Recreation and collaboration within the Expanded Chronic Care Model: working towards social transformation.

Assisting people to live well with a chronic physical or mental health condition requires the creation of intersectoral community-based supports for chronic condition self-management. One important but underutilized resource for supporting chronic condition self-management in the community is recreation, which refers to relatively self-determined and enjoyable physical, social or expressive everyday activities. The Expanded Chronic Care Model (ECCM) provides a framework for identifying systems-level strategies to support self-management through increased access to community recreation opportunities. In this article, an occupation-based social transformation approach, which involves examining assumptions, considering contexts of daily activities and partnering to create meaningful social change, is used to examine the ECCM. Recommendations related to strengthening social change with a specific focus on collaborations and networks through recreation are provided. Through such collaborations, self-management of chronic conditions in community recreation contexts is advanced. Health providers and community-based recreation services providers are invited to be part of these intersectoral changes that will promote health amongst those living with chronic conditions.

Promising Practices for Making Recreation Programming Matter for People who Experience Mental Illness.

There is merit in understanding how recreation-oriented programs for adults living with mental illness address barriers to participation and how programming is structured to create safe and inclusive environments, resulting in programming that amplifies the benefits of recreation for mental well-being. Following an environmental scan of programs targeting adults living with mental illness in Canada, ten coordinators in community mental health settings were interviewed. Four themes were constructed to reflect characteristics deemed to be 'promising practices' related to recreation-oriented programming: (a) barriers and solutions to individual participation, (b) characteristics of welcoming and supportive environments,

Peer support for people with chronic conditions in rural areas: a scoping review.

INTRODUCTION: Chronic conditions are a growing healthcare concern. People living in rural regions are particularly affected because many barriers exist to accessing services and supports. Peer support for chronic condition self-management, where people living with chronic conditions learn about how to care for themselves and maintain their health from people also living with chronic conditions, is one approach gaining recognition. What remains unknown are the unique challenges and strategies associated with peer support for chronic condition self-management in rural contexts. In order to inform the development of peer supports in the authors' local context in rural eastern Canada, a scoping review was undertaken to discover community-based peer support initiatives for adults in rural settings living with chronic conditions. METHODS: The authors followed established scoping review methods to answer the research question What is known from the existing literature about the key features and potential formats of community-based peer support initiatives for adults living with chronic conditions in rural settings? Six databases (CINAHL, PubMed, Sociological Abstracts, Embase, Cochrane Libraries and PsycInfo) were searched using the following concepts: chronic conditions, peer support, community-based and rural context. Two researchers reviewed the titles and/or abstracts of the 1978 articles retrieved from the initial search to include articles that were in English, published in 2000 to 2014, and that explicitly discussed rural programs/interventions with peers that were community-based. The initial screen excluded 1907 articles, leaving 71 articles, which were read by two research members in light of the inclusion/exclusion criteria. Thirteen articles representing 10 separate programs were included and analyzed using qualitative content analysis. RESULTS: Included programs were from the USA, Australia and Canada. A range of formats (telecommunications only, in-person meetings only, or a combination of both) were used. Peer leaders had varied experiences with chronic conditions and received training in content and facilitation skills. Peer leaders were provided with ongoing support. Program participants received training on chronic conditions, and programs provided opportunities for social support and the development of new skills. Programs focused on creating social connections, reducing stigma, ensuring relevance and promoting empowerment. Of the nine programs that reported outcomes, eight reported positive outcomes and one reported mixed results. DISCUSSION: Consistent with the extant literature, the programs identified unique issues faced by people with chronic conditions in rural areas that these programs addressed. The key findings of this scoping review are as follows: 1. A combination of telecommunications with some face-to-face meetings can support the accessibility of peer support programs in rural areas. 2. Core elements of these programs are the provision of social support and skill development. 3. Peer leaders benefit from skills training and ongoing support. 4. Sustainability of such programs is complex and requires multiple strategies. CONCLUSIONS: Cultural relevance, ongoing support and the use of telecommunications were key features of rural peer support programs. Guiding questions to facilitate a community consultation around these findings are provided. Peer support chronic condition self-management programs require further research.

Not Just One Long Vacation: Revisiting the Importance of Lifestyle Planning in the Transition to Retirement.

