Canadian Experience Research Articles

Dance for Wellness: Indigenous adolescents’ Perspectives on Mental Health, Wellness, and Dance

ABSTRACT Purpose Indigenous adolescents living on reservations in Canada experience mental health disparities, and there is an urgent need to address this as mental illness and suicide increase. Therefore, a dance program was initiated to attempt to improve mental health and wellness for Indigenous adolescents The reaearch purpose was to gain insight into theexperiences of mental health and wellness in Indigenous adolescents and identify if and how a four-week dance program affected their mental health and wellness. Design A trauma-informed, qualitative, single-case study design was used. Method Semi-structured interviews and symbol-based data were used to interview eight adolescents aged 11 – 16 years living in a Denesuliné community from February to June 2022. Findings Three multidimensional themes emerged: It Helped My Mental Health and Everything (Dance Helps Me Escape, Dance Makes Me Feel Good, and Dance Is Just Really Fun); A Little Bubble Around Me When I Dance (I Can Be More Confident and I Can Be Myself), and We Won’t Judge You Here (Creation of Friendship, He Said I Was Really Good, and Improved School Attendance). Conclusions The dance program impacted the participants’ mental health and wellness by providing positive activities to engage the adolescents. Clinical Evidence Community health nurses (CHNs) assist in promoting health and wellness in Indigenous adolescents living on reservation and can use these findings to advocate for funding for the development of dance-based mental health and wellness programs.

Abstract 4134778: Myocardial Recovery and Survival after Weaning of Left Ventricular Assist Device Therapy in Patients with Toxic and non-Toxic Cardiomyopathy, A Canadian Experience

Left ventricular assist devices (LVAD) are increasingly used in refractory heart failure, mainly as a bridge to transplant or as destination therapy. LVAD unloading of the left ventricle (LV) can also promote myocardial recovery leading to improvement of the LV systolic function, allowing LVAD explantation. However, parameters associated with LVAD weaning and long-term outcomes are not well documented. The aim of this study was to assess the clinical and echocardiographic characteristics of weaned patients and to evaluate their event-free survival post-explantation. We conducted a single-center retrospective study recruiting patients who underwent a second or third generation LVAD implantation at a Canadian cardiology center between November 2009 and October 2021. A total of 98 patients underwent LVAD implantation during this period. All patients were on guideline-directed medical therapy (GDMT). Fourteen patients (14%) had significant LV recovery and were explanted/decommissioned after a median support time of 309 days (range 55-595 days). Toxic cardiomyopathy, defined as abuse of amphetamines (n=2), energy drinks (n=2) or multiple substances (n=6), was the most likely diagnosis in 10 of the weaned patients (71%). The LVEF was significantly higher and the left ventricular end-diastolic diameter (LVEDD) was significantly lower in weaned patients compared to unweaned patients after 3 months of support. Myocardial recovery manifested as pump thrombosis in 4 of the weaned patients (29%). Prior to explantation, 12 patients had a decrease in GDMT doses to minimize post explantation vasoplegia. After explantation, median follow-up time was 40 months (range 8-109 months) and the majority of patients were anticoagulated for 3 months. At last follow up, the LVEF was 44±6% and no patient had a LVEF below 35%. All patients were NYHA I or II and no death, heart transplant, or mechanical support initiation occurred. LVAD therapy can induce LV reverse remodeling leading to myocardial recovery in a significant proportion of patients, especially young patients with toxic and non-ischemic cardiomyopathies. Early reverse remodeling with decreasing LVEDD and improving LVEF at 3 months following implantation is associated with successful weaning. Pump thrombosis seems to be associated with LV reverse remodeling and weaning of mechanical support in certain patients. Weaned patients maintain satisfactory LVEF recovery after explantation and have good long-term event-free survival.

Switching biologics in chronic rhinosinusitis with nasal polyps: A multicenter Canadian experience.

