Educational Trajectories and Health over the Life Course: A Role for the DSBN Academy?

Research demonstrates that despite post-secondary expansion, there are still vast socioeconomic differences in educational attainment. Educational attainment can have a tremendous impact on the life course in terms of income, employment, and perhaps most significantly, health. Recognizing these issues, the Niagara region opened the DSBN Academy in September 2011. The DSBN Academy, the first school of its kind in Canada, offers social and academic programming designed to encourage its students to not only graduate from high school, but also, to become the first in their family to pursue post-secondary education. From a life course perspective, this paper assesses the relationship between education and health followed by an examination of the primary processes of cumulative advantage and disadvantage involved in producing variation in educational trajectories, which in turn impact health outcomes. I then evaluate the role of the DSBN Academy as a potential strategy to facilitate the completion of higher education by working-class students, and accordingly, to improve their health outcomes. Through analyzing the Academy, I argue that while the school has the potential to be a turning point in the lives of its students, it also risks committing a form of Bourdieu’s symbolic violence. That is, it enforces middle-class ideals of education and good health as both desirable and indicators of success. Consequently, this paper raises a fundamental question in the study of social inequality, namely, how sociologists can work toward ameliorating inequality without perpetuating the symbolic violence we continually fight against.Les recherches démontrent que, malgré le développement de l’enseignement postsecondaire, il existe encore de grandes différences socio-économiques en matière de niveau d’études. Le niveau d’études peut avoir un impact énorme dans un parcours de vie en termes de revenus, d’emploi, et peut-être plus important encore, de santé. Conscient de ces enjeux, la région du Niagara a ouvert la DSBN Academy en septembre 2011. La DSBN Academy , la première école du genre au Canada, offre des programmes sociaux et des programmes d’études conçus pour encourager ses élèves à non seulement obtenir leur diplôme d'études secondaires, mais également à devenir les premiers de leur famille à poursuivre des études postsecondaires. Dans la perspective d’une trajectoire de vie, cette étude évalue la relation entre l'éducation et la santé suivie d'un examen des principaux processus des avantages et désavantages cumulatifs liés qui jouent un rôle dans la variation du parcours scolaire, ce qui à son tour a des impacts sur l’état de santé. J'ai ensuite évalué le rôle de la DSBN Academy; le fait de l’intégrer peut-être une stratégie possible pour faciliter l'achèvement de l'enseignement supérieur par les étudiants de la classe ouvrière et, par conséquent, améliorer leur état de santé. Mon analyse de l'Académie me permet de soutenir que, même si l'école peut représenter un tournant dans la vie de ses élèves, elle risque aussi de commettre une forme de violence symbolique telle que celle définie par Bourdieu. Autrement dit, cela favorise les idéaux de la classe moyenne en matière d’éducation et de bonne santé comme étant à la fois souhaitable et indicateurs de succès. Par conséquent, ce document soulève une question fondamentale dans l'étude des inégalités sociales, à savoir, comment les sociologues peuvent chercher à estomper l'inégalité sans perpétuer la violence symbolique contre laquelle nous continuons de nous battre.

Gender and Health Over the Life Course: Temporal, Contextual, and Intersectional Considerations

Research has continuously demonstrated differences in health between men and women and emphasized a “gender paradox” whereby women live longer than men, but have higher rates of morbidity. Still, relatively little attention has been given to the underlying mechanisms and processes involved within groups of women and men that may provide greater insight into the patterns of health experienced among each group rather than simply between them. Specifically, there has been an over-reliance on cross-sectional and retrospective data; inattention to multiple resources and health conditions; limited consideration of various age ranges and time spans; and an over-emphasis on comparing women and men rather than what contributes to their respective health outcomes separately. This dissertation examines contributing factors to heterogeneity in the health of women and men, incorporating principles from the life course perspective and intersectionality theory. Each integrated chapter uses data from the U.S. Panel Study of Income Dynamics. Methods utilized include latent growth curve modelling, latent class analysis, discrete-time hazard models, and ordinary least squares and logistic regression. Findings contribute to the emerging body of literature that seeks to challenge traditional approaches to the conceptualization and measurement of gender and health through revealing the role of historical context, dynamic early life experiences, and intersecting dimensions of inequality across multiple health outcomes

