Structures last longer than intentions: creation of Ongomiizwin - Indigenous Institute of Health and Healing at the University of Manitoba.

Ongomiizwin - Indigenous Institute of Health and Healing at the University of Manitoba's Rady Faculty of Health Sciences (RFHS) was launched in June of 2017 with a mandate to provide leadership and advance excellence in research, education and health services to achieve health and wellness for Indigenous peoples and to implement the Truth and Reconciliation Commission of Canada's Calls to Action within the Faculty. The RFHS Reconciliation Action Plan has five broad themes: (1) Honoring traditional knowledge systems and practices, (2) Safe learning environments and professionalism, (3) Student support, mentorship and retention (4) Education across the spectrum and 5) Closing the gap in admissions. Community engagement is the focus of our work. Learners and practicing clinicians are grounded in the knowledge of ongoing colonial harms, engaged in critical self-reflection on one's own biases and trained to confront anti-indigenous racism in health care. This alignment is changing the health human resource landscape in northern Manitoba and beyond.

A First Nations voice in the present creates healing in the future.

This paper discusses the urgency for change and improvements in health policy determined by the exploding demographics and inequities in the health status of First Nation people. A historical overview of health services for First Nation clients was conducted as set out through government legislation and health and social policies. Until WWII ended, the federal government provided assistance to First Nations through Indian Affairs branches of several departments. This responsibility was gradually transferred to National Health and Welfare. In 1962, the federal government established a Medical Services Branch, later renamed First Nations and Inuit Health Branch, and mandated to provide services to First Nation clients, which fell outside the provincial jurisdiction of health care. Initially centered on public health priorities, services have expanded to include primary health care, dental, mental health, environmental health, home and continuing care, and Non-Insured Health Benefits. The Romanow Report substantiated the urgency for health policy improvements voiced by many First Nations. However, it generalized Aboriginal issues in health care on a national front. Furthermore, its recommendations were specific to health care providers and delivery models and did not address the social and spiritual determinants of health, which are fundamental to a First Nations' holistic approach. Health planners must think holistically, considering traditional and westernized medicine, First Nations' values, priorities and government systems, and present and evolving health systems. Universities, health authorities, provinces and the federal government are continually developing new research and health models, which will also need consideration. Further, the imperative of involving community-level input must be recognized.

Critical thinking about fables: examining language production and comprehension in adolescents.

PURPOSE: This study was designed primarily to determine if a critical-thinking task involving fables would elicit greater syntactic complexity than a conversational task in adolescents. Another purpose was to determine how well adolescents understand critical-thinking questions about fables. METHOD: Forty adolescents (N=20 boys and 20 girls; mean age=14 years) with typical language development answered critical-thinking questions about the deeper meanings of fables. They also participated in a standard conversational task. The syntactic complexity of their responses during the speaking tasks was analyzed for mean length of communication unit (MLCU) and clausal density (CD). RESULTS: Both measures of syntactic complexity, MLCU and CD, were substantially greater during the critical-thinking task compared with the conversational task. It was also found that the adolescents understood the questions quite well, earning a mean accuracy score of 80%. CONCLUSIONS: The critical-thinking task has potential for use as a new type of language-sampling tool to examine language production and comprehension in adolescents.

Conversational and narrative speaking in adolescents: examining the use of complex syntax.

PURPOSE: Few tools are available to examine the narrative speaking ability of adolescents. Hence, the authors designed a new narrative task and sought to determine whether it would elicit a higher level of syntactic complexity than a conversational task in adolescents with typical language development. METHOD: Forty adolescents (Mage = 14;0 [years;months]; 20 boys and 20 girls) were individually interviewed. Each adolescent participated in a standard conversational task followed by a narrative task that involved listening to fables and retelling the stories. It was predicted that the narrative task would elicit a higher level of syntactic complexity than the conversational task because fables, although superficially simple stories, express rather sophisticated meanings. RESULTS: The narrative task elicited greater syntactic complexity than the conversational task as measured by mean length of C-unit and clausal density. Additionally, the 2 syntactic measures, mean length of C-unit and clausal density, were closely associated on both tasks. CONCLUSION: Fables can elicit a high level of syntactic complexity in adolescents with typical language development. Future studies are needed to build a normative database using fables.

Reliability and validity of two versions of the upper extremity functional index.

