Population genomic structure of a widespread, urban-dwelling mammal: The eastern grey squirrel (Sciurus carolinensis).

Urbanization is a persistent and widespread driver of global environmental change, potentially shaping evolutionary processes due to genetic drift and reduced gene flow in cities induced by habitat fragmentation and small population sizes. We tested this prediction for the eastern grey squirrel (Sciurus carolinensis), a common and conspicuous forest-dwelling rodent, by obtaining 44K SNPs using reduced representation sequencing (ddRAD) for 403 individuals sampled across the species' native range in eastern North America. We observed moderate levels of genetic diversity, low levels of inbreeding, and only a modest signal of isolation-by-distance. Clustering and migration analyses show that estimated levels of migration and genetic connectivity were higher than expected across cities and forested areas, specifically within the eastern portion of the species' range dominated by urbanization, and genetic connectivity was less than expected within the western range where the landscape is fragmented by agriculture. Landscape genetic methods revealed greater gene flow among individual squirrels in forested regions, which likely provide abundant food and shelter for squirrels. Although gene flow appears to be higher in areas with more tree cover, only slight discontinuities in gene flow suggest eastern grey squirrels have maintained connected populations across urban areas in all but the most heavily fragmented agricultural landscapes. Our results suggest urbanization shapes biological evolution in wildlife species depending strongly on the composition and habitability of the landscape matrix surrounding urban areas.

Distress experienced by lung cancer patients and their family caregivers in the first year of their cancer journey.

OBJECTIVES: Diagnosis of cancer is emotionally threatening not only for patients but also for their family caregivers (FC) who witness and share much of the illness experience. This study compares distress experienced by lung cancer patients and their FC during the year following the diagnosis. METHODS: A prospective cohort study of 206 patients recently diagnosed with inoperable lung cancer (participation rate 79.5%) and 131 FC (participation rate 63.6%) was conducted in an ambulatory oncology clinic in Quebec City (Canada). They completed validated questionnaires regarding their personal and psychological characteristics (Hospital and Anxiety Depression Scale-HADS), in the first months after the diagnosis of lung cancer and after 6 and 12 months. Univariate, bivariate, and linear mixed models were conducted to compare patient and FC distress. RESULTS: At baseline, 7.8% of patients reported distress (HADS total score >15) and their mean distress score was 7.0 ± 4.9 (range 0-42). In contrast, 33.6% of FC presented significant distress and their mean distress score was 12.0 ± 7.2 (P < 0.0001). Proportions of patients and FC with distress remained relatively stable at 6 and 12 months, and at every time point, FC reported higher levels of distress compared to their relative with cancer (P < 0.0001). Comparable trends were found when looking at the mean scores of distress, anxiety, and depression throughout the study. SIGNIFICANCE OF RESULTS: Being diagnosed with lung cancer and going through its different phases seems to affect more FC than patients. The psychological impact of such diagnosis appears early after the diagnosis and does not significantly change over time. These findings reinforce the importance for oncology teams, to include FC in their systematic distress screening program, in order to help them cope with their own feelings and be able to play their role in patient support and care throughout the cancer journey.

Continuity of Cancer Care and Collaboration Between Family Physicians and Oncologists: Results of a Randomized Clinical Trial.

