Navigating interprofessional boundaries: Midwifery students in Canada.

The literature on professional socialization focuses on how students adopt and internalize professional identities and values, and assumes that boundary work is essential to learning how best to practice their profession. However, a focus on boundary work in the context of midwifery training - which is embedded in the gendered and hierarchical landscape of maternity care - is lacking. Thus, this article examines how Canadian student-midwives learn to navigate and negotiate interprofessional boundaries. Grounded in a symbolic interactionist approach, it draws on 31 semi-structured qualitative interviews from a mixed-methods national study on midwifery retention, explores how midwifery students make sense of the tensions among midwives, physicians, and nurses, and describes what strategies they utilize when navigating boundaries. Our analysis, based in constructivist grounded theory, revealed that participants learned about interprofessional tensions in clinical placement encounters via direct or indirect interactions with other healthcare professionals, and that strategies to navigate these tensions included educating others about midwifery training and adopting a learner identity. This article proposes that the process of professional socialization enables to reshape professional boundaries and that students are not only learners but also agents of change. These findings may yield practical applications in health education by highlighting opportunities for improving interprofessional collaborations.

Prevalence, comorbidities and mediators of childhood anxiety disorders in urban Turkey: a national representative epidemiological study.

PURPOSE: The aim of this study is to evaluate the prevalence of anxiety disorders, its correlation with sociodemographic characteristics, its comorbidities with other psychiatric disorders and its predictors in school-aged children. METHODS: This study is part of a representative, multi-centered national study that is planned by the Turkish Association of Child and Adolescent Mental Health to evaluate the prevalence of psychopathology among elementary school students in Turkey between the years 2014-2015. Children are screened via Kiddie Schedule for Affective Disorders and Schizophrenia for School Age Children Present and Lifetime Version. Impairment is assessed by a 3-point Likert type scale independently by the parent and the teacher. The final sample included 5842 children with the mean age of 8.7 years. RESULTS: The prevalence of any anxiety disorder without considering impairment is 16.7% and considering impairment is 5.2% in children according to our study. We found significant differences for comorbid Attention Deficit Hyperactivity Disorder, Disruptive Behavior Disorder, Mood Disorders, Tic Disorders, Obsessive Compulsive Disorder, Enuresis Nocturna, Encopresis, and Intellectual Disability. Having a history of paternal physical disorder, living in the regions of Marmara, Mediterranean and Black Sea were found to be the main predictors of having childhood anxiety disorders according to the logistic regression analysis. CONCLUSION: Better understanding of childhood anxiety disorders, comorbid conditions and predictors will result in earlier diagnosis and more appropriate treatment.

Hours of work and on-call weeks preferences of Canadian midwives: relationships with intention to stay in the profession.

BACKGROUND: Midwives have long workdays and work many weeks on call. There is a concern that these extended work schedules can negatively affect their intention to stay in the profession. PURPOSE: This study provides evidence on Canadian midwives' preferences for and experiences with policies and guidelines which limit the hours of work and weeks per year preferred to be on call, and examines the relationship between preferences and midwives' intention to stay in the profession. METHODS: Data come from our 2018 pan-Canadian survey of midwives. Descriptive statistics of 720 midwives' preferences and experiences are provided. In the correlations followed by the OLS regressions, 596 midwives' data are used to test the associations between preferences and intention to stay in the profession. STATA (version 15) is used. A thematic analysis of 274 midwives' responses to the open-ended survey question is conducted to give voice to midwives on what can be done for retention. RESULTS: Three quarters of the 720 respondents prefer policies and guidelines to limit hours of work in a 24-hour period, though less than half have policies and guidelines on hours of work. More than half prefer to have fewer on-call weeks or never to be on call, less than a third prefer same number of on-call weeks, and only 2% prefer more weeks to be on call. Midwives are currently working on average 33 weeks per year on call. OLS regression analysis shows that 'met preference' for hours of work and on-call weeks are positively associated with intention to stay. In responding to the open-ended survey question, midwives recommend limiting the consecutive hours of work and on-call weeks to manageable hours and weeks to retain them in the profession. CONCLUSION: Midwives whose preferences are met are the ones intending to stay in the profession. There is, however, a large number of midwives with 'unmet needs' preferring to have policies and guidelines to limit the hours but do not have that currently, and would like to work fewer weeks on call than currently. These are the midwives who are not intending to stay in the profession.