PURPOSE: To examine the reliability, validity, and sensitivity to change of the 20-item version and the Rasch-refined 15-item version of the Upper Extremity Functional Index (UEFI-20 and UEFI-15, respectively) and to determine the impact of arm dominance on the positive minimal clinically important difference (pMCID). METHODS: Adults with upper-extremity (UE) dysfunction completed the UEFI-20, Upper Extremity Functional Scale (UEFS), Pain Limitation Scale, and Pain Intensity Scale at their initial physiotherapy assessment (Time 1); 24-48 hours later (Time 2); and 3 weeks into treatment or at discharge, whichever came first (Time 3). Demographics, including working status, were obtained at Time 1. Global ratings of change (GRC) were provided by the treating physiotherapist and patient at Time 3. The UEFI-15 was calculated from relevant items in the UEFI-20. The intra-class correlation coefficient (ICC) and minimal detectable change (MDC) quantified test-retest reliability (Time 1-Time 2). Cross-sectional convergent validity was determined by the association (Pearson's r) between Time 1 measures of function and pain. Known-groups validity was evaluated with a one-way ANOVA across three levels of working status. Longitudinal validity was determined by the association (Pearson's r) between function and pain change scores (Time 1-Time 3). Receiver operating characteristic (ROC) curves estimated the pMCID using Time 1-Time 3 change scores and average patient/therapist GRC. RESULTS: Reliability for the UEFI-20 and UEFI-15 was the same (ICC=0.94 for both measures). MDC values were 9.4/80 for the UEFI-20 and 8.8/100 for the UEFI-15. Cross-sectional, known-groups, and longitudinal validity were confirmed for both UEFI measures. pMCID values were 8/80 for the UEFI-20 and 6.7/100 for the UEFI-15; pMCID was higher for people whose non-dominant arm was affected. CONCLUSIONS: Both UEFI measures show acceptable reliability and validity. Arm dominance affects pMCID. The UEFI-15 is recommended because it measures only one dimension: UE function.

Objectif : Étudier la fiabilité, la validité et la sensibilité au changement des versions à 20 questions et à 15 questions raffinées par Rasch de l'Indice fonctionnel des membres supérieurs (IFMS-20 et IFMS-15, respectivement) et déterminer l'effet du bras dominant sur la différence minimale positive cliniquement importante (pDMCI). Méthodes : Les adultes ayant une dysfonction des membres supérieurs (MS) ont répondu au questionnaire IFMS-20, aux questionnaires de l'Échelle fonctionnelle des membres supérieurs (EFMS), de l'Échelle de limitation de la douleur et de l'Échelle de l'intensité de la douleur au cours de leurs premières évaluations en physiothérapie (moment 1); de 24 à 48 heures plus tard (moment 2) et 3 semaines après le début du traitement ou le congé, selon l'échéance la plus rapprochée (moment 3). On a réuni des données démographiques, y compris sur leur état de travailleur, au cours du moment 1. Le physiothérapeute traitant et le patient ont fourni des évolutions globales du changement (EGC) au moment 3. On a calculé le résultat du questionnaire IFMS-15 à partir de questions pertinentes contenues dans la version IFMS-20. Le coefficient de corrélation intracatégorie (CCI) et le changement détectable minimal (CDM) ont quantifié la fiabilité de test­retest (moment 1­moment 2). La validité convergente transversale a été déterminée par le lien (r de Pearson) entre les mesures de fonction et de douleur prises au moment 1. On a évalué la validité des groupes connus au moyen d'une analyse bidirectionnelle des écarts (ANOVA) entre trois niveaux d'état de fonctionnement. La validité longitudinale a été déterminée en fonction du lien (r de Pearson) entre les scores de changement de la fonction et de la douleur (moment 1­moment 3). Des courbes des caractéristiques opérationnelles du récepteur (COR) ont estimé la pDMCI à partir des scores de changement entre le moment 1 et le moment 3 et les EGC moyennes patient/thérapeute. Résultats : La fiabilité des questionnaires IFMS-20 et IFMS-15 a été la même (CCI=0,94 pour les deux mesures). Les valeurs du CDM se sont établies à 9,4/80 pour le questionnaire IFMS-20 et à 8,8/100 pour le questionnaire IFMS-15. La validité transversale, de groupes connus et longitudinale a été confirmée pour les deux mesures de l'IFMS. Les valeurs de la pDMCI s'établissaient à 8/80 pour le questionnaire IFMS-20 et à 6,7/100 pour le questionnaire IFMS-15; la pDMCI était plus élevée chez les personnes dont le bras non dominant était atteint. Conclusions : Les deux mesures de l'IFMS montrent une fiabilité et une validité acceptables. Le bras dominant a un effet sur la pDMCI. On recommande le questionnaire IFMS-15 parce qu'il mesure une dimension seulement: la fonction des membres supérieurs.