Increase in Trauma Leading to Psychological Injury Among Canadian Homelessness Services Workers During the COVID-19 Pandemic.

OBJECTIVES: This study examined the traumatic psychological impact of the pandemic on frontline workers in homelessness services. METHODS: Staff from homelessness serving organizations completed pre- and mid-COVID pandemic surveys measuring traumatic stress symptoms (PTSS), burnout, and job-related traumatic experiences. The mid-pandemic survey was expanded to seven Canadian cities to determine prevalence of workplace PTSS nationally. RESULTS: In the comparison group, baseline rates of PTSS (41%) rose to 47.3% ( n = 164), while 75% reported low-moderate levels of burnout both times. Nationwide, PYSS was 51% ( n = 574). Case managers working at remotely had greater levels of PTSS. CONCLUSIONS: COVID-19 exacerbated risk of psychological workplace injury from traumatic stress; however, burnout did not increase significantly, indicating the primary dynamic as anxiety and emotional exhaustion associated with ubiquitous trauma induced by COVID-19. Working remotely increased the hazards of psychological workplace injury.

Understanding Why Many People Experiencing Homelessness Reported Migrating to a Small Canadian City: Machine Learning Approach With Augmented Data.

BACKGROUND: Over the past years, homelessness has become a substantial issue around the globe. The largest social services organization in Thunder Bay, Ontario, Canada, has observed that a majority of the people experiencing homelessness in the city were from outside of the city or province. Thus, to improve programming and resource allocation for people experiencing homelessness in the city, including shelter use, it was important to investigate the trends associated with homelessness and migration. OBJECTIVE: This study aimed to address 3 research questions related to homelessness and migration in Thunder Bay: What factors predict whether a person who migrated to the city and is experiencing homelessness stays or leaves shelters? If an individual stays, how long are they likely to stay? What factors predict stay duration? METHODS: We collected the required data from 2 sources: a survey conducted with people experiencing homelessness at 3 homeless shelters in Thunder Bay and the database of a homeless information management system. The records of 110 migrants were used for the analysis. Two feature selection techniques were used to address the first and third research questions, and 8 machine learning models were used to address the second research question. In addition, data augmentation was performed to improve the size of the data set and to resolve the class imbalance problem. The area under the receiver operating characteristic curve value and cross-validation accuracy were used to measure the models' performances while avoiding possible model overfitting. RESULTS: Factors predicting an individual's stay duration included home or previous district, highest educational qualification, recent receipt of mental health support, migrating to visit family or friends, and finding employment upon arrival. For research question 2, among the classification models developed for predicting the stay duration of migrants, the random forest and gradient boosting tree models presented better results with area under the receiver operating characteristic curve values of 0.91 and 0.93, respectively. Finally, home district, band membership, status card, previous district, and recent support for drug and/or alcohol use were recognized as the factors predicting stay duration. CONCLUSIONS: Applying machine learning enables researchers to make predictions related to migrants' homelessness and investigate how various factors become determinants of the predictions. We hope that the findings of this study will aid future policy making and resource allocation to better serve people experiencing homelessness. However, further improvements in the data set size and interpretation of the identified factors in decision-making are required.

Understanding Barriers to Implementing and Managing Therapeutic Diets for People Living with Chronic Kidney Disease in Remote Indigenous Communities.

Indigenous peoples in Canada, and globally, experience a disproportionate burden of chronic kidney disease (CKD) and end-stage renal disease (ESRD) ESRD patients in remote Indigenous communities might experience significant challenges in adhering to dietary guidelines. Much research has documented the poor quality, high cost, and limited availability of healthy foods in remote, Indigenous communities. Food quality and availability are poor in remote communities, indicating that persons with ESRD and CKD might have limited ability to adhere to dietary guidelines. This article reports on research designed to understand food-access barriers in remote First Nations for persons living with stage 4 and 5 CKD/ESRD. The study involved semi-structured interviews with 38 patients in remote communities. It concludes with some reflections on the significance of this issue in the context of dietetic practice.

COVID-19 and pandemic planning in the context of rural and remote homelessness.

Addressing the vulnerability and unique needs of homeless populations during pandemics has been a major component of the Canadian federal response to the COVID-19 crisis. Rural and remote communities, however, have received little to no funding to aid in their care of homeless people during the pandemic. Similarly, there has been little to no research on rural communities' pandemic preparedness in the context of homelessness. There are large numbers of homeless individuals in rural and remote Canada, including Indigenous peoples who are over-represented in homeless populations. Rural communities, including rural and remote Indigenous communities, are often isolated and more limited than urban areas in their capacity to respond to pandemics. They are particularly vulnerable due to fewer healthcare and social service resources-the lack of which has been particularly evident during the COVID-19 pandemic. In this commentary, we suggest that policy-makers need to take seriously the situation of rural homelessness in Canada, its implications for individual and community health, and consequences in the context of pandemics. Policy- and decision-makers can address these concerns through increased homelessness funding and support for rural and remote communities, policy change to recognize the unique challenges associated with rural pandemic planning and homelessness, and more research that can be translated into policy, programs, and supports for rural homelessness and pandemic planning response.

