Serving High-Risk Youth in Context: Perspectives from Hong Kong

Background: High-risk youth are often defined in occupational therapy terminology as adolescents and young adults who experience personal, contextual, or environmental barriers to effective participation in healthy, age-appropriate occupations. Without assistance for participation, these youth may acquiesce to daily routines of unhealthy risk-taking or isolation, failing to achieve developmental milestones needed for successful transition to adulthood. There are known therapeutic services targeting this population, but occupational therapy involvements have been sparsely documented. Method: Having been affiliated with a community-based occupational therapy program serving high-risk youth for many years in the US, the principal investigator of the study used a sabbatical opportunity to explore services provided to high-risk youth in Hong Kong (HK). This paper reports preliminary findings obtained from an exploratory study of analyzing transcripts of 13 one-on-one interviews with service providers in HK. Results: Two major themes are discussed in this paper: the prevalent behavioral risks among high-risk youth as perceived by the service providers and the intervention approaches used by the service providers with the high-risk youth population in HK. Conclusion: Reflecting on the preliminary outcome of the study, the authors suggest that occupational therapy may contribute to mitigating youths’ risk factors through ecological occupational engagement

Ethical Issues in Conducting Community-Based Participatory Research: A Narrative Review of the Literature

Community-based participatory research (CBPR) is a methodology increasingly used within the social sciences. CBPR is an umbrella term that encompasses a variety of research methodologies, including participatory research, participatory action research, feminist participatory research, action research, and collaborative inquiry. At its core, they share five key attributes: (i) community as a unit of identity; (ii) an approach for the vulnerable and marginalized; (iii) collaboration and equal partnership throughout the entire research process; (iv) an emergent, flexible, and iterative process; and (v) the research process is geared toward social action. While there is no shortage of literature that highlights the benefits and potential of CBPR, relatively little discussion exists on the ethical issues associated with the methodology. In particular, current gaps within the literature include ethical guidance in (i) balancing community values, needs, and identity with those of the individual; (ii) negotiating power dynamics and relationships; (iii) working with stigmatized populations; (iv) negotiating conflicting ethical requirements and expectations from Institutional Review Boards (IRBs); and (v) facilitating social action emerging from the findings. For CBPR’s commendable goals and potential to be realized, it is necessary to have a more fulsome discussion of the ethical issues encountered while implementing a CBPR study. Further, a lack of awareness and critical reflection on such ethical considerations may perpetuate the very same problems this methodology seeks to address, namely, inequality, oppression, and marginalization. The purpose of this article is to provide a narrative review of the literature that identifies ethical issues that may arise from conducting CBPR studies, and the recommendations by researchers to mitigate such challenges

Initial Validity and User Experience of a Dynamic Assessment of Occupational Performance for Transitional Age Youth

Background: The Double OT (DOT) assessment is occupation-based and dynamic, designed with a client-centered format requiring skill demonstration. It was developed to support youth transitioning into the workplace. This research intended to analyze initial validity and users’ experience. Method: This study includes qualitative and quantitative analyses of data collected from surveys from 169 client participants (APs) and 30 recipient participants (ARRs) from eight sites in the USA and Europe. AP were 14­ to 25 years of age and engaged in residential, educational, and vocational settings. The ARRs comprised partners who had received DOT assessment summaries about APs with whom they worked. Results: The APs showed high engagement and learning; average ratings for each item fell between 4.24–4.54 on a 5-point Likert scale. The ARRs agreed on the validity and usability of the DOT; average ratings for each item fell between 3.75 and 4.53 on a 5-point Likert scale. Qualitative themes indicated that the DOT is: “fun and engaging,” “vocationally informative and applicable,” and that there is an absence of commonly used assessments informing vocational transitions. Conclusion: The results support initial validity of the DOT. Users find it to be highly engaging, with good usability, and indicate that it facilitates participant learning

Cultural Norms Shaping Research Group Interviews with Chinese American Immigrants

