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Artigo em Inglês | MEDLINE | ID: mdl-32124155


Homelessness has negative implications for mental well-being and quality of life. This paper identifies the quality of life variables that contribute to positive or negative wellbeing, reporting on a regression analysis from 343 individuals experiencing homelessness in Canada. Results indicate that a lack of sleep duration and quality reduced mental well-being for both genders, not having access to food and/or hygiene facilities decreased men's well-being, and engaging in illegal subsistence strategies, such as selling drugs, negatively impacted women's mental well-being. For persons experiencing homelessness, mental well-being and quality-of-life are gendered outcomes of their limited access to social determinants of health.

Rural Remote Health ; 20(1): 5485, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-32000499


CONTEXT: Food insecurity in northern, remote Canadian communities has become increasingly recognised as a significant issue in rural health research and policy. Over the past decade, numerous government and academic reports have emerged, documenting the severity of this issue for the health people living in the Canadian north. People living in northern and remote Canadian communities experience significant challenges related to the cost, quality, and variety of market (store-bought) foods. These issues may be of particular concern for those living with chronic diseases that require therapeutic diets, such as chronic kidney disease (CKD). ISSUES: There is little to no research that documents the impact of food insecurity on disease management and quality of life for those living with CKD and end-stage renal disease (ESRD). There is also limited literature on food access for people living with ESRD in northern and remote communities. People living with food insecurity and CKD in remote communities might experience significant challenges in accessing the foods necessary for adhering to dietary guidelines. LESSONS LEARNED: This commentary examines northern food insecurity and draws attention to dietary challenges for residents of remote communities who are living on restricted or therapeutic diets due to chronic disease. In particular we point to the needs of those living with late-stage CKD and ESRD. We call attention to the need for clinicians to understand the capacity of patients to adhere to therapeutic dietary guidelines in remote communities.

Int J Drug Policy ; 67: 58-62, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30959410


Alcohol policy in North America is dominated by moderation and abstinence-based modalities that focus on controlling population-level alcohol consumption and modifying individual consumption patterns to prevent and reduce alcohol-related harms. However, conventional alcohol policies and interventions do not adequately address harms associated with high-risk drinking among individuals experiencing severe alcohol use disorder (AUD) and structural vulnerability such as poverty and homelessness. In this commentary we address this gap in alcohol harm reduction, and highlight the lack of, and distinct need for, alcohol-specific harm reduction for people experiencing structural vulnerability and severe AUD. These individuals, doubly impacted by structural oppression and severe AUD, engage in various high-risk drinking practices that contribute to a unique set of harms that conventional abstinence-based treatments and interventions fail to adequately attend to. Managed alcohol programs (MAPs) have been established to address these multiple intersecting harms, and though gaining momentum across Canada, have had a hard time finding their place within the harm reduction movement. We illustrate how MAPs play a crucial role in the harm reduction movement in their ability to not only address high-risk drinking practices among structurally marginalized individuals, but to respond to harms associated with broader structural inequities such as poverty and homelessness.

Consumo de Bebidas Alcoólicas/prevenção & controle , Alcoolismo/prevenção & controle , Redução do Dano , Pessoas em Situação de Rua , Programas de Assistência Gerenciada , Pobreza , Canadá , Humanos
J Int Assoc Provid AIDS Care ; 18: 2325958219831018, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30803298


Men with HIV have highlighted the importance of understanding their fertility desires. However, most research has focused on women. We aimed (1) to develop a survey instrument to assess fertility desires and intentions among HIV-positive men and (2) to assess its face, content, and construct validity, as well as test-retest reliability and internal consistency. Principal component analysis was used for construct validity analysis in a sample of 60 men with HIV. The test-retest reliability and internal consistency were assessed using Spearman correlation and Cronbach α, respectively. The initial and the final version of the questionnaire consisted of 10 domains and 14 constructs. We found a one-component model for the 3 constructs analyzed and Cronbach α values were ≥.70. Test-retest statistic was stable with Spearman correlation >0.70. In conclusion, a reliable and valid questionnaire was developed for determining the fertility desires and intentions of men with HIV.