RéSUMé: La prise en compte de la vulnérabilité et des besoins spécifiques des populations itinérantes lors des pandémies a été un élément majeur de la réponse fédérale canadienne à la crise de la COVID-19. Toutefois, pendant la pandémie, les communautés rurales et éloignées n'ont reçu que peu ou pas de financement pour les soutenir dans leur offre de soins et de services aux personnes en situation d'itinérance. De même, il n'y a que très peu de recherche dans le contexte de l'itinérance sur la préparation des communautés rurales en cas de pandémie. Or, il existe un nombre important de personnes en situation d'itinérance dans les mileux ruraux et éloignés, parmi lesquelles on observe une surreprésentation de personnes d'ascendance autochtone. Les communautés rurales, incluant les communautés autochtones rurales et éloignées, sont souvent isolées et plus limitées que les milieux urbains dans leur capacité à répondre aux pandémies. Elles sont particulièrement vulnérables en raison du manque de ressources en matière de soins de santé et de services sociaux; ceci est particulièrement évident dans le contexte actuel de pandémie de la COVID-19. Dans ce commentaire, nous appelons les décideurs politiques à prendre au sérieux la situation de l'itinérance en milieu rural au Canada, ses implications sur la santé individuelle et communautaire, et ses conséquences dans le contexte des pandémies. Les responsables politiques et les décideurs peuvent répondre à ces préoccupations en augmentant le financement pour contrer l'itinérance et mieux soutenir les milieux ruraux et éloignés en modifiant les politiques afin de reconnaître les défis uniques associés à l'itinérance et la planification en cas de pandémies pour ces milieux. Davantage de recherches sont aussi requises afin d'appliquer les connaissances aux politiques, programmes et programmes de soutien pour l'itinérance et la préparation aux pandémies en milieu rural et éloigné.

Quality of Life and Mental Well-Being: A Gendered Analysis of Persons Experiencing Homelessness in Canada.

Homelessness has negative implications for mental well-being and quality of life. This paper identifies the quality of life variables that contribute to positive or negative wellbeing, reporting on a regression analysis from 343 individuals experiencing homelessness in Canada. Results indicate that a lack of sleep duration and quality reduced mental well-being for both genders, not having access to food and/or hygiene facilities decreased men's well-being, and engaging in illegal subsistence strategies, such as selling drugs, negatively impacted women's mental well-being. For persons experiencing homelessness, mental well-being and quality-of-life are gendered outcomes of their limited access to social determinants of health.

Improving access to phosphorus- and sodium-restricted foods for people living with chronic kidney disease in remote First Nations.

CONTEXT: Food insecurity in northern, remote Canadian communities has become increasingly recognised as a significant issue in rural health research and policy. Over the past decade, numerous government and academic reports have emerged, documenting the severity of this issue for the health people living in the Canadian north. People living in northern and remote Canadian communities experience significant challenges related to the cost, quality, and variety of market (store-bought) foods. These issues may be of particular concern for those living with chronic diseases that require therapeutic diets, such as chronic kidney disease (CKD). ISSUES: There is little to no research that documents the impact of food insecurity on disease management and quality of life for those living with CKD and end-stage renal disease (ESRD). There is also limited literature on food access for people living with ESRD in northern and remote communities. People living with food insecurity and CKD in remote communities might experience significant challenges in accessing the foods necessary for adhering to dietary guidelines. LESSONS LEARNED: This commentary examines northern food insecurity and draws attention to dietary challenges for residents of remote communities who are living on restricted or therapeutic diets due to chronic disease. In particular we point to the needs of those living with late-stage CKD and ESRD. We call attention to the need for clinicians to understand the capacity of patients to adhere to therapeutic dietary guidelines in remote communities.

On the outside looking in: Finding a place for managed alcohol programs in the harm reduction movement.