PURPOSE: Collaboration between family physicians (FPs) and oncologists can be challenging. We present the results of a randomized clinical trial of an intervention designed to improve continuity of care and interprofessional collaboration, as perceived by patients with lung cancer and their FPs. METHODS: The intervention included (1) supplying FPs with standardized summaries related to each patient, (2) recommending that patients see their FP after receiving the cancer diagnosis, (3) supplying the oncology team with patient information resulting from FP visits, and (4) providing patients with priority access to FPs as needed. A total of 206 patients with newly diagnosed lung cancer were randomly assigned to the intervention (n = 104) or control group (n = 102), and 86.4% of involved FPs participated. Perceptions of continuity of care and interprofessional collaboration were assessed every 3 months for patients and at baseline and at the end of the study for FPs. Patient distress and health service utilization were also assessed. RESULTS: Patients and FPs in the intervention group perceived better interprofessional collaboration (patients: P <.0001; FPs: P = .0006) than those in the control group. Patients reported better informational continuity (P = .001) and management continuity (P = .05) compared to the control group, but no differences were found for FPs (information: P = .22; management: P = .13). No effect was found with regard to patient distress or health service utilization. CONCLUSIONS: This intervention improved patient and FP perception of interprofessional collaboration, but its effectiveness on continuity of care was less clear for FPs than for patients. Additional strategies should be considered to sustainably improve continuity of care and interprofessional collaboration.

A randomized clinical trial assessing a pragmatic intervention to improve supportive care for family caregivers of patients with lung cancer.

OBJECTIVE: Family caregivers (FCs) of cancer patients often experience high distress. This randomized clinical trial assessed the feasibility and preliminary effects of an intervention to improve FC supportive care. METHOD: A pragmatic and minimal intervention to improve FC supportive care was developed and pretested with FCs, oncology team, and family physicians to assess its relevance and acceptability. Then, FCs of lung cancer patients were randomized to the intervention or the control group. The intervention included (1) systematic FC distress screening and problem assessment in the first months after their relative cancer diagnosis, and every 2 months after; (2) privileged contact with an oncology nurse to address FC problems, provide emotional support and skills to play their caregiving role; (3) liaison with the family physician of FCs reporting high distress (distress thermometer score ≥4/10) to involve them in the provision of supportive care. Distress, the primary outcome, was measured every 3 months, for 9 months. Secondary outcomes included quality of life, caregiving preparedness, and perceived burden. At the end of their participation, a purposive sample of FC from the experimental group was individually interviewed to assess the intervention usefulness. Content analysis was performed. RESULTS: A total of 109 FCs participated in the trial. FC distress decreased over time, but this reduction was observed in both groups. Similar results were found for secondary outcomes. However, FCs who received the intervention felt better prepared in caregiving than controls (p = 0.05). All 10 interviewed FCs valued the intervention, even though they clearly underused it. Knowing they could contact the oncology nurse served as a security net. SIGNIFICANCE OF RESULTS: Although the intervention was not found effective, some of its aspects were positively perceived by FCs. As many of them experience high distress, an improved intervention should be developed to better support them.

Patient, primary care physician and specialist expectations of primary care physician involvement in cancer care.

BACKGROUND: In Canada, many health authorities recommend that primary care physicians (PCP) stay involved throughout their patients' cancer journey to increase continuity of care. Few studies have focused on patient and physician expectations regarding PCP involvement in cancer care. OBJECTIVE: To compare lung cancer patient, PCP and specialist expectations regarding PCP involvement in coordination of care, emotional support, information transmission and symptom relief at the different phases of cancer. DESIGN: Canadian survey of lung cancer patients, PCPs and cancer specialists PARTICIPANTS: A total of 395 patients completed questionnaires on their expectations regarding their PCP participation in several aspects of care, at different phases of their cancer. Also, 45 specialists and 232 community-based PCP involved in these patients' care responded to a mail survey on the same aspects of cancer care. RESULTS: Most specialists did not expect participation of the PCP in coordination of care in the diagnosis and treatment phases (65% and 78% respectively), in contrast with patients (83% and 85%) and PCPs (80% and 59%) (p < 0.0001). At these same phases, the best agreement among the 3 groups was around PCP role in emotional support: 84% and more of all groups had this expectation. PCP participation in symptom relief was another shared expectation, but more unanimously at the treatment phase (p = 0.85). In the advanced phase, most specialists expect a major role of PCP in all aspects of care (from 81% to 97%). Patients and PCP agree with them mainly for emotional support and information transmission. CONCLUSION: Lung cancer patient, PCP and specialist expectations regarding PCP role differ with the phase of cancer and the specific aspect of cancer care. There is a need to reach a better agreement among them and to better define PCP role, in order to achieve more collaborative and integrated cancer care.