Practical knowledge on how to tailor research methods for Asian Americans is relatively scarce despite the rapid population growth of this ethnic group and the ongoing calls for greater cultural competence among researchers. Based on a 4-year qualitative study of family and cultural issues in diabetes management among Chinese American immigrants, this article presents data-based analyses of culturally nuanced group interview processes, and recommendations for conducting culturally appropriate group interviews. Group interview processes were prominently shaped by 4 cultural norms: sensitivity to social hierarchy, monitoring public display of strong emotions, face concerns, and emphasis on group harmony. Strategies for facilitating open and dynamic group interviews in the presence of these norms were identified. Skillful facilitation of group processes, either by accommodating or diffusing norms, was required to promote participant rapport and encourage disclosure of everyday experience

Gestion des anticoagulants : une formation interdisciplinaire pour les résidents en médecine familiale

Implication Statement Anticoagulants are high-risk medications with the potential to cause significant patient harm if inappropriately managed. Medical trainees and practicing physicians often report inadequate education and uncertainty in decision-making related to anticoagulation therapy. To address this gap, an interdisciplinary Anticoagulation Management Training Program was developed for family medicine residents at the Toronto Western Family Health Team. Evaluation data demonstrated both improved knowledge and confidence in prescribing, monitoring, and adjusting anticoagulation therapy. This suggests that similar dedicated curricula be considered in other family medicine programs in order to optimize patient safety by enhancing the knowledge and self-efficacy of future practising physicians.Énoncé des implications de la recherche Les anticoagulants sont des médicaments à haut risque qui, mal gérés, peuvent causer des dommages importants aux patients. De nombreux étudiants en médecine et médecins en exercice déclarent que leur formation est inadéquate et qu’ils ont des doutes lorsqu’ils prescrivent un traitement anticoagulant. Pour combler cette lacune, une formation interdisciplinaire en gestion des anticoagulants a été élaborée pour les résidents en médecine familiale au sein de la Toronto Western Family Health Team. Les données d’évaluation de la formation indiquent une amélioration sur le plan des connaissances et de la confiance lors de la prescription, ainsi que sur celui du suivi et de l’ajustement de l’anticoagulothérapie. Ces résultats suggèrent qu’il serait donc pertinent d’envisager l’introduction de formations spécialisées de ce type dans les programmes de médecine familiale pour mieux assurer la sécurité des patients par le développement des connaissances et de l’auto-efficacité des futurs praticiens

Acculturation and Bicultural Efficacy Effects on Chinese American Immigrants’ Diabetes and Health Management

The primary goal of this study was to examine effects of bicultural efficacy, or perceived confidence in dealing with bicultural acculturation stressors, on type 2 diabetes management and health for first-generation, Cantonese-speaking, Chinese American immigrants (N=162) recruited for a larger community-based diabetes intervention study (Chesla et al., 2013). The current study also tested whether a new Bicultural Efficacy in Health Management (BEFF-HM) scale is a more robust predictor of diabetes and health outcomes than proxy (years in the U.S.) and general acculturation measures. Hierarchical regression analyses of cross-sectional data revealed that high BEFF-HM was significantly related to positive outcomes on five of six diabetes and health measures as hypothesized after accounting for participant characteristics, proxy and general acculturation measures, and social support. Proxy and general acculturation measures failed to predict any study outcome supporting our secondary hypothesis that BEFF-HM is a better predictor of Chinese American immigrants’ diabetes and health management. An immigrant-focused research approach advances understanding of acculturation and bicultural efficacy effects on health by identifying key acculturation domains for study

Allelic expression mapping across cellular lineages to establish impact of non-coding SNPs

This is an open access article under the terms of the Creative Commons Attribution 4.0 License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited

Anticoagulation management: an interdisciplinary curriculum for family medicine residents

Implication Statement Anticoagulants are high-risk medications with the potential to cause significant patient harm if inappropriately managed. Medical trainees and practicing physicians often report inadequate education and uncertainty in decision-making related to anticoagulation therapy. To address this gap, an interdisciplinary Anticoagulation Management Training Program was developed for family medicine residents at the Toronto Western Family Health Team. Evaluation data demonstrated both improved knowledge and confidence in prescribing, monitoring, and adjusting anticoagulation therapy. This suggests that similar dedicated curricula be considered in other family medicine programs in order to optimize patient safety by enhancing the knowledge and self-efficacy of future practising physicians

