A Study on Food Security Among Single Parents and Elderly Populations in St. John’s: Final Report

According to the Food and Agriculture Organization, food security is defined as “the idea that all people at all times have access (including physical, social, and economic access) to sufficient, safe, and nutritious food necessary to lead active and healthy lives.” While more than one-fifth of NL’s population does not have enough disposable income to buy the necessities like food, one in every twenty uses food banks on a regular basis. Around 60% of people who use food banks in the province are women, and the majority of the recipients are on social assistance. The senior population is another group likely to suffer from food insecurity. Many of these seniors live alone and often face multiple complex challenges in the ability to purchase and prepare healthy food. Despite this precarious situation, in comparison to other provinces, there is scarce evidence on the complex dynamics of food insecurity affecting these vulnerable populations and hinders the development and implementation of appropriate and efficient strategies. We intended to study the ways, and extent food insecurity affects food-related practices among the elderly population and single parents living in St John’s, NL. We used the mixed method approach, including the key informant (KI) interviews, followed by face-to-face survey interviews with a representative sample of 50 single parents and 48 seniors (over the age of 65 years). We first conducted KI interviews of government officials and service providers who deal with such vulnerable population. Following this, we conducted a survey. The survey questions were based on the validated questionnaire for the general population, developed by the Statistics Canada, during their latest Canadian Community Health Survey in 2012. In order to reach out to the participants, we partnered with Single Parents Association of Newfoundland and Senior Resource Centre NL and followed convenient sampling. The KI interviews and the additional comments from the survey respondents reveal that there is a growing trend in the consumption of processed/semi-processed or take-out foods, particularly among the single parents. Cooking skills and practices have markedly decreased, particularly among the single parents and further motivates to buy processed/semi-processed or take-out foods. Single parents use food banks more than the seniors. For seniors, mobility and physical disability are the major issues for a regular visit to groceries and cooking. Quantitative analysis: Income wise single parents are in more disadvantageous position than seniors. While 80% of single parents earn less than $25,000/year, only 4$40,000/year. For seniors, the proportions of these income brackets are 50% and 22% respectively. Single parents mostly (80%) relied upon government sponsored income support and wages/salaries (35%). The majority of the elderly persons depended on old age security and guaranteed income support (71%) and job-related retirement pensions (48%). Regular eating of healthy food was more among the elderly population than single parents. Our study shows that single parents and seniors are vulnerable to food security, however, the former population group is more vulnerable than the other. The strong association between food insecurity and low educational status (not with income) indicates the importance of awareness generation. Existing food guide can be further improvised with more inputs on quick, easy, affordable but healthy cooking recipe. The study findings strongly advocate the scaling up of social safety nets with more promotion of healthy foods and reaching out to the vulnerable communities with more practical health promotion message

Rubella antibody levels in school-aged children in Newfoundland: Implications for a two-dose rubella vaccination strategy

OBJECTIVE: To determine the prevailing levels of rubella immunity among school-aged children who received a single dose of measles-mumps-rubella (MMR) vaccine at one year of age. DESIGN: Cross-sectional study with a two stage cluster sampling of randomly picked schools across the province of Newfoundland. STUDY POPULATION AND METHODS: A total of 1053, five to 17-year-old children were enrolled; vaccination history was verified through official records; and a sample of blood was taken. Rubella immunity was determined by enzyme immunoassay based on a serum antibody protective cut-off titre of more than 10 IU. RESULTS: A total of 145 (13.8%) were found to be nonimmune. The rate of susceptibility ranged from 3.2% to 25.9% for different age groups. The proportion susceptible was significantly higher at 16.5% in the age group eight to 17 years old versus 3.9% for the age group five to eight years old (χ2=24.08; df=1, P<0.001). There was a significant regression of logarithm titre values on the age of children with an average decline in titre values of 8.1% per annum. CONCLUSIONS: A substantial number of those who were given a single dose of MMR II vaccine may not have protective immunity against rubella as they reach prime reproductive age. There is a definite need to consider a two-dose rubella vaccination strategy in Canada, and these data suggest the second dose given after eight years of age will be most beneficial. In the move towards a routine two-dose measles vaccination strategy in Canada, the MMR II vaccine is being used for the second dose and given either at 18 months of age or at school entry. While this approach will have an overall beneficial effect, the impact of the above timing of the second dose on long term rubella immunity cannot be predicted at this time. These data also underscore the continuing need for prenatal rubella screening program

Sustaining information and communication technology use among Canadians with at least one activity limitation

