A critical examination of how Ontario’s home care system policy affects PSW-provided home care and client risk

The demand for home care is increasing as aging populations grow in Canada and internationally. Personal Support Workers (PSWs) provide the majority of the direct home care in Ontario, yet there are longstanding and acute shortages of these workers. Home care client safety is of concern given complex client needs, the unregulated status of the workforce, and the home care setting. This thesis aimed to identify policy gaps related to PSW work, and the resultant risks for home care clients. Investigating policy relevant to PSW work, home care, and client safety created opportunity for a contextually informed examination and interpretive analysis of policy gaps and intersecting aspects of PSW-provided home care that may increase client risk. For the purposes of this thesis, client risk describes potential harm (physical and psychological) stemming from policy governing PSW-provided home care. This meaning of client risk has been used by the UK Professional Standards Authority to define potential harms to patients in a PSW-occupation risk assessment. This study was conducted with qualitative research methods and tools from Yanow’s Interpretive Policy Analysis (IPA). Drawing on the case of Ontario, policies related to PSWs in the home care context were examined. Interviews were conducted with 16 key informants (KIs) experienced in core areas of PSW work, home care, policy, and safety. This study highlighted safety concerns with PSW education, recruitment, hiring, complex care tasks, and supervision. PSW shortages during COVID-19 were found to prompt policy measures such as accelerated, condensed education and rapid recruitment and hiring, further elevating pre-existing worker and client risks. This thesis examines how policy that is contextually situated in PSW-provided home care in Ontario affects client risk, adding a policy-prioritised lens to other research that considers home care workers, client risk or client safety, and worker-client interrelatedness

Self-employment, work and health: A critical narrative review

BACKGROUND: Self-employment (SE) is a growing precarious and non-standard work arrangement internationally. Economically advanced countries that favor digital labor markets may be promoting the growth of a demographic of self-employed (SE’d) workers who are exposed to particular occupational diseases, sickness, and injury. However, little is known about how SE’d workers are supported when they are unable to work due to illness, injury, and disability. OBJECTIVE: Our objective was to critically review peer-reviewed literature focusing on advanced economies to understand how SE’d workers navigate, experience, or manage their injuries and illness when unable to work. METHODS: Using a critical interpretive lens, a systematic search was conducted of five databases. The search yielded 18 relevant articles, which were critically examined and synthesized. RESULTS: Five major themes emerged from the review: (i) conceptualizing SE; (ii) double-edged sword; (iii) dynamics of illness, injury, and disability; (iv) formal and informal health management support systems; and (v) occupational health services and rehabilitation. CONCLUSION: We find a lack of research distinguishing the work and health needs of different kinds of SE’d workers, taking into consideration class, gender, sector, and gig workers. Many articles noted poor social security system supports. Drawing on a social justice lens, we argue that SE’d workers make significant contributions to economies and are deserving of support from social security systems when ill or injured.The authors acknowledge the support from the SSHRC/CIHR Healthy Productive Workforce Partnership Grant, Grant number: 895-2018-4009

372. Prevalence of Anti-AAV8 Neutralizing Antibodies and ARSB Cross-Reactive Immunologic Material in MPS VI Patients Candidates for a Gene Therapy Trial

Recombinant vectors based on adeno-associated virus serotype 8 (AAV8) have been successfully used in the clinic and hold great promise for liver-directed gene therapy. Pre-existing immunity against AAV8 or the development of antibodies against the therapeutic transgene product might negatively affect the outcomes of gene therapy. In the prospect of an AAV8-mediated, liver-directed gene therapy clinical trial for Mucopolysaccharidosis VI (MPS VI), a lysosomal storage disorder due to arylsulfatase B (ARSB) deficiency, we investigated in a multiethnic cohort of MPS VI patients the prevalence of neutralizing antibodies (Nab) to AAV8 and the presence of ARSB cross-reactive immunologic material (CRIM), which will either affect the efficacy of gene transfer or the duration of phenotypic correction. Thirty-six MPS VI subjects included in the study harbored 45 (62.5%) missense, 13 (18%) nonsense, 9 (12.5%) frameshift (2 insertions and 7 deletions), and 5 (7%) splicing ARSB mutations. To the best of our knowledge, four mutations had not been previously described. These include: one missense (c.1178 A>G p.H393R) and three frameshift mutations [883-884duplTT (p.F295FfsX42), c.1036delG (p.E346SfsX11), c.1475delC (pP492LfsX80)] predicted to result in truncated proteins. The detection of ARSB protein in twenty-four patients out of 34 (71%) was predicted by the type of mutations. Pre-existing Nab to AAV8 were undetectable in 19/33 (58%) analyzed patients. Twelve out of 31 patients (39%) tested were both negative for Nab to AAV8 and CRIM-positive. In conclusion, this study allows estimating the number of MPS VI patients eligible for a gene therapy trial by intravenous injections of AAV8

