Canadian Experience Research Articles

The barriers to healthcare access and their impact on health outcomes for people medically uninsured in Canada: A scoping review

Objective: The objective of the scoping review was to summarize the current literature on the barriers to healthcare access and its impact on health outcomes for people who are medically uninsured (including those with precarious or no immigration status) in Canada; identify gaps in the existing knowledge; and highlight implications for practice and policy. Methods: We undertook a systematic search in the electronic databases of PsycInfo, MEDLINE (Ovid), CINAHL, ProQuest Nursing and Allied Health, Web of Science and ProQuest Dissertations and Theses Global. Inclusion criteria consisted of articles published in English reporting information about barriers to healthcare access or its impact on health among people with precarious immigration status in Canada. Relevant themes emerging from the included studies were reviewed by the research team and organized into three levels of barriers to accessing healthcare. Results: Ten articles were included in this scoping review. Our review found that individuals living with precarious or no immigration status and being denied public health insurance experienced significant obstructions to accessing healthcare services, the result of policy, interpersonal and intrapersonal-level barriers. These barriers include ineligibility for provincial or federal healthcare insurance, negative interactions with healthcare providers, fear of interacting with public services and lack of sufficient income to pay for out-of-pocket healthcare expenses. This resulted in unmet healthcare needs, negative and worsening health outcomes, avoidance of formal healthcare institutions and reliance on emergency care services caused by delays in help-seeking. Conclusions: People who are medically uninsured in Canada experience avoidable negative health outcomes, including higher risk of death because of barriers to access to healthcare. Provincial healthcare insurance should be available for these vulnerable groups to avoid unnecessary health problems and complications and to reduce the burden on the healthcare system. New (im)migrants should receive education on their right to receive health services, and healthcare providers must receive training on how to best support the health and wellbeing of this population.

Investing in Saving Lives: Designing Second-Stage Women’s Shelters on First Nation Reserves

Most Indigenous women in Canada (61%) experience intimate partner violence (IPV), which is significantly worse than the high rate of 44 percent for other women in Canada. Despite the great risk for IPV, only three unfunded second-stage shelters for more than 600 First Nation reserves exist in Canada to provide First Nation women and their children a safe home. Second-stage housing offers IPV survivors transitional homes for an extended period that provide safety and renewal after their initial emergency shelter stays. This article documents the need for safe, nurturing, and culturally appropriate second-stage shelters for Indigenous women and their families to heal and rebuild. The authors provide two second-stage prototype designs based on domestic environmental analysis and concepts of houselessness, home, and co-housing. We discuss how these designs are one step in an action plan to protect Indigenous women and stop the genocide of Indigenous Peoples by supporting cultural, economic, health, and social development. The literature review and design concepts form an agenda to have design goals for housing IPV survivors that answers the “Calls to Justice for Murdered and Missing Women” and expands this needed service to every reserve.

Development of a ParticipACTION App–Based Intervention for Improving Postsecondary Students’ 24-Hour Movement Guideline Behaviors: Protocol for the Application of Intervention Mapping

The Canadian 24-Hour Movement Guidelines for adults provide specific recommendations for levels of physical activity, sedentary behavior, and sleep (ie, the movement behaviors) required for optimal health. Performance of the movement behaviors is associated with improved mental well-being. However, most postsecondary students do not meet the movement behavior recommendations within the Canadian 24-Hour Movement Guidelines and experience increased stress and declining well-being, suggesting the need for an intervention targeting students' movement behaviors. We aimed to develop and implement a theory-informed intervention intended to improve the movement behaviors and mental well-being of first-year postsecondary students. The Intervention Mapping protocol was applied in the development and implementation of the intervention. Intervention Mapping entailed performing a needs assessment, determining the intervention outcomes, selecting theory- and evidence-based change methods and applications, preparing and producing intervention plans and materials, developing the implementation plan, and finally developing an evaluation plan. The Theoretical Domains Framework and the Behavior Change Wheel were also used in conjunction with the Intervention Mapping protocol to ensure a solid theoretical basis for the intervention. This protocol led to the development and implementation of a 6-week, theory-informed ParticipACTION app-based intervention aimed at helping first-year postsecondary students improve their movement behaviors and mental well-being. The developed app content provided students with information on each of the movement behaviors and behavioral strategies (ie, goal setting, action planning, monitoring, and coping planning). The use of Intervention Mapping allowed for the continuous involvement of various multidisciplinary partners and end users, ensuring that the intervention design and implementation was appropriate for the target audience. The feasibility, acceptability, and potential impact of the intervention will be examined in a subsequent proof-of-concept study at 2 Canadian university campuses. Participant recruitment occurred during September 2021, and the intervention was conducted from October to December 2021. The deadline for completion of the postintervention questionnaire by participants was mid-December 2021. The analysis of data examining the feasibility, acceptability, and potential impact of the intervention began in January 2022, with the publication of the proof-of-concept evaluation expected in 2023. Intervention Mapping with the Theoretical Domains Framework and Behavior Change Wheel was a useful approach to combine evidence and theoretical concepts to guide the design and implementation of a ParticipACTION app-based intervention targeting postsecondary students' movement behaviors and mental well-being. This process may serve as an example for other researchers developing multiple behavior change app-based interventions. Should the forthcoming evaluation demonstrate the intervention's acceptability, feasibility, and potential impact, the intervention may provide a scalable method of improving postsecondary students' movement behaviors and mental well-being. RR1-10.2196/39977.