Changes in vitamin and mineral supplement use after breast cancer diagnosis in the Pathways Study: a prospective cohort study

BACKGROUND: Vitamin and mineral supplement use after a breast cancer diagnosis is common and controversial. Dosages used and the timing of initiation and/or discontinuation of supplements have not been clearly described. METHODS: We prospectively examined changes in use of 17 vitamin/mineral supplements in the first six months following breast cancer diagnosis among 2,596 members (28% non-white) of Kaiser Permanente Northern California. We used multivariable logistic regression to examine demographic, clinical, and lifestyle predictors of initiation and discontinuation. RESULTS: Most women used vitamin/mineral supplements before (84%) and after (82%) diagnosis, with average doses far in excess of Institute of Medicine reference intakes. Over half (60.2%) reported initiating a vitamin/mineral following diagnosis, 46.3% discontinuing a vitamin/mineral, 65.6% using a vitamin/mineral continuously, and only 7.2% not using any vitamin/mineral supplement before or after diagnosis. The most commonly initiated supplements were calcium (38.2%), vitamin D (32.01%), vitamin B6 (12.3%) and magnesium (11.31%); the most commonly discontinued supplements were multivitamins (17.14%), vitamin C (15.97%) and vitamin E (45.62%). Higher education, higher intake of fruits/vegetables, and receipt of chemotherapy were associated with initiation (p-values <0.05). Younger age and breast-conserving surgery were associated with discontinuation (p-values <0.05). CONCLUSIONS: In this large cohort of ethnically diverse breast cancer patients, high numbers of women used vitamin/mineral supplements in the 6 months following breast cancer diagnosis, often at high doses and in combination with other supplements. The immediate period after diagnosis is a critical time for clinicians to counsel women on supplement use

SABINA + Hong Kong: a territory wide study of prescribing trends and outcomes associated with the use of short-acting β2 agonists in the Chinese population

Background: Excessive use of short-acting β2 agonists (SABA) in patients with asthma continues to be a notable concern due to its link to higher mortality rates. Global relevance of SABA overuse in asthma management cannot be understated, it poses significant health risk to patients with asthma and imposes burden on healthcare systems. This study, as part of global SABINA progamme, aimed to describe the prescribing patterns and clinical outcomes associated with SABA use in the Chinese population. Methods: Retrospective cohort study was conducted using anonymized electronic healthcare records of Clinical Data Analysis and Reporting System (CDARS) from Hong Kong Hospital Authority (HA). Patients newly diagnosed with asthma between 2011 and 2018 and aged ≥12 years were included, stratified by SABA use (≤2, 3–6, 7–10, or ≥11 canisters/year) during one-year baseline period since asthma diagnosis date. Patients were followed up from one-year post-index until earliest censoring of events: outcome occurrence and end of study period (31 December 2020). Cox proportional regression and negative binomial regression were used to estimate the mortality risk and frequency of hospital admissions associated with SABA use respectively, after adjusting for age, sex, Charlson Comorbidity Index (CCI), and inhaled corticosteroid (ICS) dose. Outcomes include all-cause, asthma-related, and respiratory-related mortality, frequency of hospital admissions for any cause, and frequency of hospital admissions due to asthma. Results: 17,782 patients with asthma (mean age 46.7 years, 40.8% male) were included and 59.1% of patients were overusing SABA (≥ 3 canisters per year). Each patient was prescribed a median of 5.61 SABA canisters/year. SABA overuse during baseline period was associated with higher all-cause mortality risk compared to patients with ≤2 canisters/year. Association was dose-dependent, highest risk in those used ≥11 canisters/year (adjusted hazard ratio: 1.42, 95% CI: 1.13, 1.79) and 3–6 canisters/year (adjusted hazard ratio: 1.22, 95% CI: 1.00, 1.50). Higher SABA prescription volume associated with increased frequency of hospital admissions with greatest risk observed in 7–10 canisters/year subgroup (adjusted rate ratio: 4.81, 95% CI: 3.66, 6.37). Conclusions: SABA overuse is prevalent and is associated with increased all-cause mortality risk and frequency of hospital admissions among the patients with asthma in Hong Kong