Family matters in Canada: understanding and addressing family homelessness in Ontario.

BACKGROUND: Homelessness is becoming an international public health issue in most developed countries, including Canada. Homelessness is regarded as both political and socioeconomic problems warranting broad and consistent result-oriented approaches. METHODS: This paper represents the qualitative findings of a project that explored risk factors associated with family homelessness and strategies that could mitigate and prevent homelessness among families using a focused ethnographic study guided by the principles of participatory action research (PAR). The sample includes 36 family members residing at a family shelter who participated in focus groups over two years (between April 2016 and December 2017). Most of the participants were single-parent women. RESULTS: The analysis yielded five major themes including, life challenges, lack of understanding of the system, existing power differentials, escaping from hardship, and a theme of proposed solutions for reducing family homelessness in the community. CONCLUSION: The findings illustrated the complex nature of family homelessness in Ontario; that the interaction of multiple systems can put families at risk of homelessness. Findings from this study underscore the need for urgent housing protocols aimed at educating homeless families on how to navigate and understand the system, enhance their conflict resolution skills, and develop strategies beyond relocation to help them to cope with difficulties with housing.

Family Matters in Ontario: Understanding and Addressing Homelessness Among Newcomer Families in Canada.

BACKGROUND: Canada, a key player in global humanitarian affairs is faced with enormous challenges in relation to housing and homelessness. As international migration continues to occur, homelessness among immigrant families is increasing worldwide; a situation that needs urgent attention and action. PURPOSE: We designed this study to explore the needs of homeless families, identify risk factors associated with family homelessness, and to find strategies that could assist in mitigating and preventing homelessness among families in Canada. METHODS: This paper reports qualitative findings from a focused ethnographic study embedded in participatory action research that explored the experiences of 11 immigrant families with housing challenges in Ontario Canada. RESULTS: Thematic analysis yielded five (5) major themes: life challenges; lack of understanding of the system; difficulty with conflict resolution; escaping as a solution for hardship; and reducing immigrant family homelessness. CONCLUSION: Findings from the study highlight the urgent need for advocacy and a well-tailored supportive housing policy to address family homelessness in Ontario.

Timely reminder interventions to improve annual Papanicolaou (Pap) smear rates among HIV-infected women in an outpatient center of southern Nevada: a short report.

Current guidelines recommend annual Papanicolaou (Pap) smears for human immunodeficiency virus (HIV)-infected women for cervical cancer screening. Rates for such screening in Nevada are below the national rate. Our cohort includes 485 eligible HIV-infected adult women from an outpatient center in Southern Nevada of which only 12 women had obtained a Pap smear in the past year. An intervention was conducted from June 2015 to September 2015, in which reminders to schedule a Pap smear were sent to the remaining cohort of 473 women via sequential text messaging, followed by phone call attempts. Of all subjects, 94% contacted by text messages and 41% contacted by phone calls were successfully reached. There was an increase in the rate of completed Pap smears from 2.5% (12/485) at baseline to 11.8% (56/473) after interventions (p < 0.0001) in a period of three months. Out of the 68 Pap smear results, 20 (29.4%) were abnormal. Our intervention, utilizing methods of communication such as text messaging and phone calls, markedly increased the rate of completed Pap smear screening in our population.

Use of physical therapy in patients hospitalized with a diagnosis of generalized weakness: a retrospective study.

In a retrospective analysis of data from a national database, we observed and compared the presence of complications, lengths of stay, inflation-adjusted charges, and discharge statuses of two groups of patients hospitalized with a primary diagnosis of generalized weakness who did or did not receive physical therapy (PT) services. From a sample of patients (n = 38,991 cumulative from 1988 through 2003) from the Nationwide Inpatient Sample (NIS), 2.3% of patients admitted to the hospital with generalized weakness received PT intervention. Patients hospitalized with a primary diagnosis of generalized weakness who received PT services were sicker, had more selected secondary complications, and were demographically and socioeconomically dissimilar from patients who did not receive PT services. Quantitative analyses indicate that PT patients had longer inpatient hospital stays, more nonroutine discharges, and higher inflation-adjusted charges. The results are consistent with the interpretation that outcomes such as those examined here (nonroutine discharge, length of stay, and charges at discharge) are related to referral patterns in which only the most serious comorbidities qualify patients for referral for PT intervention services.

