Youth cannabis use in Canada post-legalization: service providers' perceptions, practices, and recommendations.

BACKGROUND: In 2018, Canada legalized recreational cannabis use with the purpose of protecting youth and restricting access. However, concerns have been raised that this objective has not been met as rates of cannabis use among youth aged 16-24 have not declined. Youth cannabis use is associated with various adverse effects including psychosis, anxiety, depression, suicidality, respiratory distress, cannabinoid hyperemesis syndrome, and intoxications. Service providers play a crucial role in addressing youth cannabis use. This study aimed to understand Ontario service providers' perceptions, practices, and recommendations on youth cannabis use. METHODS: This mixed method study included a survey and two focus groups. The survey was distributed to mental health service providers serving youth aged 16-24 across Ontario who were given the option to participate in a focus group. The survey included closed and open-ended questions regarding perceptions, practices, and recommendations, while the focus groups explored these categories in greater depth. Descriptive statistics were used to analyze close-ended questions and interpretative content analysis was applied for open-ended questions. Focus group data were analyzed using thematic analysis. RESULTS: The survey was completed by 160 service providers and 12 participated in two focus groups. Regarding perceptions, 60% of survey participants agreed with legalization, 26% had a strong understanding of medical versus recreational cannabis, 84% believed that cannabis has physical and mental health risks, and 49% perceived stigmatization. Less than half of the survey participants reported screening or assessing cannabis use, 16% stated they are highly familiar with treating cannabis use, and 67% reported that they rarely work with families. Subthemes identified in the focus groups under perceptions included normalization and stigmatization, harms for youth, and stigma, racism, and discrimination. Subthemes under practice included cannabis not being the primary focus, challenges with screening, assessment, and intervention, and referral to specialized services. Both the survey and focus group participants recommended increasing public education, enhancing service provider training, improving regulation and policies, reducing stigma and minimization, improving service access, and providing more culturally responsive services. CONCLUSION: Youth cannabis use in Canada remains a significant public health concern, necessitating a more comprehensive plan to protect Ontario youth and reduce associated harms.

Testing a Middle -Range Theory of Heart Failure Self-Care.

A middle-range theory of heart failure self-care, derived from the self-care deficit theory of nursing, was tested among 175 Arab American older adults with heart failure. The middle-range theory achieved good statistical fit, but not all hypothesized relationships were supported. Specifically, conceptualizing basic conditioning factors as a single latent variable was not supported. However, individual factors of depression, social support, and time living with heart failure had a direct effect on both self-care agency and quality of life. Understanding predictors and outcomes of self-care within a theoretical framework is essential in caring for patients with heart failure.

Developing a Middle-Range Theory of Heart Failure Self-Care.

Middle-range nursing theories provide a bridge between the more abstract grand nursing theories, research, and clinical practice. As such, middle-range nursing theories derived from extant nursing theories are critical for developing and advancing both nursing science and practice. This paper describes the strategy used in developing a middle-range theory of heart failure self-care. After integrating theoretical and empirical literature, a hypothetico-deductive approach was used to develop the middle-range theory of heart failure self-care from Orem's theory of self-care. Theoretical substruction was used to provide a graphic representation of the conceptual-theoretical-empirical structure demonstrating the congruence between the theoretical and operational systems.

Recovery-oriented social work practice in mental health and addictions: a scoping review protocol.

INTRODUCTION: Social work is a key profession in the field of mental health worldwide and the profession has values that are aligned with a recovery paradigm. However, there are gaps in understanding how social workers are applying the recovery paradigm in practice. This study will scope and synthesise the literature related to recovery and social work practice in mental health and addictions. There will also be an exploration of best practices and gaps in recovery-oriented social work practice. METHODS AND ANALYSIS: Using a scoping review framework developed by Arksey and O'Malley, we will conduct our search in five academic databases: PsycINFO, Medline, CINAHL Plus, Sociological Abstracts and Social Services Abstracts. Articles meeting inclusion criteria will be charted to extract relevant themes and analysed using a qualitative thematic analysis approach. ETHICS AND DISSEMINATION: This review will provide relevant information about best practices and gaps in recovery-oriented social work practice in mental health and addictions. The study will inform the development of mental health curricula in social work programmes and clinical settings. Results will be disseminated through a peer-reviewed journal and at conferences focusing on mental health, addictions, and social work education. Ethics approval is not required for this scoping review.