Type 2 biologics have been used increasingly for the treatment of chronic rhinosinusitis with nasal polyps (CRSwNP). However, patterns of biologic switching are understudied, and established guidelines for sequential or simultaneous use do not yet exist. This is a Canadian multicenter retrospective study of real-world patient data. Patients were included if they had recurrent CRSwNP despite maximal medical and surgical management, and received at least one dose of a type 2 biologic. Patients who remained on their initial biologic comprised the continuous group. Patients with sequential or simultaneous use of more than one biologic comprised the switched group. We compared the characteristics of patients who continued and switched biologics. Note that 225 consecutive patients were included. Thirty-six (16%) switched biologics at least once, and six (3%) switched twice. The most common switch was from mepolizumab to dupilumab, with poor control of CRSwNP symptoms being the leading cause for this switch. Lack of efficacy was the main reason for switching off mepolizumab and omalizumab, while adverse events were the leading cause for switching off dupilumab. Additionally, mepolizumab patients were more likely to switch biologics late in their treatment, while dupilumab patients rarely switched after 12 months of therapy (p-value<0.001). Switching biologics for CRSwNP is frequent in Canadian rhinology practices, with 16% of patients switching at least once. The most common switch is from mepolizumab to dupilumab with inadequate CRSwNP control driving this switch. This study may help guide sequential or simultaneous use of biologics in CRSwNP patients.

Research on Strengthening China's Economic Losses from Ship Oil Pollution Based on Compensation Mechanisms

The oil pollution compensation system in China was established late, and the design of the legal system is not perfect, which exposes many problems in the practice of claim settlement. This paper analyzes the present situation and problems of compensation mechanism for oil pollution damage from ships in China, and draws lessons from the legislative experience of Canada and the United States, and puts forward some suggestions for improvement. The specific contents include the legislative status and existing problems of compensation for oil pollution damage from ships in China, the relevant legislative status of representative countries, the comparison of three major international compensation systems, and the legislative choice and specific system suggestions of China. By using the method of literature analysis, this paper systematically analyzes the legislative status, advantages and disadvantages of compensation for oil pollution damage from ships in various countries through the study of relevant legal documents and practical cases at home and abroad. Through comparative study and drawing lessons from international experience, it is suggested that China adopt a dual-track compensation mechanism.

LINCing learners to digital literacy: supporting social integration and English language learning during COVID-19

Abstract Many newcomers to Canada experience significant difficulties adjusting to life in their new community, with few more challenging than learning English. While Canada’s Language Instruction for Newcomers to Canada (LINC) program suggests a pathway to social integration, ideologies pertaining to language and diversity that inform the LINC program can lead to the assimilation and marginalization of immigrant and refugee newcomers. The disruptions that COVID-19 brought to LINC classes exacerbated these issues. Here, we explore these themes in an ethnographic study of one LINC site and suggest that the incorporation of digital technologies could offer a space for a translingual pedagogy to take root. With appropriate guidance, the adoption of a translingual pedagogy could work against the problematic discourses perpetuating within LINC and improve English learning outcomes by providing increased opportunities for digital literacy socialization.

Canadian cross‐border insolvency law and the triumph of “modified universalism”: A retrospective

Abstract“This article examines the implementation of the Model Law on Cross‐Border Insolvency in Canada and the evolution of the concept of “modified universalism”. In particular, the article argues that Canadian courts have developed an expansive view of modified universalism, based upon a liberal and purposive interpretive approach, that prioritizes cooperation and coordination with foreign courts to the greatest possible extent. This expansive view of modified universalism began developing in the jurisprudence long before Canada adopted the Model Law in 2009. Although this evolution was not entirely without controversy, since 2009 the law has continued to develop along the same lines. Thus, the Canadian experience illustrates the important role played by the courts in laying the groundwork for the successful adoption and implementation of the Model Law. This can be contrasted with the more restrictive approaches taken by courts in certain other jurisdictions. At the same time, the article also highlights the conceptual indeterminacy of modified universalism, suggesting that more work is needed to fill gaps and resolve inconsistencies that may hamper the law's further development.