Real-time updates of meta-analyses of HIV treatments supported by a biomedical ontology.

Meta-analyses involve a systematic statistical explanation of available evidence and are a commonly used systematic reviewing strategy for addressing health related scientific research. Publication biases often delay reporting of meta-analyses and subsequent policy making. Ontologies have the capacity to provide real time meta-analyses that can reduce publication delay. The purpose of this study was to describe the meta-analytic process of a recently revised ontology. Three recently published meta-analyses were replicated using an ontology that extracts appropriate statistical "tags" from the originally reviewed published manuscripts. The ontology was able to closely represent the findings of the original meta-analysis including funnel, forest, and summary statistics. The use of an ontology could improve the speed in which meta-analytic publications occur as well as potentially standardizing the required elements within a randomized controlled trial. The findings in this study demonstrate similar ontological output as used in the Trial Bank Project with decreased time requirements of the manuscript author and the software programmers. The use of an ontology may improve the reporting of meta-analysis and, when combined with an open access website, should assist in timely policy-making decisions by healthcare providers.

Fifth metatarsal stress fractures in elite basketball players: evaluation of forces acting on the fifth metatarsal.

Our hypothesis in this study was that significant forces act on the fifth metatarsal during certain maneuvers commonly performed while playing basketball and that medial arch support influences these forces. Eleven male collegiate basketball players participated in this study. Electronic pressure sensors capable of dynamic readings were inserted into the players' shoes, and surface electromyographic (EMG) electrodes were placed over the peroneus longus and brevis muscles. The players performed 3 common maneuvers postulated to place maximal stress on the fifth metatarsal. The maneuvers were performed in a standard basketball shoe, then in a shoe with an orthosis supporting the arch. During each of these maneuvers, EMG activity of the ankle everters was recorded, along with maximal force, total work, and time elapsed beneath the fifth metatarsal.

Validation of the NHANES ADL scale in a sample of patients with report of cervical pain: factor analysis, item response theory analysis, and line item validity.

BACKGROUND: Few functional outcomes scales have used Item Response Theory (IRT) for validation. IRT allows individual line item validations and offers substantial advantages over classic methods of scale validation or the simplest from of IRT known as Rasch. Rasch analysis reduces data to dichotomous variables thus decreasing the sensitivity of Likert-type data responses. PURPOSE: The purpose of this study was to create an outcome scale associated with the latent trait of functioning and disability, validated using IRT, in a population with report of cervical pain. METHODS: Using the NHANES database, a recently created scale (NHANES ADL scale) was analysed using factor analysis, internal analyses of consistency, IRT, and comparison with internal measures of functioning and disability. RESULTS: The newly created NHANES ADL scale demonstrated uni-dimensionality, was internally reliable, and was correlated to internal measures of functioning and disability. Additionally, the majority of the scale items demonstrate strong discrimination and suitable thresholds. DISCUSSION: The NHANES ADL scale effectively measures physical, social, and emotional disability in patients with a cervical impairment, and may be an efficient measure of perceived limitations from working and generalized daily physical activity. CONCLUSION: The newly created NHANES ADL scale demonstrates internal consistency, unidimensionality, and line item validity. The NHANES ADL scale appears to be a useful instrument in measurement of functioning and disability in patients with report of cervical pain.

Cross-cultural adaptation and validation of the Brazilian Portuguese version of the Neck Disability Index and Neck Pain and Disability Scale.