Social work education and training in mental health, addictions and suicide: a scoping review protocol.

INTRODUCTION: Social workers are among the largest group of professionals in the mental health workforce and play a key role in the assessment of mental health, addictions and suicide. Most social workers provide services to individuals with mental health concerns, yet there are gaps in research on social work education and training programmes. The objective of this scoping review is to examine literature on social work education and training in mental health, addictions and suicide. METHODS AND ANALYSIS: Using a scoping review framework developed by Arksey and O'Malley, we will search for literature through seven academic databases: PsycINFO, Sociological Abstracts, CINAHL Plus, Social Sciences Abstracts, Education Source, ERIC and Social Work Abstracts. Two independent reviewers will screen articles utilising a two-stage process. Titles and abstracts will be reviewed in the first stage and full texts will be reviewed in the second stage. Selected articles that meet inclusion criteria will be charted to extract key themes and they will be analysed using a qualitative thematic analysis approach. ETHICS AND DISSEMINATION: This review will fill a knowledge gap in social work education and training in mental health, addictions and suicide. Ethics approval is not required for this scoping review. Through dissemination in publications and relevant conferences, the results may guide future research and education in social work.

Is there a relationship between adverse childhood experiences and problem drinking behaviors? Findings from a population-based sample.

OBJECTIVES: The study investigated the relationships between adverse childhood experiences (ACEs) and heavy and binge drinking, stratified by gender. STUDY DESIGN: Population-based cross-sectional study. METHODS: Data were retrieved from 2012 Behavioral Risk Factor Surveillance System. Over 39,000 individuals from five states were included in the study. Multiple logistic regression models were used to analyze the weighted data to determine factors associated with heavy and binge drinking for men and women. Each model included ACEs and controlled for sociodemographic variables, depression and smoking status. Bonferroni method was used to correct multiple comparisons. RESULTS: Only a few relationships between ACEs and problem drinking were observed. Among men, living with a drug abuser as a child was significantly associated with both heavy and binge drinking compared to men who did not reside with a drug abuser as a child. Childhood verbal abuse was linked with men's binge drinking compared to men who were not verbally abused as children. Among women, none of the nine ACEs examined in the study were associated with their heavy drinking. Only one ACE, verbal abuse, was found to be correlated with binge drinking, compared to women who did not experience childhood verbal abuse. In addition, we did not find the hypothesized, step-wise, graded relationship between the number of ACEs and heavy and binge drinking. However, the risk of heavy drinking was greater if the individual was exposed to four or more childhood adversities among both men and women. CONCLUSION: Study hypotheses were only partially supported. Future studies should unpack the interplay among gender, socio-economic status, ACEs, and problem alcohol consumption.

Nonurgent Use of the Emergency Department by Pediatric Patients: A Theory-Guided Approach for Primary and Acute Care Pediatric Nurse Practitioners.

Providing quality, cost-effective care to children and their families in the appropriate setting is the goal of nurse practitioners in primary and acute care. However, increased utilization of the emergency department (ED) for nonurgent care threatens cost-effective quality care, interrupts continuity of care, and contributes to ED overcrowding. To date, descriptive research has identified demographics of those using the ED for nonurgent care, the chief complaints of children seeking nonurgent care, the cost to the health care system of pediatric nonurgent care, and characteristics of associated primary care settings. Using Donabedian's Model of Quality of Healthcare and a Theory of Dependent Care by Taylor and colleagues, acute and primary care pediatric nurse practitioners can incorporate interventions that will channel care to the appropriate setting and educate caregivers regarding common childhood illnesses and the value of continuity of care. By using a theoretical framework as a guide, this article will help both acute and primary care pediatric nurse practitioners understand why parents seek nonurgent care for their children in the ED and actions they can take to ensure that care is provided in an optimal setting.

Preoperative ICD risk score variables predict 30-day readmission after implantable cardioverter defibrillator implantation in patients with heart failure.