BACKGROUND: There is a need to further understand the nature and role of planning for one's lifestyle in retirement. OBJECTIVE: The purpose of this study was to examine retirement planning and how it impacts perceived preparedness and satisfaction with the retirement transition, as well as to explore personal experiences of retirement. METHODS: Canadians (n = 748) fully or partly retired participated in an online survey that included quantitative questions about perceived retirement preparedness and satisfaction and open-ended questions about retirement goals, fears, challenges, and advice. FINDINGS: Results determined that while both financial and lifestyle planning were significant predictors of higher perceived preparedness, only lifestyle planning was a significant predictor for satisfaction. Overall, no gender differences were detected. Open-ended comments highlighted the importance of planning for one's lifestyle in retirement, including meaningful activities and social connections. DISCUSSION: Individualized career advising as well as group-based educational programs or peer-assisted learning initiatives appear warranted to support people in planning for their lifestyle in retirement.

Onset, Maintenance, and Cessation of Effect of Galcanezumab for Prevention of Migraine: A Narrative Review of Three Randomized Placebo-Controlled Trials.

INTRODUCTION: Galcanezumab, a humanized monoclonal antibody that binds to calcitonin gene-related peptide, is approved for the preventive treatment of migraine in adults. It is self-administered once monthly as a subcutaneous injection. This paper describes the time course of effect of galcanezumab in patients with episodic and chronic migraine. METHODS: Data were based on three double-blind, placebo-controlled, phase 3 studies. Patients (1773 episodic and 1113 chronic) were randomized (2:1:1) to monthly doses of placebo, galcanezumab 120 mg with a 240 mg loading dose, or galcanezumab 240 mg (January 2016-March 2017). Onset of effect was determined using a sequential analysis approach based on earliest time point at which galcanezumab achieved and subsequently maintained statistical superiority to placebo. Maintenance of effect was a comparison of the percentages of galcanezumab- and placebo-treated patients with maintenance of at least 50% response at the individual patient level. Cessation of effect was determined during a 4-month post-treatment period on the basis of change from baseline in monthly migraine headache days. RESULTS: Galcanezumab led to a lower percentage of patients who had a migraine headache on the first day after injection, provided maintenance of effect throughout the duration of the double-blind treatment period, and gradually lost effect without signs of rebound headache throughout the post-treatment period in most patients with episodic and chronic migraine. CONCLUSION: Galcanezumab is a novel preventive therapeutic option for adult patients with migraine that has early onset of action, maintenance of effect, and gradual reduction of effect upon treatment cessation. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02614183 (EVOLVE-1); NCT02614196 (EVOLVE-2); NCT02614261 (REGAIN).

Diagnosis and treatment of the menstrual migraine patient.

Women presenting with recurrent disabling headache frequently have migraine; but physicians need to rule out other headache disorders before they reach a diagnosis of migraine with or without aura. Many women who experience migraine in close association to their menstrual cycle may meet the diagnostic criteria for either menstrually related migraine (MRM), or pure menstrual migraine (PMM). Once an accurate diagnosis is made, treatment may be established to best suit the individual needs of that patient. Most women will find that migraine associated with hormone fluctuations respond well to standard treatment approaches including pharmacological and nonpharmacological treatments. Pharmacological approaches include acute, preventive, and short-term prophylaxis. Herein we review the difference between non-menstrual migraine, PMM, and MRM and identify effective treatment strategies for appropriate management of migraine associated with hormonal fluctuations.

Menstrual migraine: case studies of women with estrogen-related headaches.

This paper presents 2 case scenarios that illustrate the complexity of diagnosing and managing migraine associated with hormonal changes. Migraine is commonly associated with comorbidies such as depression, anxiety, obesity, cardiovascular disease, as well as other conditions, thereby making management more challenging for the physician and the patient. The first case is a 35-year-old woman who has migraine almost exclusively during menstruation. She is under a physician's care for long-term management of premenstrual dysphoric disorder (PMDD). Achieving a differential diagnosis of pure menstrual migraine is illustrated, and a detailed treatment plan including use of a migraine miniprophylaxis protocol, management of her PMDD, and prescription of acute treatment medications is reviewed. The second case scenario describes the diagnosis of menstrually associated migraine in a woman who suffers from a frequent disabling migraine along with work-related anxiety and depression. This paper reviews her differential diagnosis, laboratory testing, treatment plan, including management of her comorbid anxiety and depressive symptoms.

When distress gives way to possibility: the relevance of leisure in adjustment to disability.

