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Sheppard CL, Roche B, Austen A, Hitzig SL. 'When the bedbugs come, that's another problem': exploring the lived experiences of bedbug infestations among low-income older adults and service providers who support them. Perspect Public Health 2024; 144:111-118. [PMID: 36127851 PMCID: PMC10916340 DOI: 10.1177/17579139221118777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS Older adults in low-income housing communities are more vulnerable to bedbug infestations. Prior research, however, has predominately focused on the effectiveness of integrated pest-management strategies, with little attention given to the lived experiences of tenants struggling with infestations. We used a qualitative approach to explore what it is like to live with and treat bedbug infestations from the perspectives of low-income older adults and service providers. METHODS Participants included low-income older adults (n = 58) and service providers (n = 58) who offer supports directly in the buildings. Semi-structured qualitative interviews and focus groups were used to explore the challenges of preparing and treating units for bedbugs, and examine how bedbugs impact access to support services. RESULTS Bedbugs were a widespread issue, and underlying physical, mental, social, and financial challenges made it difficult for older tenants to prepare their units and access treatment. Tenants also faced bedbug stigma from community services, as many were unwilling to provide services in infested units. Although some service providers utilized strategies to minimize exposure, many were concerned these strategies created additional stigma. CONCLUSION Our findings highlight an urgent need to increase public health funding to support older adults with the costs of bedbug elimination and to enhance pest-management strategies through partnerships with health and social service agencies to improve outcomes for older adults.
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Affiliation(s)
- CL Sheppard
- St. John’s Rehab Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - B Roche
- Wellesley Institute, Toronto, ON, Canada
| | - A Austen
- Seniors Services and Long-Term Care, City of Toronto, Toronto, ON, Canada
| | - SL Hitzig
- St. John’s Rehab Research Program, Sunnybrook Research Insitute, 285 Cummer Avenue, Toronto, ON M2M 2G1, Canada
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Loh E, Guy SD, Mehta S, Moulin DE, Bryce TN, Middleton JW, Siddall PJ, Hitzig SL, Widerström-Noga E, Finnerup NB, Kras-Dupuis A, Casalino A, Craven BC, Lau B, Côté I, Harvey D, O'Connell C, Orenczuk S, Parrent AG, Potter P, Short C, Teasell R, Townson A, Truchon C, Bradbury CL, Wolfe D. The CanPain SCI Clinical Practice Guidelines for Rehabilitation Management of Neuropathic Pain after Spinal Cord: introduction, methodology and recommendation overview. Spinal Cord 2017; 54 Suppl 1:S1-6. [PMID: 27444714 DOI: 10.1038/sc.2016.88] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
STUDY DESIGN Clinical practice guidelines. OBJECTIVES The objective was to develop the first Canadian clinical practice guidelines for the management of neuropathic pain in people with spinal cord injury (SCI). SETTING The guidelines are relevant for inpatient and outpatient SCI rehabilitation settings in Canada. METHODS The guidelines were developed in accordance with the Appraisal of Guidelines for Research and Evaluation II tool. A Steering Committee and Working Group reviewed the relevant evidence on neuropathic pain management (encompassing screening and diagnosis, treatment and models of care) after SCI. The quality of evidence was scored using Grading of Recommendations Assessment, Development and Evaluation (GRADE). A consensus process was followed to achieve agreement on recommendations and clinical considerations. RESULTS The Working Group developed 12 recommendations for screening and diagnosis, 12 recommendations for treatment and 5 recommendations for models of care. Important clinical considerations accompany each recommendation. CONCLUSIONS The Working Group recommendations for the management of neuropathic pain after SCI should be used to inform practice.