ЭКОСИСТЕМНЫЙ, ЦИФРОВОЙ И ЧЕЛОВЕКОЦЕНТРИЧНЫЙ ПОДХОД НА ГОСУДАРСТВЕННОЙ СЛУЖБЕ: МЕЖДУНАРОДНЫЙ ОПЫТ И ВОЗМОЖНОСТИ ДЛЯ КАЗАХСТАНА

Abstract. The article discusses the importance of new approaches development in the context of public administration modernization in Kazakhstan. The study of the ecosystem, digital and human-centric approach to civil service, which is used in many countries, is becoming increasingly in demand in the modern public administration system. The article analyzes key modern concepts of human resource management in the civil service, which are distinguished by their focus on innovation, involvement and personnel development. The experience of Estonia, Singapore, Great Britain, Finland, Canada, New Zealand and other countries is also considered, which would be useful in developing of new approaches to the formation and development of the civil service of Kazakhstan in modern realities and requirements. Keywords: public service, human resource management, ecosystem, serviceability, customer orientation, digitalization.

“Trying to twist your way out of your skin” — different faces of Chinese Canadian experience in selected poems by Grace Lau

The notions of inclusion, exclusion, and otherness remain at the core of the diasporic experience and an integral part of the history of Chinese diaspora in Canada. In her debut collection The Language We Were Never Taught to Speak (2021), Grace Lau, a Chinese Canadian poet, explores these ideas and their impact on individuals and on the whole Chinese diaspora. Through the analysis of four of Lau’s poems — “When Yuhua Hamasaki Went Home”, “3 a.m. Communion”, “Pedicure at Pinky’s”, and “Escape Artist” — this article discusses how the poet connects experiences of inclusion and exclusion with both historical instances of prejudice and discrimination and their modern counterparts, highlighting the role consumerism plays in those processes.

Canadian Expert Recommendations on Safety Overview and Toxicity Management Strategies for Sacituzumab Govitecan Based on Use in Metastatic Triple-Negative Breast Cancer.

Sacituzumab Govitecan (SG) is an antibody-drug conjugate (ADC) comprised of an anti-Trop-2 IgG1 molecule conjugated to SN-38, the active metabolite of irinotecan, via a pH-sensitive hydrolysable linker. As a result of recent Canadian funding for SG in advanced hormone receptor (HR)-positive breast cancer and triple-negative breast cancer (TNBC), experience with using SG and managing adverse events (AEs) has grown. This review presents a summary of evidence and adverse event recommendations derived from Canadian experience, with SG use in metastatic TNBC for extrapolation and guidance in all indicated settings. SG is dosed at 10 mg/kg on day 1 and day 8 of a 21-day cycle. Compared to treatment of physicians' choice (TPC) the phase III ASCENT and TROPiCS-02 studies demonstrated favorable survival data in unresectable locally advanced or metastatic TNBC and HR-positive HER2 negative metastatic breast cancer, respectively. The most common AEs were neutropenia, diarrhea, nausea, fatigue, alopecia, and anemia. This review outlines AE management recommendations for SG based on clinical trial protocols and Canadian guidelines, incorporating treatment delay, dose reductions, and the use of prophylactic and supportive medications.

Predicting Mental Health Hospitalizations Among First Nations Adults in Residential Treatment

Indigenous peoples in Canada experience disproportionately higher rates of hospitalization for mental health and substance use concerns than non-Indigenous populations. Ambulatory care sensitive conditions are community-level markers of mental illness which can theoretically be managed through community-based health services, and therefore should not require urgent care services. Previous mental health related ambulatory sensitive conditions have included psychotic and mood disorders; however, limited research has explored these relationships of increased hospitalization among specific health disorders with Indigenous populations. This study analyzed predictors of prior mental health hospitalizations among a predominately First Nations population seeking residential treatment for substance use. We hypothesized that increased co-morbid mental health concerns would predict increased hospitalizations for mental health concerns, and this relationship would be moderated by higher Adverse Childhood Experience (ACE) scores. Logistic regression showed that for every increase in each reported mental health concern, the odds of prior hospitalization was 1.6 times higher among this sample, although ACEs did not moderate this relationship. Participants with depressive, anxiety-related, psychotic, and personality-related disorders reported proportionally more hospitalization. Although study results suggest ACEs are not a useful predictor of hospitalization, their presence has previously shown to exacerbate co-morbid concerns, and thus, may influence prior hospitalization history indirectly. Further research can explore relationships between exposure to childhood trauma and hospitalization, particularly in consideration of access to tertiary mental health services.