Previous research has suggested that leisure assists in coping with and adjusting to negative life events in at least four different ways: by being diverting, by generating hope, by restoring some aspects of self, and by affording a context for personal transformation. An assault to the brain, whether due to a stroke, chronic disease, injury or trauma, would be such an event and would likely by served by leisure in the same way. This paper reviews the supporting evidence regarding the value and utility of leisure in coping with and adjusting to living with a disability. The concept of posttraumatic growth is then examined and related research is reviewed with particular attention to the relevance of leisure. Finally, considerations are offered for incorporating leisure as an aspect of treatment and care for those working in neurorehabilitation settings.

Leisure as a resource for successful aging by older adults with chronic health conditions.

Drawing on the model of Selective Optimization with Compensation (SOC) (Baltes & Baltes, 1990), the purpose of this article is to examine leisure-related goals of older adults with chronic conditions and the strategies they use to not only successfully manage their chronic health conditions but live well with them. Semi-structured in-person interviews were conducted with 18 community-dwelling older adults (nine males, nine females, ages 58-87 years) with a variety of chronic conditions. Inductive and deductive within and cross-case thematic analyses resulted in descriptions of changes and continuity in participants' leisure participation following the onset of their chronic condition and construction of four themes: drawing on existing resources for continued involvement, setting leisure-based goals, using strategies to get more out of life, and more than managing: living a life of meaning. Implications for promoting successful aging are discussed, specifically the benefits of incorporating information and skill-building to help older adults recognize that leisure can be a resource for healthy aging and self-managing their chronic health condition.

Is "raging" good for health?: older women's participation in the Raging Grannies.

We explore the meanings and potential health-related benefits of older women's participation in the Raging Grannies, a voluntary activist organization. The group's activities are focused on social and political protest while also challenging stereotypes about aging women. Drawing on qualitative interview and focus group data, we employed empowerment theory as a means to examine the ways in which participation in the Raging Grannies contributed to older women's personal empowerment. Results were constructed around four key themes: (1) personal and social factors influencing involvement in the Raging Grannies; (2) leisure as a context for "raging," (3) empowering processes within the Raging Grannies, and (4) empowering outcomes resulting from participation.

Oral sumatriptan for the acute treatment of probable migraine: first randomized, controlled study.

OBJECTIVE: To evaluate the efficacy and tolerability of sumatriptan tablets in adults who meet International Headache Society (IHS) criteria for probable migraine but who do not meet IHS criteria for migraine with or without aura. BACKGROUND: Headaches with some but not all of the features of migraine meet criteria for probable migraine, a form of migraine recognized by the IHS. Probable migraine attacks are also prevalent and frequently underdiagnosed. METHODS: This was a randomized, multicenter, double-blind, placebo-controlled, parallel-group study. Adults (18 to 65 years) with a 1-year history of headaches that met 2004 IHS criteria for probable migraine without aura (same operational definition as 1988 IHS migrainous disorder) were eligible for enrollment. All patients were triptan- and ergot-naïve and had never been diagnosed with migraine. Patients were randomized in a 1:1:1:1 fashion to receive sumatriptan 25, 50, or 100 mg conventional tablets or matching placebo and were instructed to treat a single moderate or severe probable migraine attack. A post hoc analysis was conducted to evaluate the population of patients who achieved headache relief sustained throughout the immediate posttreatment period. Patients who reported relief within 2 hours and subsequently lost headache relief within 4 hours were considered nonresponders. RESULTS: At 2 hours, more patients treated with sumatriptan achieved headache relief, the primary efficacy measure, compared with placebo, but differences only approached statistical significance for 100 mg (P= .053). The 2-hour headache relief rate in the sumatriptan 25 or 50 mg groups was not significantly different than placebo. The time to use of rescue was significantly shorter in the placebo group compared with the sumatriptan 100 mg group (P= .002). The time to use of rescue in the sumatriptan 25 or 50 mg groups was not significantly different than placebo. More patients treated with placebo (22%) lost headache relief within 4 hours compared with patients treated with sumatriptan 25 mg (17%), 50 mg (14%), or 100 mg (7%). A post hoc analysis demonstrated that at 2 hours, headache relief sustained through 4 hours (S 0-4 hours) was achieved in 44%, 49%, and 57% of patients treated with sumatriptan 25, 50, and 100 mg, respectively, compared with 34% of patients treated with placebo (P < .05 for sumatriptan 50 and 100 mg vs. placebo). All doses of sumatriptan were well tolerated and no serious adverse events were reported. CONCLUSION: These results suggest that oral sumatriptan may be effective and is well tolerated for the acute treatment of probable migraine without aura, however, the difference between sumatriptan and placebo was not statistically significant for the a priori defined primary endpoint.