Violence, Harassment, and Turnover Intention in Home and Community Care: The Role of Training.

BACKGROUND: Violence and harassment affect healthcare workers' well-being and career decisions in the home and community care sector. PURPOSE: The objective of this study is to assess the role of training in alleviating the relationship between violence and harassment at work and turnover intention among personal support workers (PSWs). METHODOLOGY/APPROACH: Cross-sectional survey data from 1401 PSWs in Ontario, Canada are analyzed with structural equation modeling. Utilizing a resource perspective, the associations between job demands (i.e., violence and harassment at work), personal resources (i.e., self-esteem), job resources (i.e., workplace violence training and challenging task training), stress, and intention to stay among personal support workers (PSWs) are examined. RESULTS: Challenging task training is positively associated with self-esteem and negatively associated with stress, whereas workplace violence training does not have a significant association with either variable. Stress has a negative relationship with intention to stay. Self-esteem is the mediator of both associations between violence and harassment at work and stress and between challenging task training and stress. DISCUSSION: The results point to varied degrees of training effectiveness that may be shaping turnover decisions of PSWs who experience violence and harassment in home and community care organizations. PRACTICE IMPLICATIONS: There seems to be a need to assess and redesign workplace violence training. Home and community care managers might be able to lower the impact of violence and harassment on PSWs' turnover by providing training that is not directly related to workplace violence and harassment.

The influence of autonomy on personal support workers' job satisfaction, capacity to care, and intention to stay.

Using survey data collected in Ontario, Canada, we explore the impacts of autonomy on community-based Personal Support Workers' intrinsic job satisfaction, capacity to care for and about clients, and intention to continue working in home care. Autonomy was measured as "freedom to decide how to do your job" and "working on your own." Findings show that freedom to do your job and working on your own are both positively associated with job satisfaction and capacity to care, and indirectly increase intention to stay through their relationships with job satisfaction and capacity to care. We suggest that policies should allow personal support workers to make decisions about how to do their job within the care plans provided, to facilitate retention of this highly needed workforce.

Evaluation of caregiver-friendly workplace policy (CFWPs) interventions on the health of full-time caregiver employees (CEs): implementation and cost-benefit analysis.

BACKGROUND: Current Canadian evidence illustrating the health benefits and cost-effectiveness of caregiver-friendly workplace policies is needed if Canadian employers are to adopt and integrate caregiver-friendly workplace policies into their employment practices. The goal of this three-year, three study research project is to provide such evidence for the auto manufacturing and educational services sectors. The research questions being addressed are: What are the impacts for employers (economic) and workers (health) of caregiver-friendly workplace policy intervention(s) for full-time caregiver-employees? What are the impacts for employers, workers and society of the caregiver-friendly workplace policy intervention(s) in each participating workplace? What contextual factors impact the successful implementation of caregiver-friendly workplace policy intervention(s)? METHODS: Using a pre-post-test comparative case study design, Study A will determine the effectiveness of newly implemented caregiver-friendly workplace policy intervention(s) across two workplaces to determine impacts on caregiver-employee health. A quasi-experimental pre-post design will allow the caregiver-friendly workplace policy intervention(s) to be tested with respect to potential impacts on health, and specifically on caregiver employee mental, psychosocial, and physical health. Framed within a comparative case study design, Study B will utilize cost-benefit and cost-effectiveness analysis approaches to evaluate the economic impacts of the caregiver-friendly workplace policy intervention(s) for each of the two participating workplaces. Framed within a comparative case study design, Study C will undertake an implementation analysis of the caregiver-friendly workplace policy intervention(s) in each participating workplace in order to determine: the degree of support for the intervention(s) (reflected in the workplace culture); how sex and gender are implicated; co-workers' responses to the chosen intervention(s), and; other nuances at play. It is hypothesized that the benefits of the caregiver-friendly workplace policy intervention(s) will include improvements in caregiver-employees' mental, psychosocial and physical health, as well as evidence of cost-benefit and cost-effectiveness for the employer. DISCUSSION: The expected project results will provide the research evidence for extensive knowledge translation work, to be carried out in collaboration with our knowledge transition partners, to the employer/human resources and occupational health/safety target populations. TRIAL REGISTRATION: ISRCTN16187974 Registered August 25, 2016.

