 56 citizen‐patients across three Canadian provinces (British Columbia, Ontario and Nova Scotia). Participants identified how they would use publicly reported performance data. We conducted a thematic analysis of the data by region. Results Common uses for primary care performance information emerged across all sessions. Participants most often discussed the utility of this information for community advocacy and participation in health system decision making. Similar barriers for using performance information to choose a primary care provider were identified in each region including the perceived lack of choice of providers and the high value placed on relationships with current providers. Finally, the value of public performance reporting in enhancing trust that people would receive good care was also a common theme. Conclusions Citizen‐patient perspectives highlight that public reporting on primary care performance could promote the health system's responsiveness by enabling public engagement in decision making at the community level. The role of public reporting in promoting trust rather than empowering patient choice may reflect unique elements of the Canadian health system's context.

BackgroundIn 2017, a provincial health-system released a Rehabilitation Model of Care (RMoC) to promote patient-centred care, provincial standardisation and data-driven innovation. Eighteen early-adopter community-rehabilitation teams implemented the RMoC using a 1.5-year-long Innovation Learning Collaborative (in-person learning sessions; balanced scorecards). More research is required on developing, implementing and evaluating models of care. We aimed to explore experiences of early-adopter providers and provincial consultants involved in the community-rehabilitation RMoC implementation in Alberta, Canada.MethodsUsing focused ethnography, we used focus groups (or interviews for feasibility/confidentiality) and aggregate, site-level data analysis of RMoC standardised metrics. Purposive sampling ensured representation across geography, service types and patient populations. Team-specific focus groups were onsite and led by a researcher-moderator and cofacilitator. A semistructured question guide promoted discussions on interesting/challenging occurrences; perceptions of RMoC impact and perceptions of successful implementation. Focus groups and interviews were audio-recorded and transcribed alongside field notes. Data collection and analysis were concurrent to saturation. Transcripts coding involves collapsing similar ideas into themes, with intertheme relationships identified. Rigour tactics included negative case analysis, thick description and audit trail.ResultsWe completed 11 focus groups and seven interviews (03/2018 to 01/2019) (n=45). Participants were 89.6% women, mostly Canadian trained and represented diverse rehabilitation professions. The implementation experience involved navigating emotions, operating among dynamics and integrating the RMoC details. Confident, satisfied early-adopter teams demonstrated traits including strong coping strategies; management support and being opportunistic and candid about failure. Teams faced common challenges (eg, emotions of change; delayed data access and lack of efficient, memorable communication across team and site). Implementation success targeted patient, team and system levels.ConclusionsWe recommend training priorities for future teams including evaluation training for novice teams; timelines for stepwise implementation; on-site, in-person time with a facilitator and full-team present and prolonged facilitated introductions between similar teams for long-term mentorship.

AbstractThe international community, comprised of national governments, multilateral agencies and civil society organisations, has recently negotiated a set of 17 sustainable development goals (SDGs) and 169 targets to replace the Millennium Development Goals, which expired in 2015. For progress in implementing the SDGs, ensuring policy coherence for sustainable development will be essential. We conducted a health impact assessment to identify potential incoherences between contemporary regional trade agreements (RTAs) and nutrition and health-related SDGs. Our findings suggest that obligations in RTAs may conflict with several of the SDGs. Areas of policy incoherence include the spread of unhealthy commodities, threats to equitable access to essential health services, medicines and vaccines, and reduced government regulatory flexibility. Scenarios for future incoherence are identified, with recommendations for how these can be avoided or mitigated. While recognising that governments have multiple policy ...

Objectives. China’ s economic reforms have led to millions of citizens being relocated to support infrastructure development, reduce poverty, and address ecological, disaster-related and other concerns. This study expands on previous research on the implications of relocation in China by examining the impact of rural elders’ relocation on the perceived availability of emotional, instrumental, and financial support. Methods. Data were dra wn from the Ankang Study of Aging and Health conducted with a representative sample of 1,062 rural residents aged 60 and over living in Ankang, China. Two-stage probit and least squares regression models assessed the impact of relocation on familial and nonfamilial emotional, instrumental, and financial support. Results. Relocation w as negatively associated with the number of social support resources that older adults perceived as being available. Although this was the case with regard to both familial and nonfamilial support, it was particularly evident with regard to family support and, within families, with regard to instrumental rather than financial or emotional support. Discussion. Relocation has ne gative implications for the number of social support resources perceived to be available by older adults in rural China. China will need to come to terms with how to provide for the instrumental support needs of an aging society.