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Affiliation(s)
- E Loh
- Lawson Health Research Institute, London, Ontario, Canada.,St. Joseph's Health Care Pain Clinic, London, Ontario, Canada.,Western University, London, Ontario, Canada.,Parkwood Institute, London, Ontario, Canada
| | - S D Guy
- Lawson Health Research Institute, London, Ontario, Canada.,Western University, London, Ontario, Canada.,Parkwood Institute, London, Ontario, Canada
| | - S Mehta
- Lawson Health Research Institute, London, Ontario, Canada.,Western University, London, Ontario, Canada.,Parkwood Institute, London, Ontario, Canada
| | - D E Moulin
- St. Joseph's Health Care Pain Clinic, London, Ontario, Canada.,Western University, London, Ontario, Canada
| | - T N Bryce
- Mount Sinai Hospital, New York, NY, USA
| | - J W Middleton
- The University of Sydney, Sydney, New South Wales, Australia
| | - P J Siddall
- The University of Sydney, Sydney, New South Wales, Australia
| | - S L Hitzig
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | | | | | | | - A Casalino
- Parkwood Institute, London, Ontario, Canada
| | - B C Craven
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | - B Lau
- University of British Columbia, Vancouver, British Columbia, Canada
| | - I Côté
- Center interdisciplinaire de reserche en réadaptation et integration sociale, Quebec City, Quebec
| | - D Harvey
- Spinal Cord Injury Ontario, Ontario, Canada
| | - C O'Connell
- Stan Cassidy Centre for Rehabilitation, Fredericton, New Brunswick, Canada
| | - S Orenczuk
- Parkwood Institute, London, Ontario, Canada
| | - A G Parrent
- Western University, London, Ontario, Canada.,London Health Sciences Center, London, Ontario, Canada
| | - P Potter
- Western University, London, Ontario, Canada.,Parkwood Institute, London, Ontario, Canada
| | - C Short
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - R Teasell
- Lawson Health Research Institute, London, Ontario, Canada.,Western University, London, Ontario, Canada
| | - A Townson
- University of British Columbia, Vancouver, British Columbia, Canada
| | - C Truchon
- Institut National d'Excellence en Santé et Services Sociaux, Montreal, Quebec
| | - C L Bradbury
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | - D Wolfe
- Lawson Health Research Institute, London, Ontario, Canada.,Western University, London, Ontario, Canada
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Heelan K, Hitzig SL, Knowles S, Drucker AM, Mittmann N, Walsh S, Shear NH. Loss of Work Productivity and Quality of Life in Patients With Autoimmune Bullous Dermatoses. J Cutan Med Surg 2015; 19:546-54. [DOI: 10.1177/1203475415582317] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Little is known about quality of life and work productivity in autoimmune bullous dermatoses (AIBDs). Objective: To determine the impact of AIBDs on quality of life and work productivity. Methods: An observational cross-sectional study took place between February and May 2013 at an AIBD tertiary referral centre. Ninety-four patients were included. All participants completed the Dermatology Life Quality Index and the Work Productivity and Activity Impairment–Specific Health Problem questionnaires. Results: Responders to treatment had less impairment ( P < .001) than nonresponders. Patients with severe AIBD had significantly more impairment that those with mild ( P < .001) and moderate ( P = .002) AIBD. Greater impairment was associated with higher percentage of work missed. Those with a higher Dermatology Life Quality Index score had greater work impairment and overall activity impairment ( P = .041, P = .024). Nonresponders had increased impairment while working ( P < .001), overall work impairment ( P < .001), and activity impairment ( P < .001). Severely affected patients had worse impairment in all Work Productivity and Activity Impairment Questionnaire domains. Conclusions: AIBD has the potential to be a large burden on ability to work and quality of life. Larger studies are needed to clarify how these domains change over time and whether or not they improve with treatment.
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Affiliation(s)
- K. Heelan
- Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - S. L. Hitzig
- Institute for Life Course and Aging, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - S. Knowles
- Division of Clinical Pharmacology and Toxicology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
- Department of Pharmacology, University of Toronto, Toronto, ON, Canada
| | - A. M. Drucker
- Division of Dermatology, University Health Network, Toronto, ON, Canada
| | - N. Mittmann
- Division of Clinical Pharmacology and Toxicology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
- Department of Pharmacology, University of Toronto, Toronto, ON, Canada
- Health Outcomes and PharmacoEconomics (HOPE) Research Centre, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - S. Walsh
- Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - N. H. Shear
- Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
- Division of Clinical Pharmacology and Toxicology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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Craven BC, Balioussis C, Hitzig SL, Moore C, Verrier MC, Giangregorio LM, Popovic MR. Use of screening to recruitment ratios as a tool for planning and implementing spinal cord injury rehabilitation research. Spinal Cord 2014; 52:764-8. [DOI: 10.1038/sc.2014.126] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 05/20/2014] [Accepted: 05/28/2014] [Indexed: 11/09/2022]
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Aidinoff E, Front L, Itzkovich M, Bluvshtein V, Gelernter I, Hart J, Biering-Sørensen F, Weeks C, Laramee MT, Craven C, Hitzig SL, Glaser E, Zeilig G, Aito S, Scivoletto G, Mecci M, Chadwick RJ, Masry WSE, Osman A, Glass CA, Soni BM, Gardner BP, Savic G, Bergström EM, Silva P, Catz A. Expected spinal cord independence measure, third version, scores for various neurological levels after complete spinal cord lesions. Spinal Cord 2011; 49:893-6. [DOI: 10.1038/sc.2011.32] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Itzkovich M, Gelernter I, Biering-Sorensen F, Weeks C, Laramee MT, Craven BC, Tonack M, Hitzig SL, Glaser E, Zeilig G, Aito S, Scivoletto G, Mecci M, Chadwick RJ, El Masry WS, Osman A, Glass CA, Silva P, Soni BM, Gardner BP, Savic G, Bergström EM, Bluvshtein V, Ronen J, Catz A. The Spinal Cord Independence Measure (SCIM) version III: Reliability and validity in a multi-center international study. Disabil Rehabil 2009; 29:1926-33. [PMID: 17852230 DOI: 10.1080/09638280601046302] [Citation(s) in RCA: 310] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To examine the third version of the Spinal Cord Independence Measure (SCIM III) for reliability and validity in a multi-center cohort study. METHOD Four hundred and twenty-five patients with spinal cord lesions from 13 spinal cord units in six countries from three continents were assessed with SCIM III and the Functional Independence measure (FIM) on admission to rehabilitation and before discharge. RESULTS Total agreement between raters was above 80% in most SCIM III tasks, and all kappa coefficients were statistically significant (P<0.001). The coefficients of Pearson correlation between the paired raters were above 0.9, and intraclass correlation coefficients were above 0.94. Cronbach's alpha was above 0.7. The coefficient of Pearson correlation between FIM and SCIM III was 0.790 (P<0.01). SCIM III was more responsive to changes than FIM in the subscales of Respiration and sphincter management and Mobility indoors and outdoors. CONCLUSIONS The results support the reliability and validity of SCIM III in a multi-cultural setup. Despite several limitations of the study, the results indicate that SCIM III is an efficient measure for functional assessment of SCL patients and can be safely used for clinical and research trials, including international multi-center studies.
