Robert R. Weaver

Purpose. This study contrasts views of university students with very low or high food security scores with respect to: obstacles to healthy eating, food pantry use, and managing dietary and educational needs. Method. Comments on open-ended survey questions (n = 1374) were counted, compared, and thematically analyzed to discern differences between the two student groups. Results. Cost concerns were paramount among students with very low food security scores. Students with very low food security experienced significant challenges in reconciling dietary needs and long-term educational goals; this was not problematic among students with high food security. Students from both very low and high food security groups mostly expressed an openness to the campus food pantry, though stigma associated with its use remained a deterrent. Conclusion. While all students face similar challenges to healthy eating, food security status substantially shapes dietary health and the management of dietary and educational needs.

To explore the lived experiences of persons with low back pain (LBP) and disability within the context of the International Classification of Function, Disability and Health (ICF) framework. Qualitative study using focus group methodology. We stratified LBP patients into two low (n=9) and one high disability (n=3) groups. Transcript-based thematic analysis was conducted through an interpretivist lens. Four themes emerged: Invisibility, Ambivalence, Social isolation, and Stigmatization and marginalization. Participants described how environmental factors affected how they experienced disability and how their awareness of people's attitudes affected personal factors and participation in social activities. High disability participants experienced challenges with self-care, employment, and activities. The invisibility of LBP and status loss contributed to depressive symptoms. LBP patients experience physical, social, economic and emotional disability. Our findings highlight the interaction between domains of the ICF framework and the importance of considering these perspectives when managing LBP patients with varying levels of disability.

Background: Individuals with a diagnosis of cancer tend to be inactive and have symptoms that impact quality of life. An individualized, community-based Nordic pole walking (NPW) program may help. Methods: Primary Objective: To assess feasibility using the Thabane framework of a randomized controlled trial (RCT). Secondary Objective: To determine the effects of NPW on physical function (Six-Minute Walk Test [6MWT], 30-second [30-s] chair stand test, Unsupported Upper-Limb Exercise Test, handgrip strength, physical activity [PA]), and health-related quality of life (HRQOL, 36-item Short-Form Health Survey [SF-36]). The Study Design: An 8-week multicentered block RCT (no blinding) comparing a community-based NPW program (vs usual daily routine) for adults with non-small cell lung, prostate, colorectal, and endometrial cancer. Results: Eight individuals were enrolled in the study with n = 4 per group (1 dropout in the NPW arm; = 67 ± 6 years). The study was deemed “feasible with modifications.” NPW significantly improved (statistically and clinically) the 30-s chair stand test when compared with baseline. There was improved 6MWT, PA levels, and SF-36 when compared with the control group (not statistically significant). No adverse events occurred. Discussion, Limitations, and Conclusions: NPW was feasible for individuals with cancer and may improve physical function, PA, and HRQOL. Larger samples are required to determine efficacy and/or program effectiveness. Future programs should include collaboration with hospital cancer centers and support groups, promotion of participant and community engagement with NPW, and consideration of the population's unique characteristics. NPW programs should include individualized exercise prescriptions, behavior change techniques, social aspects, HRQOL assessments, and device-measured PA.

Objective: Characterize the prevalence and dimensions of student food insecurity and the associations with academic performance. Participants: An online survey was distributed (November 2017) to 13,897 undergraduates at a midsized, New Jersey Public University; 2,055 (15%) responded. Methods: Demographic, behavioral, and food security data from University IT services, and the survey were combined in a single dataset. The USDA food security index was adapted to assess food insecurity. Results: Forty-eight percent of students were food insecure. Odds were higher for: women, African Americans, Hispanics, students with partial or no meal plan, commuters, and students receiving financial assistance. Food insecurity increased the odds of being among the lower 10% GPA and reduced the odds of being among the upper 10% GPA. Conclusions: Food insecurity among university students is high and is associated with academic performance. Understanding the mechanisms underlying this relationship is essential to design programs to address this problem.