The Emergence of Naturopathy in Two Canadian Provinces: British Columbia and Ontario, 1920-1970

This paper explores the development and regulation of naturopathy in two Canadian provinces, Ontario and British Columbia, prior to 1950. Naturopathy has been a regulated profession in British Columbia since 1936. In Ontario the regulated group, since 1926 until recently, has been ‘drugless therapy.’ Through a comparative case study we not only document the early history of naturopathy, and its regulation, but we explore the factors shaping professional regulation and development historically. In particular, we highlight the importance of provincial patterns of professional regulation, and inter-professional relations in shaping regulatory trajectories.Voici un article qui traite de l’évolution et de la réglementation de la naturopathie dans deux provinces canadiennes, l’Ontario et la Colombie-Britannique, avant 1950. La naturopathie est une profession réglementée en Colombie-Britannique depuis 1936. En Ontario, le groupe réglementé a été, de 1926 jusqu’à tout récemment, celui des « praticiens ne prescrivant pas de médicaments ». Au moyen d’une étude de cas comparative, nous rendons compte des débuts de la naturopathie et de sa réglementation, mais nous étudions aussi les facteurs qui, pendant très longtemps, ont façonné la réglementation et l’évolution des professions. Nous soulignons en particulier l’importance des caractéristiques provinciales de la réglementation des professions et celle des relations interprofessionnelles dans l’orientation des trajectoires en matière de réglementation

Maternal Factors and the Emotional and Behavioural Functioning of Adolescents With Chronic Health Conditions

Purpose: This study investigated the association between mothers’ mental health and education and the emotional and behavioural functioning of adolescents with chronic health conditions over time. Methods: Data were drawn from an ongoing study. Study participants (N¼363) were recruited through eight children’s rehabilitation centres. Logistic regression models were estimated. Results: There were significantly reduced odds that girls would display clinical signs of hyperactivity/inattention one year later compared to boys when a maternal mental health condition was present (OR¼0.10; p50.01). Where low maternal education was present, girls were more likely to display peer relationship problems one year later (OR¼3.72; p50.01). For both genders, having a mother with less than a high school education was also associated with conduct problems one year later (OR¼2.89; p50.01). Conclusions: Findings support a link between maternal factors and emotional and behavioural functioning in adolescents with chronic conditions. A holistic and family-centred approach to assessment and service delivery is indicated

Youth with Disabilities Talk About Spirituality:A Qualitative Descriptive Study

There is little known about what spirituality means for youth with disability or about the potential relevance of youths’ spirituality in pediatric rehabilitation. This study explored perceptions of spirituality for youth with disabilities. Using a qualitative descriptive methodology, we examined the lived experiences of eighteen youth ages 11-20 years with disabilities including cerebral palsy, central nervous system disorder or autism spectrum disorder. In individual interviews, followed by a focus group, youth identified key spiritual themes – the importance of their beliefs, personal sources of comfort and strength, finding purpose in helping others, significance of personal connections, and strengths-based perspectives on disability. This study makes a unique contribution by informing health care professionals about the relevance of youths’ spirituality in service delivery

Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo

Sex and gender analysis in knowledge translation interventions: challenges and solutions

Abstract Sex and gender considerations are understood as essential components of knowledge translation in the design, implementation and reporting of interventions. Integrating sex and gender ensures more relevant evidence for translating into the real world. Canada offers specific funding opportunities for knowledge translation projects that integrate sex and gender. This Commentary reflects on the challenges and solutions for integrating sex and gender encountered in six funded knowledge translation projects. In 2018, six research teams funded by the Canadian Institutes of Health Research’s Institute of Gender and Health met in Ottawa to discuss these challenges and solutions. Eighteen participants, including researchers, healthcare professionals, trainees and members of the Institute of Gender and Health, were divided into two groups. Two authors conducted qualitative coding and thematic analysis of the material discussed. Six themes emerged, namely Consensus building, Guidance, Design and outcomes effectiveness, Searches and recruitment, Data access and collection, and Intersection with other determinants of health. Solutions included educating stakeholders on the use of sex and gender concepts, triangulating perspectives of researchers and end-users, and participating in organisations and committees to influence policies and practices. Unresolved challenges included difficulty integrating sex and gender considerations with principles of patient-oriented research, a lack of validated measurement tools for gender, and a paucity of experts in intersectionality. We discuss our findings in the light of observations of similar initiatives elsewhere to inform the further progress of integrating sex and gender into the knowledge translation of health services research findings

