Suchergebnisse

Background: Use of opiates, including synthetic opioids, is associated with a number of negative consequences, including increased risk of opioid use disorders and other mental health conditions. However, studies are limited in examining patterns of opiate use among persons in inpatient psychiatry, particularly those that consider the relationship between pain and opiate use. Objective: This study examined the prevalence in the prior 12 months to admission and patterns of opiate use and pain in a population-based study of persons admitted to inpatient psychiatry in Ontario, Canada. Methods: We conducted retrospective cross-sectional study of 165 434 persons admitted to inpatient psychiatry between January 1, 2006 and December 31, 2017. Using data from the Resident Assessment Instrument for Mental Health, we examined prevalence and factors associated with opiate use in the prior 12 months by a number of patient characteristics, including demographics, mental and physical health status, concurrent substance use, pain severity and frequency, and health region of residence. Results: The prevalence of opiate use within 12 months of admission was 7.5%, between 17% and 22% among those experiencing daily pain, and 27% among persons with a primary substance use disorder. Multivariable analyses revealed strong associations among demographic and clinical variables with opiate use ( c = 0.91), including being of younger age, use of other substances, greater frequency and severity of pain, and health region of residence. Conclusion: The strong relationship between pain and opiate use in this population, and the regional variation in this pattern, supports the need for integrated care for mental illness and substance use, and therapeutic approaches to pain management that reduce risks of problems associated with substance use for persons with mental health conditions.

Small non-governmental organizations (NGOs) working in water-based development in low- and middle-income countries face unique challenges when it comes to evaluative practice. Few prioritize evaluation because they lack expertise and/or feel strongly about funding programs and not processes, given accountability to donors. To examine facilitators and barriers to evaluation in this context, we embarked on an organizational-level evaluation of H2O 4 ALL, a Canadian NGO with no prior evaluation experience. We first conducted an evaluability assessment, guided by Thurston and Potvin's framework for social change programs, to understand evaluation priorities and needs. By triangulating findings from three qualitative sources of data – an environmental scan, a document review, and in-depth interviews – we demonstrated evaluability assessments' applicability to water-based development and established a baseline for further research.

Background: Marginalization is a multidimensional social construct that influences the mental health status of individuals and their use of psychiatric services. However, its conceptualization and measurement are challenging due to inconsistencies in definitions, and the lack of standard data sources to measure this construct. Aims: To create an index for screening marginalization based on an existing comprehensive assessment system used in inpatient psychiatry. Method: Items anticipated to be indicative of marginalization were identified from the Resident Assessment Instrument-Mental Health (RAI-MH) that is used in all inpatient mental health beds in Ontario, Canada. Principal Component Analysis (PCA) and cluster analysis of these items was performed on a sample of 81,232 patients admitted into psychiatric care in Ontario between 1 January 2011 and 31 December 2016 to identify dimensions being measured. Various weights and scoring methods were tested to assess convergent validity on multiple outcomes of marginalization. Receiver Operating Characteristic (ROC) curve analysis was utilized to determine optimal cut-offs for the index by modeling the likelihood of different marginalization outcomes, including homelessness. Results: Fifteen items were identified for the development of the Marginalization Index (MI). PCA and cluster analysis identified that the items measured five dimensions. ROC curve analysis among homeless individuals identified an Area Under the Curve of 0.76 and an optimal cut-off of five on the MI. Frequency analysis of the index by different characteristics identified homeless individuals, frequent mental health service users, persons with a history of violence and police intervention, and persons with addictions issues, as groups with the highest scores, confirming the convergent validity of the index. Conclusion: The MI is a valid measure of marginalization and is strong predictor of risk of homelessness among psychiatric inpatients. MI provides a resource that can be used for social and health policy, decision-support and evaluation.