Religious contestation and Islamophobia among Iranian communities residing in the Greater Toronto area and York region.

Religion is an omnipresent concern for the Iranian community residing in the Greater Toronto Area and York Region (GTA and YR). While the experience of Islamophobia appears to be a unidirectional attitude from the host onto the diasporic community, this research indicates the complexities of Canada's Muslim experience. According to this research, the Iranian Diasporas present an ingroup Islamophobia by expressing anger and hostility toward Iranian Muslim community members. In an attempt to set communal boundaries by restructuring one's ethnic identity, the historical and environmental factors simultaneously influence social interaction between the Iranian Muslim community and other Iranian-Canadians. This paper examines the Iranian religious identity and its relationship with Iranian history, Western Islamophobia, and non-Islamiosity to examine the Iranian Muslims' experience in Canada.

“When I Spoke, I Spoke From the Heart”: Empirical Insights and Therapeutic Lessons From an Indigenous Counseling Center

Indigenous Peoples in Canada experience inequities in behavioral health outcomes stemming from colonial subjugation, including tacit cultural assimilation through health care. Indigenous communities assert that culturally commensurate health interventions improve wellbeing. This study, conducted with clients and staff at a First Nations behavioral health treatment program, sought to identify how respondents conceived of the therapeutic endeavor with respect to possibilities for remedying colonial injuries such as the abuses of the Indian Residential Schools (IRSs). Thematic analysis of 32 interviews revealed that targeted therapeutic goals as well as specific counselor qualities were important for a positive therapeutic experience for those in the program. Ultimately, assimilative practices, such as the IRSs of the past and mainstream behavioral health treatment programs in the present may collectively contribute to the continuation of inequities in health outcomes for Indigenous Canadians. Decolonizing the therapeutic endeavor offers a potential avenue for positive change.

1304P Investigator-initiated study of crizotinib in patients with MET activated advanced stage non-small cell lung cancer: A Canadian experience

1304P Investigator-initiated study of crizotinib in patients with MET activated advanced stage non-small cell lung cancer: A Canadian experience

Efficacy of Rezūm water vapor therapy for the treatment of catheter-dependent urinary retention: A single-center, Canadian experience.

Urinary retention secondary to benign prostatic hyperplasia (BPH) requiring catheterization is a prevalent and morbid condition. The objective of this study was to evaluate the real-world efficacy and safety of Rezūm as the primary treatment of catheter-dependent urinary retention. A single-center, retrospective study analyzed patients with catheter-dependent urinary retention secondary to BPH who were treated with Rezūm between April 2022 and April 2024. Standardized postoperative followup was required for inclusion. Patient demographics, medication use, volume drained at time of urinary retention, catheter-free status, complications, and postoperative International Prostate Symptom Score (IPSS) was collected. A total of 53 patients were included. Mean age was 73.4 years (standard deviation 9.4), and the mean Charlson comorbidity index score was 3.7. The baseline mean prostate volume was 81.7 (range 33-179) mL. Patients were catheter-dependent for an average of 225 (range 30- 1821) days prior to surgical intervention. Average followup time was 10.2 months. Of the 53 patients treated, 42 (79%) patients were able to become catheter-free after treatment. Twenty-six (49%) patients failed their initial trial of void at 14 days postoperatively; 11% (n=6) of patients experienced hematuria with one admitted to hospital due to hematuria/clot retention. There were no Clavien Dindo ≥3 complications. Only retention volume ≥1 L was a significant independent predictor of treatment failure on univariate and multivariate logistic regression analysis. Rezūm effectively treated catheter-dependent urinary retention. Given the simplicity of treatment, accessibility, and minimal anesthetic requirements, providers should consider Rezūm to minimize indwelling catheter-related morbidity for catheter-dependant patients.