Politics and intelligence analysis: the Canadian experience

ABSTRACT Academic debate on the interplay between politics and intelligence is dominated by the U.S. experience. Our research, based on interviews with over sixty individuals in the Canadian intelligence and national security community and including political staffers, provides a new case study: that of Canada, a middle power with considerable access to intelligence through the Five Eyes partnership. We found that cases of hard politicization of intelligence analysis are virtually non-existent in Canada. The most important factor explaining this finding is Canada’s structural position in the world, or how its geography shapes the broader context of interactions between intelligence and politics. Beyond this, six more specific factors at the domestic level also matter: the relative unimportance of foreign and security policy as political issues, few opportunities, a lack of political benefits, low intelligence literacy generally among policy makers, poor transparency in national security decision making, and a tradition of non-partisanship in the civil service. The paper concludes by reflecting on this assessment: while hard politicization remains a rarity in Canada, the shields that have prevented the emergence of politicization will likely be increasingly tested in the future.

The myth of wartime prosperity: Evidence from the Canadian experience

This paper investigates therelationship between prosperity and national account data during wartime, focusing on Canada. In particular, we build off of existing literature arguing that military outlays must be excluded for real output measures to reasonably approximate economic prosperity. We analyse all non‐war components of Canadian gross national product during both world wars and estimate a novel price deflator for World War II in order to take into account wartime price controls. This allows us to obtain a new estimate of real output in Canada excluding military outlays. We then compare the trends in our new real output series with domestic private investment and stock market trends, all three of which either fell or grew at an anemic pace in Canada during both world wars. Combined, we argue that this provides evidence against the idea of wartime prosperity and more specifically, against the notion of World War II ending the Great Depression in Canada.

Retrograde cricopharyngeus dysfunction: A Canadian experience fueled by social media.

Retrograde cricopharyngeus dysfunction: A Canadian experience fueled by social media.

The impact of cannabis legalization for recreational purposes: The Canadian experience

AbstractCannabis Legalization for Recreational Purposes took place in Canada in October 2018. One of the federal government’s stated goals with this legalization was to protect Canadian youth from cannabis-related harms. The Canadian model differs from other jurisdictions that legalized recreational cannabis use, especially with regard to a higher degree of government regulation of the cannabis market. Another difference is the development and endorsement of lower-risk cannabis use guidelines to educate the public and health professionals. Here, we will present the changes in the regulation of the Canadian cannabis market. We will also present some changes in the epidemiology and parameters of cannabis use (modes of use, potency of cannabis) among adults and youths. Although it is clear that prevalence of use has increased in some groups (notably older adults), results for youth are mixed, with the majority of studies showing no pronounced increase. A trend of a decrease in youth cannabis use seen pre-legalization may have reversed. Data about changes in the age of initiation, the influence of legalization on sex and gender, and race/ ethnicity are limited, with evidence suggesting that the age of initiation slightly increased and the prevalence of use has become more similar between females and males. The development and utility of the lower-risk cannabis use guidelines will be also presented.Disclosure of InterestB. Le Foll Grant / Research support from: . Dr. Le Foll has in-kind donations of cannabis products from Aurora Cannabis Enterprises Inc. . Dr. Le Foll has obtained industry funding from Canopy Growth Corporation (through research grants handled by the Centre for Addiction and Mental Health and the University of Toronto)