Momentary assessment of interpersonal process in psychotherapy

To demonstrate how a novel computer joystick coding method can illuminate the study of interpersonal processes in psychotherapy sessions, we applied it to Shostrom's (1966) well-known films in which a client, Gloria, had sessions with 3 prominent psychotherapists. The joystick method, which records interpersonal behavior as nearly continuous flows on the plane defined by the interpersonal dimensions of control and affiliation, provides an excellent sampling of variability in each person's interpersonal behavior across the session. More important, it yields extensive information about the temporal dynamics that interrelate clients' and therapists' behaviors. Gloria's 3 psychotherapy sessions were characterized using time-series statistical indices and graphical representations. Results demonstrated that patterns of within-person variability tended to be markedly asymmetric, with a predominant, set-point-like interpersonal style from which deviations mostly occurred in just 1 direction (e.g., occasional submissive departures from a modal dominant style). In addition, across each session, the therapist and client showed strongly cyclical variations in both control and affiliation, and these oscillations were entrained to different extents depending on the therapist. We interpreted different patterns of moment-to-moment complementarity of interpersonal behavior in terms of different therapeutic goals, such as fostering a positive alliance versus disconfirming the client's interpersonal expectations. We also showed how this method can be used to provide a more detailed analysis of specific shorter segments from each of the sessions. Finally, we compared our approach to alternative techniques, such as act-to-act lagged relations and dynamic systems and pointed to a variety of possible research and training applications

Interpersonal Problems Associated With Multidimensional Personality Questionnaire Traits in Women During the Transition to Adulthood

Personality traits are known to be associated with a host of important life outcomes, including interpersonal dysfunction. The interpersonal circumplex offers a comprehensive system for articulating the kinds of interpersonal problems associated with personality traits. In the current study, traits as measured by the Multidimensional Personality Questionnaire in a sample of 124 young women were correlated with interpersonal dysfunction as measured by the Inventory of Interpersonal Problems–Circumplex. Results suggest that Multidimensional Personality Questionnaire traits vary in their associations with interpersonal distress and in their coverage of specific kinds of interpersonal difficulties among women undergoing the transition to adulthood

Laws, Policies, and Collective Agreements Protecting Low-wage and Digital Platform Workers During the COVID-19 Pandemic

In the context of the COVID-19 pandemic, this commentary describes and compares shifting employment and occupational health social protections of low-wage workers, including self-employed digital platform workers. Through a focus on eight advanced economy countries, this paper identifies how employment misclassification and definitions of employees were handled in law and policy. Debates about minimum wage and occupational health and safety standards as they relate to worker well-being are considered. Finally, we discuss promising changes introduced during the COVID-19 pandemic that protect the health of low-wage and self-employed workers. Overall, we describe an ongoing "haves" and a "have not" divide, with on the one extreme, traditional job arrangements with good work-and-health social protections and, on the other extreme, low-wage and self-employed digital platform workers who are mostly left out of schemes. However, during the pandemic small and often temporary gains occurred and are discussed.Funding Agencies|Canadian Institutes of Health Research [VR5-172687]</p

Behavior Genetics and the Within-Person Variability of Daily Interpersonal Styles: The Heritability of Flux, Spin and Pulse

A classical twin study was used to estimate the magnitude of genetic and environmental influences on four measurements of within-person variability, namely dominance flux, warmth flux, spin, and pulse. Flux refers to the variability of an individual’s interpersonal dominance and warmth. Spin measures changes in the tone of interpersonal styles, and pulse measures changes in the intensity of interpersonal styles. Daily reports of interpersonal styles were collected from 494 same-sex female twins (142 monozygotic pairs and 105 dizygotic pairs) over 45 days. For dominance flux, warmth flux, and spin, genetic effects accounted for a larger proportion of variance (37%, 24%, and 30%, respectively) than shared environmental effects (14%, 13%, and 0%, respectively), with the remaining variance due to the nonshared environment (62%, 50%, and 70%, respectively). Pulse appeared to be primarily influenced by the nonshared environment, although conclusions about the contribution of familial influences were difficult to draw from this study

A Further Validation of the Minnesota Borderline Personality Disorder Scale

Previous research indicates that borderline personality disorder (BPD) is well conceptualized as a dimensional construct that can be represented using normal personality traits. A previous study successfully developed and validated a BPD measure embedded within a normal trait measure, the Minnesota Borderline Personality Disorder Scale (MBPD). The current study performed a further validation of the MBPD by examining its convergent validity, external correlates, and heritability in a sample of 429 female twins. The MBPD correlated strongly with the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II) screener for BPD and moderately with external correlates. Moreover, the MBPD and SCID-II screener exhibited very similar patterns of external correlations. Additionally, results indicated that the genetic and environmental influences on MBPD overlap with the genetic and environmental influences on the SCID-II screener, which suggests that these scales are measuring the same construct. These data provide further evidence for the construct validity of the MBPD

Impacts of familiarity, conflict, and sex on continuous interpersonal behavior

Examines impacts of familiarity, conflict, and sex on continuously assessed behavior in dyadic interactions using the Continuous Assessment of Interpersonal Dynamics across several samples. Establishes norms and basic psychometrics for CAID while also informing factors that influence interpersonal behavior

Array comparative genomic hybridisation analysis of boys with X‐linked hypopituitarism identifies a 3.9 Mb duplicated critical region at Xq27 containing SOX3

Copyright © 2007 by the BMJ Publishing Group Ltd.Nicola M Solomon, Shelley A Ross, Susan M Forrest, Paul Q Thomas, Thomas Morgan, Joseph L Belsky, Frans A Hol, Pamela S Karnes, Nancy J Hopwood, Susan E Myers, Anjanette S Tan, Garry L Warn