Drug Alcohol Rev ; 37 Suppl 1: S132-S139, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29573059


INTRODUCTION AND AIMS: People with severe alcohol dependence and unstable housing are vulnerable to multiple harms related to drinking and homelessness. Managed Alcohol Programs (MAP) aim to reduce harms of severe alcohol use without expecting cessation of use. There is promising evidence that MAPs reduce acute and social harms associated with alcohol dependence. The aim of this paper is to describe MAPs in Canada including key dimensions and implementation issues. DESIGN AND METHODS: Thirteen Canadian MAPs were identified through the Canadian Managed Alcohol Program Study. Nine key informant interviews were conducted and analysed alongside program documents and reports to create individual case reports. Inductive content analysis and cross case comparisons were employed to identify six key dimensions of MAPs. RESULTS: Community based MAPs have a common goal of preserving dignity and reducing harms of drinking while increasing access to housing, health and social services. MAPs are offered as both residential and day programs with differences in six key dimensions including program goals and eligibility, food and accomodation, alcohol dispensing and administration, funding and money management, primary care services and clinical monitoring, and social and cultural connections. DISCUSSION AND CONCLUSIONS: MAPs consist of four pillars with the alcohol intervention provided alongside housing interventions, primary care services, social and cultural interventions. Availability of permanent housing and re-establishing social and cultural connections are central to recovery and healing goals of MAPs. Additional research regarding Indigenous and gendered approaches to program development as well as outcomes related to chronic harms and differences in alcohol management are needed.

Alcoolismo/terapia , Redução do Dano , Acesso aos Serviços de Saúde , Pessoas em Situação de Rua , Canadá , Humanos , Avaliação de Programas e Projetos de Saúde
J Hum Lact ; 32(3): NP9-NP18, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25425631


BACKGROUND: Maternal attitudes to infant feeding are predictive of intent and initiation of breastfeeding. OBJECTIVES: The Iowa Infant Feeding Attitude Scale (IIFAS) has not been validated in the Canadian population. This study was conducted in Newfoundland and Labrador, a Canadian province with low breastfeeding rates. Objectives were to assess the reliability and validity of the IIFAS in expectant mothers; to compare attitudes to infant feeding in urban and rural areas; and to examine whether attitudes are associated with intent to breastfeed. METHODS: The IIFAS assessment tool was administered to 793 pregnant women. Differences in the total IIFAS scores were compared between urban and rural areas. Reliability and validity analysis was conducted on the IIFAS. The receiver operating characteristic (ROC) of the IIFAS was assessed against mother's intent to breastfeed. RESULTS: The mean ± SD of the total IIFAS score of the overall sample was 64.0 ± 10.4. There were no significant differences in attitudes between urban (63.9 ± 10.5) and rural (64.4 ± 9.9) populations. There were significant differences in total IIFAS scores between women who intend to breastfeed (67.3 ± 8.3) and those who do not (51.6 ± 7.7), regardless of population region. The high value of the area under the curve (AUC) of the ROC (AUC = 0.92) demonstrates excellent ability of the IIFAS to predict intent to breastfeed. The internal consistency of the IIFAS was strong, with a Cronbach's alpha greater than .80 in the overall sample. CONCLUSION: The IIFAS examined in this provincial population provides a valid and reliable assessment of maternal attitudes toward infant feeding. This tool could be used to identify mothers less likely to breastfeed and to inform health promotion programs.

Atitude Frente a Saúde , Alimentação Artificial/psicologia , Aleitamento Materno/psicologia , Mães/psicologia , Gravidez/psicologia , Inquéritos e Questionários , Adulto , Estudos Transversais , Feminino , Humanos , Intenção , Terra Nova e Labrador , Curva ROC , Reprodutibilidade dos Testes , População Rural , População Urbana