Family physician involvement in cancer care and lung cancer patient emotional distress and quality of life.

PURPOSE: This study aims to describe emotional distress and quality of life (QoL) of patients at different phases of their lung cancer and the association with their family physician (FP) involvement. METHODS: A prospective study on patients with lung cancer was conducted in three regions of Quebec, Canada. Patients completed, at baseline, several validated questionnaires regarding their psychosocial characteristics and their perceived level of FP involvement. Emotional distress [profile of mood states (POMS)] and QoL [European Organization for Research and Treatment of Cancer Quality of Life Core 30 (EORTC QLQ-C30)] were reassessed every 3-6 months, whether patients had metastasis or not, up to 18 months. Results were regrouped according to cancer phase. Mixed models with repeated measurements were performed to identify variation in distress and QoL. RESULTS: In this cohort of 395 patients, distress was low at diagnosis (0.79 ± 0.7 on a 0-4 scale), raising to 1.36 ± 0.8 at the advance phase (p < 0.0001). Patient's global QoL scores significantly decreased from the diagnosis to the advance phase (from 66 to 45 on a 0-100 scale; p < 0.0001). At all phases of cancer, FP involvement was significantly associated with patients' distress (p = 0.0004) and their global perception of QoL (p = 0.0080). These associations remained statistically significant even after controlling for age, gender, and presence of metastases. CONCLUSIONS: This study provides new knowledge on patients' emotional distress and QoL with cancer evolution and, particularly, their association with FP involvement. Other studies should be conducted to further explore FP role in cancer supportive care.

Family physician involvement in cancer care follow-up: the experience of a cohort of patients with lung cancer.

PURPOSE: There has been little research describing the involvement of family physicians in the follow-up of patients with cancer, especially during the primary treatment phase. We undertook a prospective longitudinal study of patients with lung cancer to assess their family physician's involvement in their follow-up at the different phases of cancer. METHODS: In 5 hospitals in the province of Quebec, Canada, patients with a recent diagnosis of lung cancer were surveyed every 3 to 6 months, whether they had metastasis or not, for a maximum of 18 months, to assess aspects of their family physician's involvement in cancer care. RESULTS: Of the 395 participating patients, 92% had a regular family physician but only 60% had been referred to a specialist by him/her or a colleague for the diagnosis of their lung cancer. A majority of patients identified the oncology team or oncologists as mainly responsible for their cancer care throughout their cancer journey, except at the advanced phase, where a majority attributed this role to their family physician. At baseline, only 16% of patients perceived a shared care pattern between their family physician and oncologists, but this proportion increased with cancer progression. Most patients would have liked their family physician to be more involved in all aspects of cancer care. CONCLUSIONS: Although patients perceive that the oncology team is the main party responsible for the follow-up of their lung cancer, they also wish their family physicians to be involved. Better communication and collaboration between family physicians and the oncology team are needed to facilitate shared care in cancer follow-up.

Interdisciplinary teaching in family medicine teaching units: the residents' points of view.

BACKGROUND: Interdisciplinary teaching (IDT) is the norm in Canadian family medicine residency programs. Literature on IDT reports many academic, collaborative and organizational benefits, but little is known about family medicine residents' own perspectives of IDT. The purpose of this study was to explore family medicine residents' points of view on IDT in family medicine teaching units (FMTU). METHODS: A mixed methods design combined interviews and self-completed online questionnaires to explore participants' perceptions of IDT during residency. Content analysis was conducted on the qualitative data and univariate analysis statistical tests on means and proportions were conducted on the quantitative survey questions. RESULTS: A total of 125 family medicine residents from 12 FMTU affiliated with Université Laval (Quebec City) participated in the study (11 interviews and 114 online questionnaires). Participants perceived significant benefits of IDT, including clinical knowledge, complementary perspectives and interprofessional collaboration skills. However, they believe that IDT works best when the educators adapt their teaching to the specific needs of residents in family medicine. CONCLUSION: These findings support those of previous IDT research and highlight the positive impacts of interdisciplinary education in family medicine residency, especially on interprofessional collaboration. IDT should remain an essential component of the family medicine curricula.