In Search for Common Ground: Canadian Studies in Contemporary Russia

This article offers a survey of the Russian scholarly literature devoted to Canada over the last twenty years. It is based on a bibliography, comprising nearly 2000 entries, which includes the works of scholars who have published in the leading Russian academic journals devoted (at least in part) to Canada. We conclude that Canada remains a significant topic of study in Russia; scholars do not limit themselves to the relationship between the two countries; they are equally interested in elements of the Canadian experience (the history of colonization, federalism, language contact, multiculturalism, among others) that have particular relevance for contemporary Russia. Despite significant geopolitical differences between the two countries, members of the Russian Canadian studies community continue to look to Canada as, at least in certain respects, a model for their own society. This article illustrates, therefore, not only the way in which Canada is perceived abroad but also the ideological pluralism that existed in Russia, at least until 2022.

Annual Meeting Panel to Examine the Evolution of Physician Aid in Dying

Back to table of contents Previous article Next article Annual MeetingFull AccessAnnual Meeting Panel to Examine the Evolution of Physician Aid in DyingMark MoranMark MoranSearch for more papers by this authorPublished Online:26 Feb 2023https://doi.org/10.1176/appi.pn.2023.03.3.26AbstractPanel members will discuss the challenge of defining standards for “irremediability” in psychiatric disorders and will discuss the impact of expanding laws regarding physician-assisted dying on marginalized populations suffering from life distress.Physician Aid in Dying (PAD), also known as Medical Aid in Dying (MAiD) has been legalized or decriminalized in over a dozen jurisdictions around the world, and assisted dying policies continue to evolve, including in the United States. Many jurisdictions are exploring whether to introduce PAD laws or expand existing law to include PAD based on a mental disorder.“The psychiatrist helping patients to consider this unique and permanent request has a responsibility to assess for potentially treatable contributing conditions, including demoralization,” says John Peteet, M.D.This year’s Annual Meeting in San Francisco will feature a panel discussion titled “Physician-Assisted Death and Psychiatric Disorders.” PAD for mental disorders has been permitted for two decades in the Netherlands and Belgium, and 2023 marks the legalization of the practice in Canada (to be introduced as of March 2023).John Peteet, M.D., will explore how capacity for PAD may differ from capacity to refuse treatment. He is an associate professor of psychiatry at Harvard Medical School and director of the psychosocial oncology and palliative care fellowship at the Dana-Farber Cancer Institute.“I plan to focus on the role of the psychiatrist in evaluating patients for capacity to request MAiD, which is a role we play in several U.S. jurisdictions now,” he told Psychiatric News. “I’ll be suggesting that rather than a straightforward assessment of depression and the intellectual understanding of what is involved, the psychiatrist as a physician helping patients to consider this unique and permanent request has a responsibility to assess for potentially treatable contributing conditions, including demoralization.”Case examples will illustrate that at stake is not only the patient’s cognitive capacity and DSM diagnosis, but also the patient’s emotional capacity and the professional and clinical responsibility of the doctor to the patient.K. Sonu Gaind, M.D., a professor of psychiatry at the University of Toronto and past president of the Canadian Psychiatric Association, will review the Canadian experience, as Canada moves toward providing MAiD for patients with psychiatric disorders. Gaind is on the Council of Canadian Academies Expert Panel reviewing PAD for mental disorders.Marie Nicolini, M.D., Ph.D., psychiatrist and researcher at the Belgian Research Foundation Flanders and Georgetown University, will discuss the history of PAD for patients with psychiatric disorders in the Netherlands and Belgium.Panel members will discuss the challenge of defining adequate standards for “irremediability” in psychiatric disorders and patient requests for PAD and discuss the potential impact of expanding PAD laws on marginalized populations suffering from life distress. ■ ISSUES NewArchived

University Competency-based Courses for Internationally Educated Nurses (IENs) in Ontario: A Pilot Education Pathway to Registered Nurse (RN) Licensure

In 2014, a team of nurse educators and champions of internationally educated nurses (IENs) in Ontario, Canada, came together to address the issue of supporting IEN transition to practice as one route to help address nursing shortages. Courses were developed with funding from the Government of Ontario, and policy and coordination support from the Council of Ontario Universities, to pilot an educational bridging pathway for IENs. The faculty team across four Ontario universities used a consortium approach to coalesce province-wide expertise in IEN education. What began as a selection of targeted, competency-based courses has since evolved into a full Competency-Bridging Program of Study for Internationally Educated Nurses in Ontario, aligned with other IEN bridging program offerings across the province. This paper describes the initial process of the group, from 2015 to 2018, to create foundational learning and competency-based courses to meet targeted entry-to-practice (ETP) competencies for Registered Nurse (RN) registration with the College of Nurses of Ontario (CNO). The barriers to IENs in meeting ETP requirements and how the gap in the existing Ontario IEN bridging to a Bachelor of Science in Nursing (BScN) education to meet regulatory requirements are also addressed. This article explores how Ontario may respond to the increasing nursing shortages and the need to engage ethically and retain IENs in practice. Lessons learned from competency-course development add to the growing body of knowledge about IEN program experiences in Canada to enable more IENs to enter the Ontario nursing workforce.

