Loss of Financial Management Independence After Brain Injury: Survivors' Experiences.

OBJECTIVE: This pilot study explored the experiences of brain injury survivors after a change in financial management (FM) independence. METHOD: Using a qualitative descriptive design, 6 participants with acquired brain injury were recruited from a community brain injury organization and participated in semistructured interviews. Data were analyzed using thematic analysis. RESULTS: Three themes emerged from the interviews: (1) trajectory of FM change, involving family members as key change agents; (2) current FM situation, involving FM strategies such as automatic deposits and restricted budgets; and (3) the struggle for control, in which survivors desired control while also accepting supports for FM. CONCLUSION: This study identifies some of the challenges brain injury survivors face in managing their finances and the adjustment associated with a loss of FM independence. Occupational therapists should be aware of clients' experiences when supporting them through a change in independence.

Mixed-methods study exploring health service access and social support linkage to the mental well-being of Canadian Indigenous pregnant persons during the COVID-19 pandemic.

OBJECTIVES: This study aimed to explore how the unprecedented stressors associated with the COVID-19 pandemic may have contributed to heightened levels of depression and anxiety among pregnant Indigenous persons, and identify protective individual-level factors. DESIGN: The current study used a mixed-methods design including standardised questionnaires and open-ended response questions. Using hierarchical regression models, we examined the extent to which COVID-19-related factors of service disruption (ie, changes to prenatal care, changes to birth plans and social support) were associated with mental well-being. Further, through qualitative analyses of open-ended questions, we examined the coping strategies used by pregnant Indigenous persons in response to the pandemic. SETTING: Participants responded to an online questionnaire consisting of standardised measures from 2020 to 2021. PARTICIPANTS: The study included 336 self-identifying Indigenous pregnant persons in Canada. RESULTS: Descriptive results revealed elevated rates of clinically relevant depression (52.7%) and anxiety (62.5%) symptoms among this population. 76.8% of participants reported prenatal care service disruptions, including appointment cancellations. Thematic analyses identified coping themes of staying informed, social and/or cultural connections and activities, and internal mental well-being strategies. Disruptions to services and decreased quality of prenatal care negatively impacted mental well-being of Indigenous pregnant persons during the COVID-19 pandemic. CONCLUSIONS: Given the potential for mental well-being challenges to persist and long-term effects of perinatal distress, it is important to examine the quality of care that pregnant individuals receive. Service providers should advance policies and practices that promote relationship quality and health system engagement as key factors linked to well-being during the perinatal period for Indigenous persons.

COVID-19 and indigenous youth wellbeing: A review.

Indigenous youth in Canada and the United States of America (USA) have been disproportionately affected by the COVID-19 pandemic due to the compounding of increased illness risk and legacies of colonization. This article reports the findings of a Cochrane rapid review of 23 studies that examined mental wellbeing outcomes for Indigenous youth from March 2020 to April 2023 in Canada and the USA. Reported pandemic-related mental wellbeing impacts included changes in alcohol and substance use, anxiety, depression, sleep, and suicidality. Protective factors emerged including cultural and community connection. Results suggest that mental wellbeing worsened for many Indigenous youth during COVID-19. Clinical implications are discussed alongside guidance for service provision improvements to support Indigenous youth wellbeing, from a lens of self-determination.

The Sociotechnical Factors Associated With Burnout in Residents in Surgical Specialties: A Qualitative Systematic Review.

OBJECTIVE: The consequences of burnout remain prevalent within general surgery training programs, yet there is no comprehensive description of the factors associated with burnout. Using sociotechnical systems theory, this review aims to qualitatively evaluate the factors associated with burnout in surgical residents. DESIGN: A systematic review of the literature was performed according to The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The review was conducted using PubMed, Web of Science, Scopus, and Embase. Two reviewers independently selected studies, extracted data, and assessed quality, with a third reviewer acting as a moderator to resolve conflicts. The Systems Engineering Initiative for Patient Safety framework was utilized to categorize factors as either contributing to or mitigating burnout. The study was registered with PROSPERO (CRD42021237448). SETTING: Included studies were conducted within the United States and published prior to November 11, 2020. PARTICIPANTS: Included studies were peer-reviewed primary data, that were written in English and evaluated the sociotechnical factors associated with burnout in surgical residents. RESULTS: A total of 4387 articles were identified and after review, 15 studies were included for analysis. Reported burnout rates ranged from 17 to 94%, with a total mean rate of 57%. Factors found to contribute to burnout include financial stress, work-life imbalance, excessive charting, insufficient job resources, poor social support, and mistreatment. Mitigating factors include having time away from work, increased didactics, supportive faculty, attending social events, and the presence of program-based wellness initiatives. Consequences of burnout include depression, substance abuse, and decreased job satisfaction. CONCLUSIONS: Reported burnout rates among surgical residents are high. A complex number of sociotechnical factors were found to contribute to burnout, yet many factors are also shown to mitigate burnout. Surgical residencies may address burnout by making changes based on the presence or absence of these factors within their program.