Canadian post-secondary students are vulnerable to food insecurity, yet lack of examination of this issue has prevented identification of policy and program solutions. This mixed-methods study aimed to characterize the experience of food insecurity among undergraduate students by eliciting barriers to food security, strategies used to manage food and money shortages, and perceived implications for health and academic achievement. Surveys and in-depth interviews were conducted with 14 students who demonstrated compromised financial access to food. Students normalized experiences of food insecurity as typical of post-secondary education but expressed anxiety and frustration with financial inaccessibility to healthy food, and described negative implications for their physical and mental health and their ability to perform well in school. Ongoing attempts to adapt or adjust to food insecurity had limited success. Findings highlight the need to challenge the "starving student" ideology, which normalizes the lack of access to healthy food during higher education. ; Les étudiants de niveau postsecondaire canadiens sont vulnérables à l'insécurité alimentaire, pourtant ce problème esquive aux examens qui mèneraient aux politiques et programmes solutions. Cette étude aux méthodes mixtes tente de définir l'expérience des étudiants en situation d'insécurité alimentaire en suscitant ses entraves, les stratégies pour gérer les manques de nourriture et d›argent, et les impacts perçus sur la santé et la réussite académique. Des sondages et des entrevues ont été menés auprès de 14 étudiants en situation d'insécurité alimentaire. Pour eux, il s'agit d'une expérience normale propre à l›éducation. Mais quant à l'inaccessibilité à une saine alimentation, tous ont parlé d'anxiété et de frustration avec les barrières financières en plus des impacts négatifs sur leur état physique et sur leur performance en classe. Les tentatives courantes d'adaptation à l'insécurité alimentaire ont eu un succès limité. Les résultats démontrent la nécessité de critiquer l'idéologie de « l'étudiant famélique » qui normalise leur accès limité à une saine alimentation durant leurs études postsecondaire.

AbstractSmall NGOs in international development have a unique advantage when it comes to engaging communities, establishing partnerships and advocating rights. However, studies suggest that small NGOs are disadvantaged when it comes to demonstrating evidence‐based impact. Small NGOs are less likely to invest in development evaluation as they lack expertise and/or feel strongly about funding programmes and not processes, given the increased demand for accountability to donors. To explore the challenge NGOs face in moving from a single project‐based entity to a vision‐led professional entity, we have documented the creation of low‐cost evaluation tools using a case study in water‐based development. Copyright © 2017 John Wiley & Sons, Ltd.

AbstractThe importance of measuring trust in health systems has been accentuated due to its correlation with important health outcomes aimed at reducing COVID‐19 transmission. A systematic review published almost a decade ago identified gaps in measures including the lack of focus on trust in systems, inconsistency regarding the dimensionality of trust and need for research to strengthen the validity of measures. Given developments in our understandings of trust since its publication, we sought to identify new scales developed, existing ones adapted in response to identified gaps, and agendas for future research. Using the PRISMA approach for systematic reviews, we conducted a search in four databases. A total of 26 articles were assessed. Twelve new scales were identified, while 14 were adapted for different settings and populations. Literature continues to focus on measuring trust in health professionals rather than systems. Various shortcomings were identified, including some articles not mentioning the dimensions included in the scale and suboptimal use of validity and reliability testing and/or reporting. Moreover, a variety of terms were used for dimensions. Future research is needed to address these gaps and consequently, to understand their correlation with health behaviors and outcomes more accurately.

Background: Cannabis is associated with the onset and persistence of psychotic disorders. Evidence suggests that accessibility of substances is associated with an increased risk of use-related harms. We sought to examine the effect of residing in proximity to non-medical cannabis retailers on the prevalence of health service use for psychosis. Methods: We conducted a cross-sectional study using linked health administrative data, and used geospatial analyses to determine whether people in Ontario, Canada (aged 14–60 years) resided within walking (1.6 km) or driving (5.0 km) distance of non-medical cannabis retailers (open as of February-2020). We identified outpatient visits, emergency department (ED) visits, and hospitalizations for psychotic disorders between 01-April-2019 and 17-March-2020. We used zero-inflated Poisson regression models and gamma generalized linear models to estimate the association between cannabis retailer proximity and indicators of health service use. Results: Non-medical cannabis retailers were differentially located in areas with high levels of marginalization and pre-existing health service use for psychosis. People residing within walking or driving distance of a cannabis retailer had a higher rate of psychosis-related outpatient visits, ED visits, and hospitalizations, compared to people living outside these areas. This effect was stronger among those with no prior service use for psychosis. Conclusions: Proximity to a non-medical cannabis retailer was associated with higher health service use for psychosis, even after adjustment for prior health service use. These findings suggest that opening of non-medical cannabis retailers could worsen the burden of psychosis on mental health services in areas with high-risk populations.