Changes in peer belonging, school climate, and the emotional health of immigrant, refugee, and non-immigrant early adolescents.

Early adolescents who are new to Canada experience dual challenges of navigating developmental changes and multiple cultures. This study examined how changes in early adolescents' emotional health from ages 9 to 12 differed by immigration background, and to what extent peer belonging and supportive school climate protected or promoted their emotional health. This study drew upon linked self-report and administrative data. Across 10 school districts in British Columbia, Canada, N = 4479 non-immigrant, immigrant, and refugee adolescents reported on their peer belonging, school climate, and emotional health (life satisfaction, optimism, self-esteem, sadness, worries) in Grades 4 and 7, using the Middle Years Development Instrument. Immigration background including immigration class (economic, family, refugee) and generation status (first, second) were obtained from linked Immigration, Refugees, and Citizenship Canada data. Multi-level modeling assessed the effect of time (grade level), immigration group, and changes in peer belonging and school climate on changes in self-reported emotional health. Analyses were adjusted for gender, English first language, and low family income. Immigrant and refugee adolescents reported worse emotional health in Grade 4 compared to non-immigrants. Non-immigrant and immigrant adolescents reported declines in emotional health from Grades 4 to 7. In contrast, first-generation refugee adolescents reported significant improvements in life satisfaction, and first- and second-generation refugees reported improvements in worries over this period. Perceived improvements in peer belonging and school climate were associated with positive changes in emotional health for all adolescents. Changes in adolescents' emotional health from Grades 4 to 7 differed between immigrants, refugees, and non-immigrants. Immigrants and refugees who enter adolescence with lower emotional health than their non-immigrant peers may particularly benefit from culturally responsive school and community-based interventions.

Campus climate assessment and action: disaggregating the social work experience in Canada

ABSTRACT Climate surveys hold the potential to advance equity in organizations, serving to generate quantitative data on the depth and breadth of climate-related issues, with its forte being those related to belonging, inclusion, and relationships. When administered in a university, it holds the potential to signal the need for improvements, as climate has been associated with engagement, motivation, wellbeing, and retention. The Faculty of Social Work, where an MSW and PhD program are located (Kitchener, Canada), conducted a climate survey in 2020. This article reports on the survey’s content, key findings, action outcomes, and provides recommendations for others considering such an initiative. The survey was a wake-up call for the department, with five concrete outcomes including establishing student caucus groups, a faculty capacity-development initiative to improve teaching, trainings to address microaggressions, improved integration of EDI into hirings, and campaigns to collect identity-based data for faculty and students. We also share two pending initiatives and two derailed initiatives. Recommendations emphasize the importance of disaggregating results to ensure that disparities are identified in the organization.

Групповые иски в Канаде

The article is dedicated to class actions and class litigation in Canada. Initially evolved from legislative sources of England and the USA, class litigation in Canada has received independent and original development. The profound reform in Ontario that took place in July 2020 made significant amendments to Class Proceedings Act, 1992, which reflect the latest achievements in the field of class litigation. The latest changes in this Act are analysed in the article. Moreover, the following questions are raised: certification and authorisation as class proceedings, necessary to confirm the group for class action, its multiplicity, necessary to form the class action, questions of preferability of group procedure (predominance and superiority) and native language in class litigation. Special point of research is question of costs in class litigation, which has peculiar features in Canadian class action law. They consist in refusal to compensate the judicial costs or in compensation by third-party investor company or by the state (state funds). These approaches offer a fresh look at the problem of compensation of judicial costs in class litigation. The experience of Canada can be used in certain boundaries in Russia.