Alcohol policy in North America is dominated by moderation and abstinence-based modalities that focus on controlling population-level alcohol consumption and modifying individual consumption patterns to prevent and reduce alcohol-related harms. However, conventional alcohol policies and interventions do not adequately address harms associated with high-risk drinking among individuals experiencing severe alcohol use disorder (AUD) and structural vulnerability such as poverty and homelessness. In this commentary we address this gap in alcohol harm reduction, and highlight the lack of, and distinct need for, alcohol-specific harm reduction for people experiencing structural vulnerability and severe AUD. These individuals, doubly impacted by structural oppression and severe AUD, engage in various high-risk drinking practices that contribute to a unique set of harms that conventional abstinence-based treatments and interventions fail to adequately attend to. Managed alcohol programs (MAPs) have been established to address these multiple intersecting harms, and though gaining momentum across Canada, have had a hard time finding their place within the harm reduction movement. We illustrate how MAPs play a crucial role in the harm reduction movement in their ability to not only address high-risk drinking practices among structurally marginalized individuals, but to respond to harms associated with broader structural inequities such as poverty and homelessness.

Understanding the Fertility Desires and Intentions among HIV-Positive Men Living in Ontario: Survey Instrument Development and Validation.

Men with HIV have highlighted the importance of understanding their fertility desires. However, most research has focused on women. We aimed (1) to develop a survey instrument to assess fertility desires and intentions among HIV-positive men and (2) to assess its face, content, and construct validity, as well as test-retest reliability and internal consistency. Principal component analysis was used for construct validity analysis in a sample of 60 men with HIV. The test-retest reliability and internal consistency were assessed using Spearman correlation and Cronbach α, respectively. The initial and the final version of the questionnaire consisted of 10 domains and 14 constructs. We found a one-component model for the 3 constructs analyzed and Cronbach α values were ≥.70. Test-retest statistic was stable with Spearman correlation >0.70. In conclusion, a reliable and valid questionnaire was developed for determining the fertility desires and intentions of men with HIV.

Community managed alcohol programs in Canada: Overview of key dimensions and implementation.

INTRODUCTION AND AIMS: People with severe alcohol dependence and unstable housing are vulnerable to multiple harms related to drinking and homelessness. Managed Alcohol Programs (MAP) aim to reduce harms of severe alcohol use without expecting cessation of use. There is promising evidence that MAPs reduce acute and social harms associated with alcohol dependence. The aim of this paper is to describe MAPs in Canada including key dimensions and implementation issues. DESIGN AND METHODS: Thirteen Canadian MAPs were identified through the Canadian Managed Alcohol Program Study. Nine key informant interviews were conducted and analysed alongside program documents and reports to create individual case reports. Inductive content analysis and cross case comparisons were employed to identify six key dimensions of MAPs. RESULTS: Community based MAPs have a common goal of preserving dignity and reducing harms of drinking while increasing access to housing, health and social services. MAPs are offered as both residential and day programs with differences in six key dimensions including program goals and eligibility, food and accomodation, alcohol dispensing and administration, funding and money management, primary care services and clinical monitoring, and social and cultural connections. DISCUSSION AND CONCLUSIONS: MAPs consist of four pillars with the alcohol intervention provided alongside housing interventions, primary care services, social and cultural interventions. Availability of permanent housing and re-establishing social and cultural connections are central to recovery and healing goals of MAPs. Additional research regarding Indigenous and gendered approaches to program development as well as outcomes related to chronic harms and differences in alcohol management are needed.

Assessing Infant Feeding Attitudes of Expectant Women in a Provincial Population in Canada: Validation of the Iowa Infant Feeding Attitude Scale.

BACKGROUND: Maternal attitudes to infant feeding are predictive of intent and initiation of breastfeeding. OBJECTIVES: The Iowa Infant Feeding Attitude Scale (IIFAS) has not been validated in the Canadian population. This study was conducted in Newfoundland and Labrador, a Canadian province with low breastfeeding rates. Objectives were to assess the reliability and validity of the IIFAS in expectant mothers; to compare attitudes to infant feeding in urban and rural areas; and to examine whether attitudes are associated with intent to breastfeed. METHODS: The IIFAS assessment tool was administered to 793 pregnant women. Differences in the total IIFAS scores were compared between urban and rural areas. Reliability and validity analysis was conducted on the IIFAS. The receiver operating characteristic (ROC) of the IIFAS was assessed against mother's intent to breastfeed. RESULTS: The mean ± SD of the total IIFAS score of the overall sample was 64.0 ± 10.4. There were no significant differences in attitudes between urban (63.9 ± 10.5) and rural (64.4 ± 9.9) populations. There were significant differences in total IIFAS scores between women who intend to breastfeed (67.3 ± 8.3) and those who do not (51.6 ± 7.7), regardless of population region. The high value of the area under the curve (AUC) of the ROC (AUC = 0.92) demonstrates excellent ability of the IIFAS to predict intent to breastfeed. The internal consistency of the IIFAS was strong, with a Cronbach's alpha greater than .80 in the overall sample. CONCLUSION: The IIFAS examined in this provincial population provides a valid and reliable assessment of maternal attitudes toward infant feeding. This tool could be used to identify mothers less likely to breastfeed and to inform health promotion programs.