Abstract Background The literature on the implementation of knowledge products is extensive. However, this literature is still difficult to interpret for policymakers and other stakeholders when faced with choosing implementation strategies likely to bring about successful change in their health systems. This work has the particularity to examine the scope of this literature, and to clarify the effectiveness of implementation strategies for different knowledge products. Consequently, we aim to (1) determine the strengths and weaknesses of existing literature overviews; (2) produce a detailed portrait of the literature on implementation strategies for various knowledge products; and (3) assess the effectiveness of implementation strategies for each knowledge product identified and classify them. Methods We will use a three-phase approach consisting of a critical analysis of existing literature overviews, a systematic review of systematic reviews, and a series of systematic reviews and meta-analyses. We will follow the Cochrane Methodology for each of the three phases. Our eligibility criteria are defined following a PICOS approach: Population, individuals or stakeholders participating in healthcare delivery, specifically, healthcare providers, caregivers, and end users; Intervention, any type of strategy aiming to implement a knowledge product including, but not limited to, a decision support tool, a clinical practice guideline, a policy brief, or a decision-making tool, a one-pager, or a health intervention; Comparison, any comparator will be considered; Outcomes, phases 1 and 2—any outcome related to implementation strategies including, but not limited to, the measures of adherence/fidelity to the use of knowledge products, their acceptability, adoption, appropriateness, feasibility, adaptability, implementation costs, penetration/reach and sustainability; phase 3—any additional outcome related to patients (psychosocial, health behavioral, and clinical outcomes) or healthcare professionals (behavioral and performance outcomes); Setting, primary healthcare has to be covered. We will search MEDLINE (Ovid), EMBASE, Web of Science, PsycINFO, CINAHL, and the Cochrane Library from their inception onwards. For each phase, two reviewers will independently perform the selection of studies, data extraction, and assess their methodological quality. We will analyze extracted data, and perform narrative syntheses, and meta-analyses when possible. Discussion Our results could inform not only the overviews’ methodology but also the development of an online platform for the implementation strategies of knowledge products. This platform could be useful for stakeholders in implementation science. Systematic review registration Protocol registered on Open Science Framework, https://osf.io/eb8w2/.

Commentary on : McDowell, C, Dishman, RK, Gordon, BR, et al . Physical activity and anxiety: a systematic review and meta-analysis of prospective cohort studies. Am J Prev Med 2019;574:545–56. Anxiety is a debilitating1 and costly chronic illness.2 Pharmacological treatment of anxiety disorders and symptoms can be challenging with side effects and expensive for many,3 which makes prevention strategies critical. Physical activity has been previously shown to reduce the symptoms of anxiety and depression.4 Whether physical activity may be effective in preventing anxiety has not yet been previously investigated, presenting a knowledge gap and …

Objectif : les meilleures pratiques sur le trouble développemental de la coordination (TDC) incluent le développement de la capacité des enseignants à favoriser la participation des enfants aux activités physiques. L’objectif de l’étude est d’évaluer l’impact d’une formation d’une journée, incluant des exposés et des ateliers sur le TDC, sur les perceptions des connaissances, des compétences et des pratiques pédagogiques d’enseignants en éducation physique (EÉP). Méthodologie : étude de cohorte avec devis mixte pré-post-suivi incluant des questionnaires avant, immédiatement après et trois mois après la formation. Des analyses descriptives, des tests de Wilcoxon et une analyse thématique ont été réalisés. Résultats : trente-huit, trente-cinq et vingt-deux EÉP ont rempli respectivement les questionnaires au trois temps de mesure. Les perceptions des connaissances, compétences et pratiques pédagogiques des EÉP étaient plus élevées après la formation comparativement aux perceptions initiales ( p < 0,006). Initialement, les EÉP rapportaient utiliser certaines stratégies pédagogiques générales (p. ex., modifications de la tâche). À la suite de la formation, les EÉP ont fourni des exemples plus concrets et ont rapporté utiliser de nouvelles stratégies (p. ex., offrir de la rétroaction à la suite de la tâche) qui semblent avoir diminué les problèmes comportementaux. Conclusion : une formation peut favorablement modifier les perceptions d’EÉP sur leurs connaissances, compétences et pratiques. Plus de recherches sont nécessaires afin d’évaluer les retombées sur la participation des enfants ayant un TDC.

Mobile phones are increasingly being used to support health activities, including the care and management of people living with HIV/AIDS. Short message service (SMS), in particular, has been explored as a means to optimize and support behaviour change. However, there is minimal guidance on messaging content development. The purpose of this review was to help inform the content of SMS messages for mobile health (mHealth) initiatives designed to support anti-retroviral therapy (ART) adherence and clinic appointment keeping in resource-limited settings. PubMed, OvidMedline, Google Scholar, K4Health’s mHealth Evidence database, the mHealth Working Group project resource, and Health COMpass were searched. A request to online communities for recommendations on message content was also made. 1010 unique sources were identified, of which 51 were included in this review. The information was organized into three categories: pre-message development, message development, and security and privacy. Fifteen of the publications explicitly provided their message content. Important lessons when developing the content of SMS were: 1) conducting formative research; 2) grounding content in behaviour change theory; and 3) reviewing proposed content with experts. Best practices exist for developing message content for behaviour change. Efforts should be continued to apply lessons learned from the existing literature to inform mHealth initiatives supporting HIV/AIDS care and treatment.

Despite a growing interest in polyamory, it is unknown how many polyamorists there are in the general population. In acknowledging that the meaning of “polyamory” is contested (e.g. Klesse, 2014), we estimated the prevalence of polyamory when it was defined as: (1) an identity, (2) relationship beliefs/preferences, (3) relationship status, and (4) relationship agreements. We recruited 972 individuals from Mechanical Turk and used a sample weighting procedure to approximate a representative sample of the population of the USA. Point prevalence estimates ranged from about 0.6% to 5%, and lifetime estimates ranged from about 2% to 23%. Thus, we estimate that there are at least 1.44 million adults in the USA who count as polyamorous.