Sacral neuromodulation in pediatric refractory bladder and bowel dysfunction Insights from Canada's first pediatric cohort.

Refractory bladder and bowel dysfunction (BBD) significantly affects the health and quality of life of children and their caregivers, emphasizing the need for effective and minimally invasive treatments. This study aims to present the inaugural Canadian experience using sacral neuromodulation (SNM ) as a therapeutic option for children with refractory BBD. Patients <18 years old with refractory BBD were prospectively followed from 2018 to the present. Preoperative evaluation included spinal MRI and video urodynamics. Two-stage SNM implantation was executed with a minimum two-week stage 1 trial. Functional outcomes and complication rates were measured following validated questionnaires. Six patients completed staged implantation at a median age of 10.8 years (range 8.2-18). The median baseline Dysfunctional Voiding Scoring System (DVSS) score was 12.5 (10-22). At six months of followup, only one patient required adjunct bladder medication. Median DVSS at one-year followup was 5.5 (0-7). Symptomatic resolution was noted in three patients at six months, sustained over one year. Early surgical complications were reported in one (infection) and late complications in three (lead fracture, battery depletion, non-traumatic malfunction), requiring reimplantation at a median of 37.5 (1-49) months. Post-SNM reimplantation, oral medication and rectal therapy decreased, and DVSS scores improved by 30% (0-63.6) at six months. SNM is feasible and offers promising results for refractory pediatric BBD in Canada. The significant improvement of symptoms highlights the treatment's potential, which must be balanced against the high need for revision detected at three years, possibly related to patients' growth and high activity level.

Articulating the Collective Immigrant Experience in Canada: The Boat People and Shut Up, You’re Pretty

ABSTRACT Exploring the ideology behind merit-based immigration policy in Canada, the paper discusses the collective immigrant experience in the works of two contemporary Canadian female authors, Shut up You’re Pretty (2019) by Congo-born Tea Mutonji, and the novel inspired by the refugee crises since the 1970s, The Boat People (2018) by Sharon Bala. The introductory part problematizes the historically discriminatory immigration policies, and explores the position of the immigrant in contemporaneity, in the process of integration through performatives shaped by the counternarratives of multiculturalism. The analysis of the specific characters’ narratives in these works explores the connection between the personal, subjective, and the collective within the groups of immigrants, refugees and born Canadians to whom Canadianness features as an unattainable goal located behind the glass ceiling. In the concluding remarks, the paper summarizes how these contemporary female authors expose the hypocritical, pragmatic and shifting nature of the multicultural narrative.

Early career family physician perspectives on their residency experience and practice choices in Canada: a qualitative study

Background: Though there are more family physicians in Canada than ever before, and residency programs are expanding, gaps in access to comprehensive care remain. This study aimed to describe and understand the role residency training experiences played in shaping practice choices, including the provision of comprehensive community-based care, among early career family physicians. Methods: A secondary analysis of sixty-three (63) qualitative interviews was conducted on data from a larger mixed method study on practice patterns and choices of early career Canadian family physicians. We utilized Braun and Clarke’s six phases of reflexive thematic analysis on portions of transcripts concerning residency training experiences. Results: Participants described positive residency training experiences that shaped practice choice with respect to preceptors and mentorship, experiences of longitudinal care, breadth of exposure, and preparedness for comprehensive clinical practice. Woven through these four domains were “points of tension” and “hidden truths”. Points of tension included: i) the promotion of an idealized professional identity and practice that was difficult to uphold, ii) lack of representation among faculty/preceptors with respect to age and gender, at some sites, and iii) frustration about the lack of opportunities for interprofessional collaborative practices that reflected training experiences. Hidden truths included: i) lack of preparation to run a business, ii) high administrative workload, iii) realities of payment models, and iv) the range of roles available for family physicians beyond the provision of comprehensive care. Conclusions: Findings highlight opportunities for educational reform supporting the transition from residency to practice alongside the importance of addressing systemic factors beyond training which impact physicians’ choices regarding comprehensive care.