OBJECTIVE: To determine if preoperative ICD Risk Score for Adverse Outcome (ICD-RSAO) would predict need for hospital 30-day readmission. BACKGROUND: Pre-analysis of National Cardiovascular Data Registry ICD database identified preoperative predictors of adverse outcomes associated with ICD implantation. METHODS: Logistic regression, descriptive statistics and Chi-square were used to examine the relationship between ICD-RSAO and 30-day readmission after ICD implantation. RESULTS: BUN >30, history of lung disease, NYHA Class IV and device implant during inpatient stay were predicative of 30-day readmission (P = 0.001; 95% CI = 0.58-0.79). Patients with a combination of two or more of four variables were more likely to be readmitted (Hosmer-Lemeshow (χ(2) = 3.44, P = 0.49), c-statistic = 0.71, and Nagelkerke R(2) = 0.15). CONCLUSION: Patients who have elevated BUN's, NYHA Class IV, chronic lung disease and ICD implantation during a concomitant hospital admission are at increased risk for readmission and need early follow up.

A Quality Improvement Project To Educate Nurses on Coudé Catheter Placement.

When only physicians are trained to insert Coudé catheters, there is an increased burden to both the patient and the providers. Training nurses for placement of Coudé catheters can improve care and allow for better use of health care resources.

Regional Hospital Collaboration and Outcomes in Medicare Heart Failure Patients: See You in 7.

OBJECTIVES: The objective of this study was to evaluate an interhospital collaborative approach to improve 7-day post-discharge follow-up (7dFU) rates and reduce 30-day readmissions in heart failure (HF) patients. BACKGROUND: Early post-discharge follow-up after HF hospitalization is associated with lower 30-day readmission rates. METHODS: Observational analyses of Medicare HF patients discharged from 10 collaborating hospitals (CH) participating in the Southeast Michigan See You in 7 Collaborative were carried out. We compared pre-intervention (May 1, 2011 to April 30, 2012) and intervention (May 1, 2012 to April 30, 2013) 7dFU rates, unadjusted 30-day readmissions, risk-standardized 30-day readmissions (RSRR), and Medicare payments in CH and Michigan nonparticipating hospitals (NPH). RESULTS: 7dFU rates increased but remained low in both groups (CH: 31.1% to 34.4%; p < 0.001; NPH: 30.2% to 32.6%; p <0.001). During the intervention period, unadjusted readmissions decreased significantly in both groups (CH: 29.0% to 27.3%; p <0.001; NPH: 26.4% to 25.8%, p = 0.004); mean RSRR decreased more in CH than in NPH (CH: 31.1% to 28.5%; p < 0.001; NPH: 26.7% to 26.1%, p = 0.02; p = 0.015 for intergroup comparisons). Findings were similar when CH outcomes were matched 1:1 with similar NPH outcomes. Combined Medicare payments for inpatient and 30 days of post-discharge care decreased by $182 in CH and by $63 in NPH (per eligible HF discharge). CONCLUSIONS: See You in 7 Collaborative participation was associated with significantly lower 30-day readmissions and Medicare payments in HF patients. Increases in 7dFU were modest, but associated processes aimed at this goal may have improved the transition from inpatient to outpatient care. Regional hospital collaboration to share best practices could potentially reduce HF readmissions and associated costs.

Impact of the Development of a Regional Collaborative to Reduce 30-Day Heart Failure Readmissions.

Thirty-day heart failure readmissions can be reduced if multiple interventions, such as 7-day postdischarge follow-up, are implemented, but this task is challenging for health systems. Ten hospitals participated in a multisystem collaborative implementing evidence-based strategies. The overall 30-day readmission rate was reduced more in the collaborating hospitals than in the noncollaborating hospitals (from 29.32% to 27.66% vs from 27.66% to 26.03%, P = .008). Regional collaboration between health care systems within a quality improvement project was associated with reduced 30-day readmission.

Potential to improve outcomes: causes of 30-day readmission after cardioverter defibrillator implantation.

