RESUMO
OBJECTIVE: This study aimed to understand how the Canadian Occupational Performance Measure (COPM) can be used as an outcome measure in primary care and to identify the occupational performance profiles in this setting. METHOD: First, the COPM was administered to all eligible clients at two sites. Second, a focus group with participating occupational therapists explored the feasibility of using the COPM in primary care. RESULTS: A total of 161 COPMs were initially administered. Self-care goals were identified most frequently (n = 248), followed by productivity (n = 229) and leisure (n = 179) goals (total goals = 656). Mean initial performance and satisfactions scores were 3.2 and 2.8, respectively. The average change (n = 22) scores were 2.1 and 2.6, respectively. CONCLUSION: The COPM is an invaluable tool to guide initial assessments and offer an occupation-focused lens. Given the lifespan approach and an emphasis on screening and assessment, the challenge was finding the opportunity for readministration.
Assuntos
Avaliação da Deficiência , Pessoas com Deficiência , Terapia Ocupacional/estatística & dados numéricos , Padrões de Prática Médica , Atenção Primária à Saúde , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ontário , Valor Preditivo dos Testes , Adulto JovemRESUMO
Plants associate with a wealth of microbes, collectively referred to as the plant microbiota, whose composition is determined by host plant genetics, immune responses, environmental factors and intermicrobial relations. Unsurprisingly, microbiota compositions change during disease development. Recent evidence revealed that some of these changes can be attributed to effector proteins with antimicrobial activities that are secreted by plant pathogens to manipulate host microbiota to their advantage. Intriguingly, many of these effectors have ancient origins, predating land plant emergence, and evolved over long evolutionary trajectories to acquire selective antimicrobial activities to target microbial antagonists in host plant microbiota. Thus, we argue that host-pathogen co-evolution likely involved arms races within the host-associated microbiota.
RESUMO
BACKGROUND: Approximately 18.9% of Canadians live with chronic pain. Primary care reform in Ontario presents unique opportunities to assess approaches to help these patients. OBJECTIVE: To assess the feasibility of an interprofessional primary care-based program for patients living with chronic pain, and to examine the potential impact of such a program on quality of life and health resource utilization. METHODS: An embedded mixed-methods evaluation (randomized controlled trial with waiting list control and semistructured interviews) of an eight-week series of small group sessions exploring multifactoral aspects of pain management was performed. Participants were randomly assigned to early intervention (EI) or delayed intervention (DI) groups. All participants received the intervention; the DI group served as a control group for comparison with the EI group. Outcomes included the Short Form-36 Health Survey version 2 (SF-36v2), medication use and health care utilization. Qualitative interviews were conducted to identify areas for program improvement. RESULTS: A total of 240 patients were recruited and 63 agreed to participate. The mean (± SD) age of the participants was 55±14.1 years and 62.3% were female. There was no significant difference in the mean change in SF-36v2 summary scores between the EI and DI groups. However, the SF-36v2 subscale score for bodily pain was significantly improved in the EI group compared with the DI group after six months of observation (mean difference = 13.1 points; P<0.05). There was also significant improvement in this score when both groups were pooled and aggregate preintervention and postintervention scores were compared. There was a significant decrease in the mean number of clinic visits in the six-month period following the intervention compared with the six-month period before the intervention (P=0.043). CONCLUSION: An interprofessional program in primary care for patients living with chronic pain may lead to improvements in quality of life and health resource utilization. The challenges to the feasibility of the program and its evaluation are recruitment and retention of patients, leading to the conclusion that the program, as it was conducted in the present study, is not appropriate for this setting.