CONTEXTE: L'enseignement interdisciplinaire (EID) constitue une norme dans les programmes canadiens de résidence en médecine familiale. La littérature disponible sur l'EID fait état de plusieurs bénéfices académiques, collaboratifs et organisationnels, mais elle rend peu compte des points de vue des résidents sur ce type d'enseignement. Cette étude a pour objectif d'explorer les points de vue des résidents en médecine familiale quant à l'EID offert dans les unités de médecine familiale (UMF). MÉTHODES: Un devis mixte a été utilisé, s'appuyant sur des entrevues semi-dirigées et des questionnaires auto-administrés en ligne. Une analyse de contenu a été effectuée pour le volet qualitatif, et des analyses univariées et bi-variées ont été réalisées pour les données obtenues dans les questionnaires auto-administrés. RÉSULTATS: Un total de 125 résidents en médecine familiale, rattachés aux 12 UMF relevant de l'Université Laval (Québec), a participé à l'étude (11 entrevues et 114 questionnaires en ligne). Les participants reconnaissent des bénéfices significatifs à l'EID, tels l'acquisition et l'approfondissement de connaissances cliniques essentielles, l'intégration de perspectives complémentaires sur les problèmes de santé, et le développement d'habiletés à la collaboration interprofessionnelle. Ils estiment toutefois que l'EID peut s'optimiser en s'adaptant davantage aux besoins spécifiques des résidents en médecine familiale. CONCLUSIONS: À l'instar des études antérieures, les résultats de cette recherche mettent en relief les impacts positifs de l'EID pendant la résidence en médecine familiale, particulièrement ceux qui sont liés à l'apprentissage de la collaboration interprofessionnelle. L'EID devrait par conséquent demeurer une caractéristique essentielle des programmes de résidence en médecine familiale.

Effectiveness of an intervention to improve supportive care for family caregivers of patients with lung cancer: study protocol for a randomized controlled trial.

BACKGROUND: Family caregivers (FC) often experience higher distress levels than their relative with cancer. Many cancer centers have implemented distress screening programs, but most of them concentrate their efforts on patients, with little attention to their FC. To fill this gap, a pragmatic intervention has been designed to improve supportive care for FC of patients with lung cancer. This article describes the study protocol of a single-center randomized controlled trial to assess its effectiveness. METHODS/DESIGN: A total of 120 lung cancer patients and their FC are randomly assigned to the experimental group (exposed to intervention, N = 60) or to the control group (usual care, N = 60). The intervention includes: (1) systematic FC distress screening and problem assessment near their relative's cancer diagnosis, and every 2 months, (2) privileged contact with an oncology nurse (ON) away from the patient to address FC problems and (3) liaison by the ON with the family physician of FC reporting high distress (thermometer score ≥5/10), or problems relying on FP expertise. In both groups, FC, patient and process-of-care outcomes are measured at baseline and every 3 months, up to 9 months. The primary endpoint is FC distress measured by the Hospital Anxiety and Depression Scale (HADS) and the Psychological Distress Index used in the Quebec Health Survey (PDQHS). Individual interviews with 10 FC and a focus group with the oncology team will be conducted at the study end to further document the effectiveness of the intervention and its impact on quality of life (for FC) and practice organization (for the oncology team). DISCUSSION: This trial will assess the effectiveness of an innovative intervention based on interprofessional collaboration between primary care and oncology care. It targets a population in great need, yet often neglected, and has the potential to clearly improve patient and caregiver experience of cancer care, and reduce the burden of disease. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT02531464 . Registered on 15 July 2015.