Objective - There are few studies that describe the characteristics of individuals who transition from information and communication technology usage to non-usage. The aim of this study was to examine the characteristics of non-sustaining Internet users who reported at least one activity limitation to the 2006 Canadian census. Non-sustainers are past users who have not used the Internet during the last 12 months. Methods - We analyzed data from the respondents of the 2006 Participation and Activity Limitation Survey (PALS 2006) using descriptive analyses. The demographic and clinical profiles of those who had given up using the Internet (non-sustainers) were compared to that of people who had continued using the Internet (sustainers). Results - PALS 2006 surveyed adult Canadians with at least one activity limitation. While nearly half of all respondents reported having used the Internet in the past, 9.8% of those had not used it in the past 12 months and were designated “non-sustainers”. Individuals who were older (60+ years of age; 44.4%), were in the lowest income category (53.8%), and lived in rural communities (28.1%) were over-represented in the non-sustainer group compared to those who had sustained Internet usage. The most commonly reported limitations were pain (68.8%), mobility (67.5%), and agility (58.3%), although overall Internet usage and dropout rate were not markedly different between conditions. More than one-third of non-sustainers reported taking five or more prescribed medications on a daily basis, compared to less than one-quarter of sustainers. Conclusion - Compared to the general population, a high percentage of people with activity limitations report not having sustained their Internet usage. While the clinical profile of this group is not markedly different from those who continue to use the Internet, non-sustainers are more likely to be older, have less income and live in a rural community. We recommend that further research be conducted to identify the reasons for giving up the Internet and potential interventions to increase sustainability since a lack of digital engagement may lead to greater disadvantage for people with disabilities

Are age friendly communities also resilient communities?

In both absolute and relative terms the number of older people is increasing globally, and while everyone hopes to stay active and healthy as they age, seniors face particular challenges to maintaining health, and consequently make more use of healthcare services than any other age group. But the challenges faced by individual seniors and to our health care system can be mitigated by policy interventions that promote seniors’ health. In this paper we focus on one such policy that has generated global interest: Age-Friendly Communities (AFC). According to the World Health Organization these are communities, “where policies, services and structures related to the physical and social environment [that] are designed to support and enable older people … to live in security, enjoy good health and continue to participate fully in society”. Specifically we present the findings of a collaborative study of the perceptions of residents–old and young–regarding age-friendliness of one Canadian city, St John’s, the capital city of the Canadian province of Newfoundland and Labrador. Our study represents the first to test whether residents’ impressions of AFC characteristics differ by age

A Quality Improvement Emergency Department Surge Management Platform (SurgeCon): Protocol for a Stepped Wedge Cluster Randomized Trial

BackgroundDespite many efforts, long wait times and overcrowding in emergency departments (EDs) have remained a significant health service issue in Canada. For several years, Canada has had one of the longest wait times among the Organisation for Economic Co-operation and Development countries. From a patient’s perspective, this challenge has been described as “patients wait in pain or discomfort for hours before being seen at EDs.” To overcome the challenge of increased wait times, we developed an innovative ED management platform called SurgeCon that was designed based on continuous quality improvement principles to maintain patient flow and mitigate the impact of patient surge on ED efficiency. The SurgeCon quality improvement intervention includes a protocol-driven software platform, restructures ED organization and workflow, and aims to establish a more patient-centric environment. We piloted SurgeCon at an ED in Carbonear, Newfoundland and Labrador, and found that there was a 32% reduction in ED wait times. ObjectiveThe primary objective of this trial is to determine the effects of SurgeCon on ED performance by assessing its impact on length of stay, the time to a physician’s initial assessment, and the number of patients leaving the ED without being seen by a physician. The secondary objectives of this study are to evaluate SurgeCon’s effects on patient satisfaction and patient-reported experiences with ED wait times and its ability to create better-value care by reducing the per-patient cost of delivering ED services. MethodsThe implementation of the intervention will be assessed using a comparative effectiveness-implementation hybrid design. This type of hybrid design is known to shorten the amount of time associated with transitioning interventions from being the focus of research to being used for practice and health care services. All EDs with 24/7 on-site physician support (category A hospitals) will be enrolled in a 31-month, pragmatic, stepped wedge cluster randomized trial. All clusters (hospitals) will start with a baseline period of usual care and will be randomized to determine the order and timing of transitioning to intervention care until all hospitals are using the intervention to manage and operationalize their EDs. ResultsData collection for this study is continuing. As of February 2022, a total of 570 randomly selected patients have participated in telephone interviews concerning patient-reported experiences and patient satisfaction with ED wait times. The first of the 4 EDs was randomly selected, and it is currently using SurgeCon’s eHealth platform and applying efficiency principles that have been learned through training since September 2021. The second randomly selected site will begin intervention implementation in winter 2022. ConclusionsBy assessing the impact of SurgeCon on ED services, we hope to be able to improve wait times and create better-value ED care in this health care context. Trial RegistrationClinicalTrials.gov NCT04789902; https://clinicaltrials.gov/ct2/show/NCT04789902 International Registered Report Identifier (IRRID)DERR1-10.2196/3045