Health and safety matters! Associations between organizational practices and personal support workers' life and work stress in Ontario, Canada.

BACKGROUND: The home and community care sector is one of the fastest growing sectors globally and most prominently in mature industrialized countries. Personal support workers (PSWs) are the largest occupational group in the sector. This paper focuses on the emotional health of PSWs working in the home and community care sector in Ontario, Canada. The purpose of this paper is to present evidence on the associations between PSWs' life and work stress and organizational practices of full-time and guaranteed hours, and PSWs' perceptions of support at work and preference for hours. METHODS: Data come from our 2015 survey of 1543 PSWs. Dependent variables are life and work stress. Independent variables are: objective organizational practices of full-time and guaranteed hours, and subjective organizational practices of perceived support at work, and preferred hours of work. Descriptive statistics, correlations and ordinary least square regression analyses with collinearity tests are conducted. RESULTS: Organizational practices of employing PSWs in full-time or guaranteed hours are not associated with their life and work stress. However, those who perceive support from their organizations are also the ones reporting lower life and work stress. In addition, those PSWs perceiving support from their supervisor report lower work stress. PSWs would like to work in their preferred hours, and those who prefer to work more hours report lower life and work stress, and conversely, those who prefer to work less hours report life and work stress. CONCLUSION: For PSWs in home and community care, perceived support from their organizations and supervisors, and employment in preferred hours are important factors related to their life and work stress.

Home Care Workers' Skills in the Context of Task Shifting: Complexities in Care Work.

Task shifting, which involves the transfer of care work from regulated health-care professionals to home care workers (HCWs), is a strategy to ensure the efficient delivery of home care services in Canada and internationally. Using a feminist political economy approach, this paper explores the effects of task shifting on HCWs' skills. Task shifting may be understood as a form of downward substitution-and an effort to increase control over workers while minimizing costs-as some of health-care professionals' responsibilities are divided into simpler tasks and transferred to HCWs. Our interviews with 46 home health-care providers in Ontario, which focused explicitly on HCWs' role in care provision, problematize the belief that "low skilled" care workers have little control over their work. HCWs' skills become more complex when they do transferred tasks, and HCWs sometimes gain greater control over their work. This results in increased autonomy and mastery for many HCWs. In turn, this serves to reinforce the intrinsic rewards of care work, despite the fact that it is low paid and undervalued work.

Task shifting policy in Ontario, Canada: does it help personal support workers' intention to stay?

The objective of this paper is to analyze the impact of task shifting policy on personal support workers' (PSWs) intention to stay in home care. Data were collected through interviews with 46 home care staff of a large home care organization in Ontario, Canada. Interviews were transcribed, coded, and a thematic analysis was conducted using a qualitative software package. Half of the study participants mentioned that task shifting increases PSWs' intention to stay in home care, while less than a quarter commented that task shifting increases PSWs intention to leave. Results show that the implementation of task shifting policy in Ontario, Canada may contribute to personal support workers' intention to stay; however, inadequate compensation may negatively affect intention to stay and should be addressed. We recommend policy-makers consider appropriate compensation to assist PSWs in effectively executing shifted tasks.

Frozen yogurt with added inulin and isomalt.