Caring for a loved one with advanced cancer: determinants of psychological distress in family caregivers.

BACKGROUND: Family caregivers caring for a patient with terminal cancer may experience significant psychological distress. OBJECTIVE: The purpose of this study was to determine the extent to which the family caregivers' psychological distress is influenced by the patients' performance status while taking into account individual characteristics of caregivers and their unmet needs. METHODS: Two hundred twelve family caregivers were assigned to three cohorts according to the patient's performance status, as measured by the Eastern Collaborative Oncology Group Functional Scale (ECOGS). Interview information was collected on the services and care provided, as well as on the caregivers' characteristics and level of psychological distress. RESULTS: Family caregivers' psychosocial distress is strongly associated with the patients' terminal disease progress and declined functioning. The level of psychological distress varies from 25.2 to 33.5 (p = 0.0008) between the groups. Moreover, the percentage of caregivers with a high level of psychological distress varies from 41% to 62%, while this percentage is estimated at 19.2% in general population. A high distress index was significantly associated with the caregiver's burden, the patient's young age, the patient's symptoms, the caregiver's young age and gender, a poor perception of his/her health and dissatisfaction with emotional and tangible support. CONCLUSIONS: Family caregivers of patients in the advanced stages of cancer experience a high level of psychological distress, which increases significantly as the patient loses autonomy. Health care policies and programs need to be revisited in order to take the reality of these patients and their families into account.

[Continuity of cancer care in Quebec: beyond the symptoms]. / La continuité des soins oncologiques au Québec.

OBJECTIVE: Serious problems in the continuity of medical care provided to cancer patients are a frequent occurrence; the source of these problems is not well understood. The purpose of this research is to determine how these problems arise and how they are perpetuated. DESIGN: Qualitative descriptive study based on Anthony Giddens's theory of structuration. SETTING: Four teaching hospitals in the Quebec City region. PARTICIPANTS: Cancer patients (n = 62), family physicians (n = 14), and oncology specialists (n = 13). METHOD: Individual interviews were conducted with breast cancer and lung cancer patients. Their medical files were examined so that they could be ranked according to the stage of their disease. We also conducted individual interviews with a sampling of the patients' family physicians and oncology specialists at the hospitals participating in the study. An analysis of the content of the interviews was performed following the principles of grounded theory. MAIN FINDINGS: When conditions arise that are likely to lead to problems in the continuity of medical care, patients and physicians often try to compensate. Health care providers employ regulation strategies and patients and their families employ substitution strategies. Although these strategies generally get results, they constitute one-time actions by the physician or patient to circumvent a problem. And because they do not address the problem across the system, the source of the problem does not change. CONCLUSION: One of the unintentional consequences of the strategies used by clinicians and patients is the masking of the real issues involved in continuity of care; these strategies actually get in the way of in-depth changes based on the needs of the health care system as a whole.

History of family dysfunction and perpetration of dating violence by adolescent boys: a longitudinal study.

PURPOSE: To examine whether there is a direct or a mediated association between dysfunctional parental behavior in later childhood and involvement in dating violence in a sample of low socioeconomic-status boys during mid-adolescence. METHODS: Subjects were 717 boys who participated in a longitudinal study. Data collected at six time periods, beginning at age 10 years and covering a span of 8 years, were analyzed. Dysfunctional parental behavior patterns were defined as perceived harsh parenting practices, laxness of monitoring, and interparental conflict witnessed by the subject. Perpetrated psychological and physical abuse in dating, measured at ages 16 and 17 years, and delinquency, measured at age 15 years, served as dependent measures. All instruments were self-report questionnaires. Multiple regression analysis was used in data analysis. RESULTS: Only two variables contributed independently to dating violence. Boys who perceived laxness of monitoring from their parents in their late childhood and reported antisocial behavior at age 15 years, such as delinquency and substance abuse, were at risk of becoming involved in violent dating relationships at age 16 years. Harsh parenting practices from ages 10 to 12 years were also predictors of dating violence. CONCLUSIONS: A direct relationship was found between harsh parenting and antisocial behavior and later dating violence. No support was found for the mediation hypothesis of antisocial behavior, but an indirect influence was noted in association with monitoring.