Health and social care providers’ perceptions of Black-Canadian parent-youth sexual health communication has important implications for addressing knowledge gaps in the provision of services to young people and their parents. Providers’ perceptions are crucial as they often act as advisers in tailoring programmes or services to the perceived needs of parents and youth. To understand these perceptions, 17 semi-structured in-depth interviews were conducted with providers who worked with African, Caribbean or Black (ACB) parents and youth in Toronto, Ontario, Canada. Critical Race Theory was used to help guide the interpretation of findings. The findings revealed providers believed that many parents were unlikely to explicitly discuss sexual health or HIV prevention with young people. Additionally, providers perceived that the content of and approach to parent-youth sexual health communication differed between African and Caribbean clients. Moreover, providers believed that both parents’ and young people’s sex and gender impacted the quality, content and style of sexual health communication and had important implications for programme development. Overall, findings suggest a need for understanding the development of providers’ perceptions of this communication, ways to address these perceptions and further parent-provider collaboration to promote Black youths’ sexual health.

This phenomenological study examines second-generation Canadian South Asian women’s experiences of an eating disorder, and explores issues of culture conflict in relation to mental health tensions and body/self-concept distortions. Eight second-generation South Asian women who have sought help for an eating disorder participated in semi-structured interviews. Using feminist and transcultural theories, our analyses suggest that body image distortions stem from myriad pressures women face in relation to others in their lives. In constant attempt to follow familial and cultural expectations, these women felt a disconnection and alienation linking to mental pressure, which may be a factor in the development of self-dissatisfaction and ultimately eating disorders for this group. This research elevates awareness of eating disorders within the South Asian community as a way to break the ‘conspiracy of silence’ that surrounds this growing health concern.

Evidence‐based and patient‐centred health care movements have each enhanced the discussion of how health care might best be delivered, yet the two have evolved separately and, in some views, remain at odds with each other. No clear model has emerged to enable practitioners to capitalize on the advantages of each so actual practice often becomes, to varying degrees, an undefined mishmash of each. When faced with clinical uncertainty, it becomes easy for practitioners to rely on formulas for care developed explicitly by expert panels, or on the tacit ones developed from experience or habit. Either way, these tendencies towards ‘cookbook’ medicine undermine the view of patients as unique particulars, and diminish what might be considered patient‐centred care. The sequence in which evidence is applied in the care process, however, is critical for developing a model of care that is both evidence based and patient centred. This notion derives from a paradigm for knowledge delivery and patient care developed over decades by Dr. Lawrence Weed. Weed's vision enables us to view evidence‐based and person‐centred medicine as wholly complementary, using computer tools to more fully and reliably exploit the vast body of collective knowledge available to define patients’ uniqueness and identify the options to guide patients. The transparency of the approach to knowledge delivery facilitates meaningful practitioner–patient dialogue in determining the appropriate course of action. Such a model for knowledge delivery and care is essential for integrating evidence‐based and patient‐centred approaches.

Leaders in health care increasingly recognize that improving health care quality and safety requires developing an organizational culture that fosters high reliability and continuous process improvement. For various reasons, a reliability-seeking culture is lacking in most health care settings. Developing a reliability-seeking culture requires leaders' sustained commitment to reliability principles using key mechanisms to embed those principles widely in the organization. The aim of this study was to examine how key mechanisms used by a primary care practice (PCP) might foster a reliability-seeking, system-oriented organizational culture. A case study approach was used to investigate the PCP's reliability culture. The study examined four cultural artifacts used to embed reliability-seeking principles across the organization: leadership statements, decision support tools, and two organizational processes. To decipher their effects on reliability, the study relied on observations of work patterns and the tools' use, interactions during morning huddles and process improvement meetings, interviews with clinical and office staff, and a "collective mindfulness" questionnaire. The five reliability principles framed the data analysis. Leadership statements articulated principles that oriented the PCP toward a reliability-seeking culture of care. Reliability principles became embedded in the everyday discourse and actions through the use of "problem knowledge coupler" decision support tools and daily "huddles." Practitioners and staff were encouraged to report unexpected events or close calls that arose and which often initiated a formal "process change" used to adjust routines and prevent adverse events from recurring. Activities that foster reliable patient care became part of the taken-for-granted routine at the PCP. The analysis illustrates the role leadership, tools, and organizational processes play in developing and embedding a reliable-seeking culture across an organization. Progress toward a reliability-seeking, system-oriented approach to care remains ongoing, and movement in that direction requires deliberate and sustained effort by committed leaders in health care.

IMPROVING SEXUAL HEALTH RESOURCES FOR YOUTH: THE USE OF SEX-POSITIVE PUBLIC HEALTH WEBSITES