The objective of this study was to produce a frozen yogurt containing low fat and no added sugar. Samples containing 5% polydextrose, 0.065% aspartame and acesulfame-K mixture, and different levels of inulin and isomalt (5.0, 6.5, and 8.0%) were produced at pilot scale and analyzed for their physical and chemical properties including proximate composition, viscosity, acidity, overrun, melting rate, heat shock stability, as well as sensory characteristics, and viability of lactic acid bacteria. With the addition of inulin and isomalt, viscosity increased by 19 to 52% compared with that of sample B (reduced-fat control). The average calorie values of samples substituted with sweeteners were about 43% lower than that of original sample. Low-calorie frozen yogurt samples melted about 33 to 48% slower than the reduced-fat control sample at 45 min. Based on quantitative descriptive profile test results, statistically significant differences among products were observed for hardness, iciness, foamy melting, whey separation, and sweetness characteristics. The results of principal component analysis showed that the sensory properties of the sample containing 6.5% inulin and 6.5% isomalt were similar to those of control. Lactic acid bacteria counts of frozen yogurt were found to be between 8.12 and 8.49 log values, 3 mo after the production. The overall results showed that it is possible to produce an attractive frozen yogurt product with the incorporation of inulin and isomalt with no added sugar and reduced fat.

Flexible employment and nurses' intention to leave the profession: The role of support at work.

OBJECTIVES: The objectives of this paper are to examine (1) the association between flexible employment and nurses' intention to leave the profession, and (2) whether or not support at work mediates the association between flexible employment and nurses' intention to leave the profession. Flexible employment is analyzed objectively using non-permanent contract, part-time employment status, casual employment status, involuntary hours and on-call work, and subjectively using job insecurity. Support at work refers to organizational, supervisor and peer support. METHODS: Data come from our survey of 1396 nurses employed in three teaching hospitals in Southern Ontario. Descriptive statistics are provided. Bivariate correlations, hierarchical regression analysis and mediation tests are conducted. RESULTS: Compared to those in full-time employment, nurses in part-time employment do not intend to leave the profession. None of the other objective flexible employment factors are associated with intention to leave the profession. Perceived job insecurity is associated with intention to leave the profession. Low support at work contributes to intention to leave the profession and mediates the association between job insecurity and intention to leave the profession. CONCLUSIONS: The study provides evidence to health sector managers and policy makers that part-time employment, perceived job security and support at work are important factors to consider in efforts to retain nurses in the profession.

Casualized employment and turnover intention: home care workers in Ontario, Canada.

The purpose of this paper is to examine the associations between casualized employment and turnover intention in home care. Casualized employment refers to employment conditions of non-permanent contracts, part-time or casual hours, involuntary hours, on-call work, split shifts, pay per visit, and hourly pay with variable hours. Casualized employment also refers to perceived employment insecurity and labour market insecurity. Data are from a survey of 991 visiting nurses, therapists and home support workers in a medium-sized city in Ontario, Canada. Results show that, controlling for many other factors, casual hours and perceived employment insecurity and labour market insecurity are positively and on-call work is negatively associated with home care workers' turnover intention. Non-permanent contract, part-time hours, involuntary hours, split shifts, and non-salaried pay are features of the market-modelled home care work environment and therefore may not be associated with turnover intention. Results provide evidence on the effects of casualized employment strategies on home care workers' turnover intention.

Office home care workers' occupational health: associations with workplace flexibility and worker insecurity.

Office home care workers provide support to visiting staff, although their work tends to be invisible in many respects. This paper focuses on managers, supervisors, coor dinators, case managers and office administrative staff in home care. We examine the effects of workplace flexibility and worker insecurity on office home care workers' occupational health, particularly their self-reported stress and musculoskeletal disorders. Data come from our survey of 300 home care office staff in a mid-sized city in Ontario. Results show that workers' perceptions of insecurity are positively associated with musculoskeletal disorders but not workplace flexibility measures. We recommend that managers and other decision-makers in the home care field pay attention to the perceptions of workers' insecurity in initiating workplace flexibility measures.

Extrapontine Myelinolysis in a Child: a Rare Case with MRI, DWI and MRS Follow-up.

We describe a case of extrapontine myelinolysis in a child presenting with chorea and parkinsonian symptoms after treatment for hyponatremic dehydration. Although both extrapontine myelinolysis (EPM) in childhood and extrapyramidal presentation of EPM are very rare in children, the patient presented with pure extrapyramidal symptoms. Besides basal ganglia involvement and sparing brain stem, MRI demonstrated involvement of the amygdala bilaterally hitherto never reported in EPM patients. While single voxel proton spectroscopy (MRS) of the basal ganglia at the beginning was normal, the follow-up MRS showed moderate to severe NAA and mI decrease. Diffusion-weighted imaging abnormalities appeared relatively late during the disease course, also an unexpected finding. In addition, there were apparent increases in apparent diffusion coefficient (ADC) values of the affected basal ganglia instead of diffusion restriction.