From hospital to home after cardiac surgery: evaluation of a community nursing care management model.

PURPOSE/OBJECTIVES: This quasi-experimental research aims to (1) evaluate the implementation process of a community nursing care management model and (2) assess the effects of this model on patients followed at home. PRIMARY PRACTICE SETTING: Two community healthcare centers had introduced a community nursing care management model in their practice (experimental groups), whereas another health community care center with no experience with such a model served as a control group. The community nursing care management model included clinical pathways designed for a clientele who had been hospitalized for cardiac surgery. FINDINGS/CONCLUSIONS: Even though the implementation process was challenging, the community nursing care management model was found useful enough to be integrated into routine nursing home care practice after cardiac surgery. Although the effects produced by this systematic home care program on the clientele did not differ significantly from those produced by usual nursing care, there was a positive effect for the clientele recorded on all measurement indicators used. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: The introduction of the nursing care management model enabled nurses to structure the care provided and reduced interindividual variation. The application of this program also proved to be an opportunity to initiate and assimilate new professional roles. Additional studies should be conducted to assess its effectiveness in home care for other health problems.

[Validity 'and Utilities' clinic of a grid observation (PACSLAC-F) to evaluate the pain in seniors with dementia's living in the Long-Term Care ]. / Validité et utilité clinique d'une grille d'observation (PACSLAC-F) pour évaluer la douleur chez des aînés atteints de démence vivant en milieu de soins de longue durée.

This study presents the validation of the French Canadian version (PACLSAC-F) of the Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC). Unlike the published validation of the English version of the PACSLAC, which was validated retrospectively, the French version was validated prospectively. The PACSLAC-F was completed by nurses working in long-term care facilities after observing 86 seniors, with severe cognitive impairment, in calm, painful or distressing but non-painful situations. The test-retest and inter-observer reliability, the internal consistency, and the discriminent validity were found to be satisfactory. To evaluate the convergent validity with the DOLOPLUS-2 and the clinical relevance of the PACSLAC, it was also completed by nurses during their work shift, with 26 additional patients, for three days per week during a period of four weeks. These results encourage us to test the PACSLAC in a comprehensive program of pain management targeting this population.

Impact of an educational program on pain management in patients with cancer living at home.

PURPOSE/OBJECTIVES: To assess the effect of an educational homecare program on pain relief in patients with advanced cancer. DESIGN: Quasi-experimental (pretest post-test, nonequivalent group). SETTING: Four community-based primary care centers providing social and healthcare services in the Quebec City region of Canada. SAMPLE: 80 homecare patients with advanced cancer who were free of cognitive impairment, who presented with pain or were taking analgesics to relieve pain, and who had a life expectancy of six weeks or longer. METHODS: The educational intervention included information regarding pain assessment and monitoring using a daily pain diary and the provision of specific recommendations in case of loss of pain control. Pain intensity data were collected prior to the intervention, and reassessments were made two and four weeks later. Data on beliefs were collected at baseline and two weeks. All data were collected by personal interviews. MAIN RESEARCH VARIABLES: Patients beliefs about the use of opioids; average and maximum pain intensities. FINDINGS: Patients beliefs regarding the use of opioids were modified successfully following the educational intervention. Average pain was unaffected in the control group and was reduced significantly in patients who received the educational program. The reduction remained after controlling for patients initial beliefs. Maximum pain decreased significantly over time in both the experimental and control groups. CONCLUSIONS: An educational intervention can be effective in improving the monitoring and relief of pain in patients with cancer living at home. IMPLICATIONS FOR NURSING: Homecare nurses can be trained to effectively administer the educational program during their regular homecare visits.