First-in-human experience using the LithoVue™ Elite Single Use Ureteroscope to measure intrarenal pressure: The Canadian experience

First-in-human experience using the LithoVue™ Elite Single Use Ureteroscope to measure intrarenal pressure: The Canadian experience

A canadian retrospective multicenter experience with selexipag in a heterogeneous group of pediatric pulmonary hypertension patients

Abstract Funding Acknowledgements Type of funding sources: None. Background The introduction of the oral prostanoid selexipag for treating severe adult pulmonary arterial hypertension (PH) has contributed to reduced rates of death and secondary complications in PAH. Pediatric physicians have extrapolated from the adult literature to utilize this medication to treat severe pediatric pulmonary hypertension. However, longitudinal, multicenter data on the therapeutic benefits of selexipag for pediatric patients is lacking. Materials and Methods We performed a retrospective review describing the clinical outcomes of pediatric PH patients receiving selexipag for pulmonary hypertension (PH) therapy in addition to standard pulmonary vasodilator therapy across three North American pediatric PH centers between January 2005 and June 2021. Results Across three Canadian centers, 24 patients (15 female) with a mean age at diagnosis of 5.4 (0.9) years were included. Of this cohort, 19 (79.2%) had group 1 PAH, 4 (16.7%) had group 3 PH, and 1 (4.2%) had group 4 PH. Genetic syndromes were noted in 7 (29.2%) patients. Dosing was targeted to achieve 20–30 mcg/kg/dose orally every 12 hours; the mean dosage after 12 months was 31.2 (10.3) mcg/kg/dose. Twelve months following selexipag initiation, a median increase of 71.5 m (p = 0.44) in six-minute walk test distance was observed together with median decreases of 0.2 cm (p = 0.17) in tricuspid annular plane systolic excursion, 3.5 mmHg (p = 0.95) in right ventricle systolic pressure, and 6.1 mmHg (p = 0.09) in mean pulmonary artery pressure. 2 patients (8.3%) died, 1 (4.2%) was referred for a heart transplant, and 1 (4.2%) received an atrial flow regulator. One patient (4.2%) required admission to a pediatric intensive care unit during their treatment course this was related to profound desaturation, six (25.0%) had gastrointestinal symptoms, and two (8.3%) had facial flushing. Conclusion Selexipag appears to be a beneficial adjunctive therapy for selected pediatric PH patients and has a tolerable adverse effect profile aside from gastrointestinal disturbances. Further prospective studies of changes in hemodynamics and functional classification over a longer period and with a larger sample are needed.

Mobilization of science advice by the Canadian federal government to support the COVID-19 pandemic response

The procurement and provision of expert-driven, evidence-informed, and independent science advice is integral to timely decision-making during public health emergencies. The 2019 coronavirus disease (COVID-19) pandemic has underscored the need for sound evidence in public health policy and exposed the challenges facing government science advisory mechanisms. This paper is a jurisdictional case study describing (i) the federal science advice bodies and mechanisms for public health in Canada (i.e., the federal science advice “ecosystem”); and (ii) how these bodies and mechanisms have mobilized and evolved to procure expertise and evidence to inform decisions during the first two years of the COVID-19 pandemic. We reviewed publicly accessible Government of Canada documents, technical reports, and peer-reviewed articles available up to December 2021. Canada’s federal landscape of science advisory bodies for public health within the Health Portfolio was largely shaped by Canada’s experiences with the 2003 severe acute respiratory syndrome and 2009 H1N1 outbreaks. In parallel, Canada has a designated science advisory apparatus that has seen frequent reforms since the early 2000s, with the current Office of the Chief Science Advisor created within the Science Portfolio in 2018. The COVID-19 pandemic has further complicated Canada’s science advice ecosystem, with involvement from departments, expert advisory groups, and partnerships within both the federal Health and Science Portfolios. Although the engagement of federal departments outside the health sector is promising, the COVID-19 experience in Canada supports the need to institutionalize science advisory bodies for public health to improve pandemic preparedness and ensure rapid mobilization of well-coordinated and independent advice in future emergencies. This review also identified pressing areas for further inquiry to strengthen science advice for public health in Canada, including to assess the independence of science advisory actors and the interaction between federal and subnational authorities.