Endoscopic treatment of in utero diagnosed suprasellar arachnoid cyst and development of salt wasting.

Suprasellar arachnoid cysts are rare lesions that constitute approximately 5-12.5% of all arachnoid cysts. We present a male infant diagnosed in utero with suprasellar arachnoid cyst and treated with endoscopic ventriculocystocisternotomy on the 38th day of life. The patient developed hyponatremia as a result of cerebral salt wasting after the operation.

Prosthetic reconstruction of the trachea in rabbit.

BACKGROUND: Various tracheal reconstruction techniques have been developed for stenosis. Different types of grafts, flaps and synthetic materials have been used for reconstruction of the defect when primary anastomosis was unsuccessful or not indicated. The mentioned reconstruction methods have limited success. Polytetrafluoro-ethylene (PTFE) prosthesis is a microporous polymer and has been applied for implantation on a wide range. It is also appropriate for tracheal reconstruction. METHODS: In the present study, segmental defects were created in 12 New Zealand rabbits. The rabbits were divided into 2 subgroups; the first group was applied an end-to-end anastomosis whilst the second a PTFE prosthesis. After 2 months, these applications were compared clinically, endoscopically and histopathologically to each other. RESULTS: Necrosis and extrusion were not observed in the rabbits with PTFE applications. After 1 month, the tracheal stenosis was found on endoscopic examination in 5 animals in the first group and 2 animals in the second group. While in longer defects, end-to-end anastomosis causes tracheal tension, PTFE applications have been well tolerated. CONCLUSIONS: It is concluded that PTFE prosthesis is a suitable alternative method in reconstruction of circumferential tracheal defects.

Efficacy of sublingual immunotherapy in children with asthma and rhinitis: a double-blind, placebo-controlled study.

To evaluate the efficacy of specific sublingual immunotherapy (SLIT), we enrolled 15 children with asthma and rhinitis (7 girls, 8 boys, mean +/- SD age of 11.7 +/- 3.3) allergic to house dust mite (HDM) into a double-blind, placebo-controlled study. After a run-in period, patients were randomized to receive either placebo (n = 7) or SLIT (n = 8) with a standardized Dermatophagoides pteronyssinus (D. pteronyssinus) + Dermatophagoides farinea (D. farinea) 50/50 extract. They received increasing doses up to 100 index units of reactivity (IR) every day for 4 weeks, then 100 IR/day for another 4 weeks, followed by maintenance therapy consisting of 20 drops 2 times a week for 4 months. Efficacy was assessed at the end of 6 months of therapy according to symptom and medication scores, serum total IgE levels, results of lung function tests, methacholine provocation tests, and skin prick tests. Daily means for the asthma score and use of inhaled beta-2-mimetics decreased significantly in the SLIT group (P = 0.05, P = 0.028, respectively), whereas no such difference was observed in the placebo group. At the end of follow-up, mean daily doses of intranasal steroids needed for control of rhinitis symptoms decreased significantly in the SLIT group (P = 0.04). Baseline skin sensitivity to D. pteronyssinus and D. farinea was not significantly different between in the two groups, whereas end-point wheal diameter obtained with D. pteronyssinus extract was significantly less in the SLIT vs. the placebo group (P = 0.026). At the end of 6 months, peak expiratory flow (PEF) values in the placebo group was significantly lower than in the SLIT group (P = 0.049). Throughout the treatment period, the SLIT group was found to have less asthma exacerbations than the placebo group (P = 0.007). The provocation concentration causing a 20% drop in forced expired volume in 1 sec did not change throughout the treatment period in either groups. None of the patients reported local or systemic side effects from SLIT. Results of this study suggests that SLIT may be a useful alternative or additional therapy in the treatment of children with asthma/rhinitis due to HDM.