Applying an intersectionality lens to the theoretical domains framework: a tool for thinking about how intersecting social identities and structures of power influence behaviour

Background: A key component of the implementation process is identifying potential barriers and facilitators that need to be addressed. The Theoretical Domains Framework (TDF) is one of the most commonly used frameworks for this purpose. When applying the TDF, it is critical to understand the context in which behaviours occur. Intersectionality, which accounts for the interface between social identity factors (e.g. age, gender) and structures of power (e.g. ageism, sexism), offers a novel approach to understanding how context shapes individual decision-making and behaviour. We aimed to develop a tool to be used alongside applications of the TDF to incorporate an intersectionality lens when identifying implementation barriers and enablers. Methods: An interdisciplinary Framework Committee (n = 17) prioritized the TDF as one of three models, theories, and frameworks (MTFs) to enhance with an intersectional lens through a modified Delphi approach. In collaboration with the wider Framework Committee, a subgroup considered all 14 TDF domains and iteratively developed recommendations for incorporating intersectionality considerations within the TDF and its domains. An iterative approach aimed at building consensus was used to finalize recommendations. Results: Consensus on how to apply an intersectionality lens to the TDF was achieved after 12 rounds of revision. Two overarching considerations for using the intersectionality alongside the TDF were developed by the group as well as two to four prompts for each TDF domain to guide interview topic guides. Considerations and prompts were designed to assist users to reflect on how individual identities and structures of power may play a role in barriers and facilitators to behaviour change and subsequent intervention implementation. Conclusions: Through an expert-consensus approach, we developed a tool for applying an intersectionality lens alongside the TDF. Considering the role of intersecting social factors when identifying barriers and facilitators to implementing research evidence may result in more targeted and effective interventions that better reflect the realities of those involved.Other UBCNon UBCReviewedFacult

Understanding how and why upskilling programmes for unregulated care providers can support health equity in underserved communities: a realist review protocol

Introduction Foot ulcers are one of the most devastating complications of diabetes mellitus leading to leg amputations. In Canada, systematically marginalised and racialised populations are more prone to developing foot ulcers and at higher risk of limb amputations. Shortages of regulated healthcare have hindered efforts to provide foot care. Upskilling unregulated care providers (UCPs) to deliver foot screening seems a reasonable solution to reduce limb loss. UCPs can advocate for health equity and deliver appropriate care. There is a need, however, to understand how and why an educational intervention for UCPs providing foot screening for these high-risk groups may or may not work.Methods and analysis This realist review will follow the Realist And Meta-narrative Evidence Syntheses: Evolving Standards standards. First, we will develop an initial programme theory (PrT) based on exploratory searches and discussions with experts and stakeholders. Then, we will search MEDLINE, Embase, PsycINFO, ERIC, CINAHL and Scopus databases along with relevant sources of grey literature. The retrieved articles will be screened for studies focusing on planned educational interventions for UCPs related to diabetic foot assessment. Data regarding contexts, mechanisms and outcomes will be extracted and analysed using a realist analysis through an iterative process that includes data reviewing and consultation with our team. Finally, we will use these results to modify the initial PrT.Ethics and dissemination Ethical approval is not required for this review. The main output of this research will be an evidence-based PrT for upskilling programmes for UCPs. We will share our final PrT using text, tables and infographics to summarise our results and draw insights across papers/reports. For academic, clinical, social care and educational audiences, we will produce peer-reviewed journal articles, including those detailing the process and findings of the realist review and establishing our suggestions for effective upskilling programmes.PROSPERO registration number CRD42022369208