Under newly restructured Centers for Medicare and Medicaid Services guidelines, hospitals are at risk for reduction in reimbursement for patients with heart failure (HF) who are readmitted within 30 days after discharge. Patients with HF who are admitted for an implantable cardioverter defibrillator (ICD) are routinely admitted with a primary diagnosis of HF. To reduce the occurrence of readmission, this article identifies the causes of 30-day readmission and recommends that patient follow-up after ICD placement should include assessment and management of HF symptoms.

Transcription factors RUNX1/AML1 and RUNX2/Cbfa1 dynamically associate with stationary subnuclear domains.

The runt-related transcription factors (RUNX/Cbfa/AML) are essential for cellular differentiation and fetal development. C-terminal truncations of RUNX factors that eliminate the targeting of these factors to subnuclear foci result in lethal hematopoietic and skeletal phenotypes. Here we demonstrate that in living cells the RUNX C-terminus is necessary for the dynamic association of RUNX into stable subnuclear domains. Time-lapse fluorescence microscopy shows that RUNX1 and RUNX2 localize to punctate foci that remain stationary in the nuclear space. By fluorescence recovery after photobleaching assays, both proteins are shown to dynamically associate at these subnuclear foci, with a 10 second half-time of recovery. A truncation of RUNX2, removing its intranuclear targeting signal (NMTS), increases its mobility by an order of magnitude, resulting in a half-time of recovery equivalent to that of EGFP alone. We propose that the dynamic shuttling of RUNX factors in living cells to positionally stabilized foci, which is dependent on the C-terminus, is a component of the mechanism for gene regulation in vivo.

Women's perceptions of personal cardiovascular risk and their risk-reducing behaviors.

BACKGROUND: Coronary heart disease is the leading cause of death in women. Risk factors include smoking, hypertension, dyslipidemia, diabetes mellitus, and obesity. Without an understanding of these riskfactors, women are poorly prepared to carry out preventive self-care actions to reduce their risk. OBJECTIVES: To describe perceptions of cardiovascular risk factors and risk-reducing behaviors among women with newly diagnosed coronary heart disease. METHODS: A descriptive study was done in a large midwestern suburban hospital. A nonprobability sample of 33 women with coronary heart disease completed a mail questionnaire. Data were collected by using the Coronary Heart Disease Knowledge Test, the Health-Promoting Lifestyle Profile II, and questions developedfor the study. RESULTS: Thirty-three women responded. Mean age was 65.64 years (range, 36-85 years; SD, 11.32 years); mean educational level was 12.67 years (range, 8-18 years; SD, 1.79 years). Most of the respondents could not identify personal cardiovascular risk factors; the risks identified were considerably fewer and differed from those documented in the women's medical records. Women reported moderate levels of most risk-reducing behaviors and low levels ofphysical activity. CONCLUSIONS: Women with coronary heart disease may not know what risk factors they have. Women must have their risk factors assessed and should be counseled about those risks.

Linkages of nuclear architecture to biological and pathological control of gene expression.

Functional interrelationships between components of nuclear architecture and control of gene expression are becoming increasingly evident. There is growing appreciation that multiple levels of nuclear organization integrate the regulatory cues that support activation and suppression of genes as well as the processing of gene transcripts. The linear organization of genes and promoter elements provide the potential for responsiveness to physiological regulatory signals. Parameters of chromatin structure and nucleosome organization support synergism between activities at independent regulatory sequences and render promoter elements accessible or refractory to transcription factors. Association of genes, transcription factors, and the machinery for transcript processing with the nuclear matrix facilitates fidelity of gene expression within the three-dimensional context of nuclear architecture. Mechanisms must be defined that couple nuclear morphology with enzymatic parameters of gene expression. The recent characterization of factors that mediate chromatin remodeling and intranuclear targeting signals that direct transcription factors to subnuclear domains where gene expression occurs, reflect linkage of genetic and structural components of transcriptional control. Nuclear reorganization and aberrant intranuclear trafficking of transcription factors for developmental and tissue-specific control that occurs in tumor cells and in neurological disorders provides a basis for high resolution diagnostics and targeted therapy. J. Cell. Biochem. Suppls. 30/31:220-231, 1998. © 1998 Wiley-Liss, Inc.