Shifting aspirations: Young Syrian refugees’ experience in Canada

Shifting aspirations: Young Syrian refugees’ experience in Canada

An Autoethnography about being an International Student

The number of immigrant and international students in Canada and other Western countries has increased in recent decades. This group of people faces many challenges, especially at the beginning of their entrance to the host country, such as different expectations regarding two different cultures, being away from their family and loneliness, financial problems, language limitations, and racism. As the experiences of these students can affect their satisfaction and success during their academic years, it is essential to explore the experiences of this growing population during their higher education. In this paper, I explore my own experience as a female international student. My first several years in Canada illustrate the everyday struggles I have faced to attain social, cultural, and linguistic development and build a new life in a new country. Using evocative autoethnography as a research methodology has revealed layers of my consciousness by connecting my personal experience to culture. This autoethnographic study presents the reflections of an Iranian female scholar’s experiences in Canadian higher education; it explores how my personal status as an Iranian female scholar, along with social factors, have shaped my academic experiences in Canada.

Canadian experience with the RAISE score to identify patients at high risk for cardiac amyloidosis in a TAVI population

Canadian experience with the RAISE score to identify patients at high risk for cardiac amyloidosis in a TAVI population

ОСОБЕННОСТИ АНТИКРИЗИСНОГО МЕНЕДЖМЕНТА В МЕЖДУНАРОДНОЙ ПРАКТИКЕ

The article discusses some fundamental mechanisms of crisis management: managing the insolvency and bankruptcy processes of international organizations. As an illustrative example, the Canadian experience as a successor system aimed at preserving the debtor organization and, if possible, restructuring the debt to restore the company’s solvency and financial stability. It characterizes the activities of the Office of the Superintendent of Bankruptcy (OSB) and trustee in bankruptcy (“trustees”). The Bankruptcy and Insolvency Act (“BIA”) and the key officials’ responsibilities in the framework of crisis measures are analyzed. Differences are identified between the voluntary bankruptcy and forced bankruptcy. In the Canadian crisis management practice, insolvency is not identical to bankruptcy for both individuals and legal entities. Moreover, the very concept of “person” has an extended interpretation. The successor system involves the search for grounds for the bankruptcy exemptions, especially for individuals who do not cease to exist as legal entities. Therefore in the Canadian crisis management practice, the provision on mandatory financial and tax advice to individuals who have become bankrupt for the first time seems extremely interesting. Conclusions about the possibility of using some individual elements of the Canadian crisis management system in Russian practice are drawn.

The Importance of Sound Monetary Policy: Some Lessons for Today from Canada's Experience with Floating Exchange Rates Since 1950

The Importance of Sound Monetary Policy: Some Lessons for Today from Canada's Experience with Floating Exchange Rates Since 1950

Legal regulation of divorce in some states of the Anglo - Saxon legal family: the experience of Australia and Canada

Legal regulation of divorce in some states of the Anglo - Saxon legal family: the experience of Australia and Canada

Scientific Research and Ethical Principles: Contemporary Debates

This article addresses debates surrounding ethical issues and dilemmas faced by scientists conducting research with human participants. Through the analysis of different stories of abuse, the research shows how ethical principles, codes, guidelines, and organizations emerged. Although various ethical rules and guidelines provide significant recommendations today, controversies in research and practice remain. In addition, the increasing process of formalizing ethical principles is causing concern among researchers. A critique of the processes of bureaucratization in the field of ethical regulation of research and practice is presented using the example of Canadian experience. Drawing on various ethical codes and recommendations, current principles for ethical research involving human subjects are identified. Risks are discussed, including those related to social sciences. The literature review demonstrates which issues are becoming more pressing today and how professional practitioners face ethical dilemmas and risks. It is concluded that the complex dilemmas that arise in research practices require interdisciplinary discussions and the introduction of research ethics courses in various academic and other institutions. Good professional practice in resolving ethical dilemmas should be taken into account when developing and improving one's own national guidelines and codes. We believe the article will contribute to broadening discussions about research ethics and professional practice.