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Affiliation(s)
- M Itzkovich
- Spinal Department, Loewenstein Rehabilitation Hospital, Raanana, Israel
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Tonack M, Hitzig SL, Craven BC, Campbell KA, Boschen KA, McGillivray CF. Predicting life satisfaction after spinal cord injury in a Canadian sample. Spinal Cord 2007; 46:380-5. [PMID: 17579615 DOI: 10.1038/sj.sc.3102088] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Cross-sectional, survey. OBJECTIVES To extend current theoretical models predicting life satisfaction post-spinal cord injury (SCI). Our primary model predicting life satisfaction as measured by the Satisfaction with Life Scale (SWLS) examined demographic characteristics, elements of the International Classification of Functioning and subjective and objective measures of health. A second model was developed to examine factors that are associated with successful community participation as measured by the Reintegration to Normal Living Index (RNL). In addition, the effects of psychological distress and chronic pain on life satisfaction and community participation were examined. SETTING Toronto Rehabilitation Institute, Spinal Cord Rehabilitation Program, Lyndhurst Centre. METHODS Prospective data collection via semi-structured telephone interview on an established SCI Canadian sample. RESULTS In predicting life satisfaction, our model accounted for 35.3% of the variance with demographic characteristics, objective and subjective health, and community participation significantly contributing to the model. In particular, psychological complications, current health rating and community participation were the only variables that made significant contributions in predicting life satisfaction. With regards to community participation, the presence of psychological complications and number of medical complications were associated with decreased reintegration. Increased time since injury onset, higher health ratings and being employed were positively related to RNL. CONCLUSION It would appear that factors involving functional decline and aging are associated with lower participation but not life satisfaction. Further, models predicting quality of life should incorporate measures of psychological functioning.
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Affiliation(s)
- M Tonack
- Lyndhurst Centre, Toronto Rehabilitation Institute, Toronto, Ontario, Canada
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Catz A, Itzkovich M, Tesio L, Biering-Sorensen F, Weeks C, Laramee MT, Craven BC, Tonack M, Hitzig SL, Glaser E, Zeilig G, Aito S, Scivoletto G, Mecci M, Chadwick RJ, El Masry WS, Osman A, Glass CA, Silva P, Soni BM, Gardner BP, Savic G, Bergström EM, Bluvshtein V, Ronen J. A multicenter international study on the Spinal Cord Independence Measure, version III: Rasch psychometric validation. Spinal Cord 2006; 45:275-91. [PMID: 16909143 DOI: 10.1038/sj.sc.3101960] [Citation(s) in RCA: 211] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND A third version of the Spinal Cord Independence Measure (SCIM III), made up of three subscales, was formulated following comments by experts from several countries and Rasch analysis performed on the previous version. OBJECTIVE To examine the validity, reliability, and usefulness of SCIM III using Rasch analysis. DESIGN Multicenter cohort study. SETTING Thirteen spinal cord units in six countries from North America, Europe, and the Middle-East. SUBJECTS 425 patients with spinal cord lesions (SCL). INTERVENTIONS SCIM III assessments by professional staff members. Rasch analysis of admission scores. MAIN OUTCOME MEASURES SCIM III subscale match between the distribution of item difficulty grades and the patient ability measurements; reliability of patient ability measures; fit of data to Rasch model requirements; unidimensionality of each subscale; hierarchical ordering of categories within items; differential item functioning across classes of patients and across countries. RESULTS Results supported the compatibility of the SCIM subscales with the stringent Rasch requirements. Average infit mean-square indices were 0.79-1.06; statistically distinct strata of abilities were 3 to 4; most thresholds between adjacent categories were properly ordered; item hierarchy was stable across most of the clinical subgroups and across countries. In a few items, however, misfit or category threshold disordering were found. CONCLUSIONS The scores of each SCIM III subscale appear as a reliable and useful quantitative representation of a specific construct of independence after SCL. This justifies the use of SCIM in clinical research, including cross-cultural trials. The results also suggest that there is merit in further refining the scale.
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Affiliation(s)
- A Catz
- Spinal Department, Loewenstein Rehabilitation Hospital, Raanana, Israel
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