STUDY DESIGN: This study's design was a cross-cultural validation of the Neck Disability Index and Neck Pain and Disability Scale. OBJECTIVES: This study's objective was to translate, culturally adapt, and validate a Brazilian Portuguese version of the Neck Disability Index (NDI-BR) and the Neck Pain and Disability Scale (NPDS-BR). SUMMARY OF BACKGROUND DATA: Although several valid measures exist for measurement of neck pain and functional impairment, these measures have yet been validated in Brazilian Portuguese. Successful linguistic and cultural translation may allow appropriate cross-cultural comparison for clinical and laboratory research analysis. METHODS: The NDI-BR and NPAD-BR were culturally and linguistically translated from English into Brazilian Portuguese. The translated version of the instrument was administered to 203 patients at a midsize hospital in southern Brazil. Psychometric evaluation included factor analysis, internal reliability measures, test-retest reliability at 1 and 7 days, and criterion validity comparison with the Brazilian version of the SF-36. RESULTS: Factor analyses demonstrated a single-factor subscale for the NDI-BR and three subscales for the NPDS-BR. An item analysis showed a high degree of internal consistency for the NDI-BR (r = 0.74) and the three subscales of the NPDS-BR (subscale 1, r = 0.89; subscale 2, r = 0.81; subscale 3, r = 0.72). Test-retest reliability was also acceptable at for the NDI-BR (0.98 at baseline and 0.48 at 7 days) and subset one (0.96 at baseline and 0.91 at 7 days), subset 2 (0.96 at baseline and 0.62 at 7 days), and subset 3 (0.52 at baseline and 0.45 at 7 days) of the NPDS-BR. Construct validity was established during comparison of the Brazilian version of the SF-36. Only items associated with physical role, bodily pain, and emotional role failed significant correlation. CONCLUSIONS: A reliable and valid Portuguese version of the Neck Disability Index and Neck Pain and DisabilityScale was developed, which will facilitate the examination of functional performance within a large patient population, as well as cross-cultural comparisons.

Dimensionality, internal consistency, and item analysis of the National Health and Nutrition Examination Surveys activities of daily living instrument among patients with report of low back pain.

OBJECTIVE: To measure selected psychometric properties of individual item responses from the National Health and Nutrition Examination Surveys (NHANES) activities of daily living (ADL) instrument among a population of patients with low back pain (LBP). METHODS: The study group consisted of 926 individual attendees of a traditional medical appointment. All subjects had self-reported LBP and completed questions within the NHANES ADL instrument, a 16-item questionnaire designed to represent the internal latent construct of ADL. Data analyses included exploratory factor analysis, internal consistency measures, and polytomous (graded) item response theory. RESULTS: The NHANES ADL instrument is a unidimensional and internally consistent measure of ADL. Graded item response theory analyses indicated that although some variability exists, all 16 single items were sensitive measures of the latent construct of ADL. Most item responses demonstrated high discrimination. CONCLUSION: Individual use of selected items of the NHANES ADL instrument may further improve the capacity of the health care provider in measuring and recording dysfunction associated with LBP.

Validation of an item bank in a sample of community-dwelling survivors of a stroke.

PURPOSE: The purpose of this study was to validate an item bank of questions associated with activities of daily living (ADL), using graded item response theory (G-IRT), in a sample of community-dwelling survivors of a stroke. METHODS: The study sample consisted of 364 community-dwelling individuals who reported a recent history of stroke. Sixteen line items from the 1999-2000 National Health and Nutrition Examination Surveys (NHANES) survey were analyzed using factor analysis, internal analyses of consistency, and G-IRT. RESULTS: The 16 line items demonstrated unidimensionality and were internally reliable. Thirteen line items demonstrated good discrimination and suitable thresholds. The majority of items exhibited appropriate sensitivity across the entire spectrum of functional severity indicating that these items closely reflected the relationship of decreased function with increased severity of illness. CONCLUSION: Each of the 13 items is scale independent, is valid for measurement of functional impairment, and may be applicable for use in a scale for assessment of functional change in community-dwelling stroke survivors.