Explore the vast range of titles available.

Individuals who are homeless or vulnerably housed are at an increased risk for mental illness, other morbidities and premature death. Standard case management interventions as well as more intensive models with practitioner support, such as assertive community treatment, critical time interventions, and intensive case management, may improve healthcare navigation and outcomes. However, the definitions of these models as well as the fidelity and adaptations in real world interventions are highly variable. We conducted a systematic review to examine the effectiveness and cost-effectiveness of case management interventions on health and social outcomes for homeless populations. We searched Medline, Embase and 7 other electronic databases for trials on case management or care coordination, from the inception of these databases to July 2019. We sought outcomes on housing stability, mental health, quality of life, substance use, hospitalization, income and employment, and cost-effectiveness. We calculated pooled random effects estimates and assessed the certainty of the evidence using the GRADE approach. Our search identified 13,811 citations; and 56 primary studies met our full inclusion criteria. Standard case management had both limited and short-term effects on substance use and housing outcomes and showed potential to increase hostility and depression. Intensive case management substantially reduced the number of days spent homeless (SMD -0.22 95% CI -0.40 to -0.03), as well as substance and alcohol use. Critical time interventions and assertive community treatment were found to have a protective effect in terms of rehospitalizations and a promising effect on housing stability. Assertive community treatment was found to be cost-effective compared to standard case management. Case management approaches were found to improve some if not all of the health and social outcomes that were examined in this study. The important factors were likely delivery intensity, the number and type of caseloads, hospital versus community programs and varying levels of participant needs. More research is needed to fully understand how to continue to obtain the increased benefits inherent in intensive case management, even in community settings where feasibility considerations lead to larger caseloads and less-intensive follow-up.

Pottie et al discuss the clinical guideline for homeless and vulnerably housed people, and people with lived homelessness experience. Homelessness encompasses all individuals without stable, permanent and acceptable housing, or lacking the immediate prospect, means and ability of acquiring it. Clinical assessment and care of homeless and vulnerably housed populations should include tailoring approaches to a person's gender, age, Indigenous heritage, ethnicity and history of trauma; and advocacy for comprehensive primary health care. As initial steps in the care of homeless and vulnerably housed populations, permanent supportive housing is strongly recommended, and income assistance is also recommended. Case-management interventions, with access to psychiatric support, are recommended as an initial step to support primary care and to address existing mental health, substance use and other morbidities.

Canada’s ageing population continues to grow rapidly and significantly more diverse, which will require unique health and home service needs. The COVID-19 pandemic exacerbated existing challenges in Canada’s healthcare system and demonstrated the need for long-term care (LTC). Semi-structured interviews were conducted with 17 decision makers, managers, and leaders in long-term ethnically focused facility care. Braun & Clarke’s six-stage process of thematic analysis was applied using an iterative, deductive approach to examine the experiences of stakeholders involved in the operational, managerial, financial, and clinical aspects of an ethnicity-focused LTC. Findings highlighted salient characteristics of impactful ethnicity-focused care and factors were uniquely shaped by the delivery of culturally specific care. Key subthemes included social isolation and emotional impact, operational and logistic difficulties during COVID-19, mitigation measures implemented in response, and the social, behavioural, and health benefits observed among seniors living in these LTC homes. Participants identified political and economic constraints (e.g., provincial funding) to establishing ethnicity-focused care homes but proposed several solutions and highlighted potential benefits that could support successful implementation. Analysis of experiences of operational challenges in safely and adequately running ethnicity-focused LTC reinforces the value of ethnicity-focused LTC during times of crisis such as the COVID-19 pandemic, as they provide a culturally safe and familiar space with preventive measures applied in a timely manner for seniors to engage with their peers in an environment that meets their health needs, ensuring safety standards.

IntroductionRacialised immigrant older adults (RIOAs) in Canada have poorer self-rated health and are more likely to report chronic conditions, while they concurrently experience well-documented challenges in navigating and accessing the healthcare system. There is strong evidence that patient and caregiver engagement in their healthcare leads to improved management of chronic disease and better health outcomes. International research suggests that engagement has the potential to reduce health disparities and improve quality of care. We aim to (1) describe what role(s) RIOAs are/are not taking in their own healthcare, from the perspectives of participant groups (RIOAs, caregivers and healthcare providers (HCPs)); and (2) develop a codesign process with these participants, creating linguistically aligned and culturally aligned tools, resources or solutions to support patient engagement with RIOAs.Methods and analysisUsing a cross-cultural participatory action research approach, our work will consist of three phases: phase 1, strengthen existing partnerships with RIOAs and appropriate agencies and cultural associations; phase 2, on receipt of informed consent, in-depth interviews with RIOAs and caregivers (n=~45) and HCPs (n=~10), professionally interpreted as needed. Phase 3, work with participants, in multiple interpreted sessions, to codesign culturally sensitive and linguistically sensitive/aligned patient engagement tools. We will conduct this research in the Waterloo-Wellington region of Ontario, in Arabic, Bangla, Cantonese, Hindi, Mandarin, Punjabi, Tamil and Urdu, plus English. Data will be transcribed, cleaned and entered into NVivo V.12, the software that will support team-based analysis. Analysis will include coding, theming and interpreting the data, and, preparing narrative descriptions that summarise each language group and each participant group (older adults, caregivers and HCPs), and illustrate themes.Ethics and disseminationEthics clearance was obtained through the University of Waterloo Office of Research Ethics (ORE #43297). Findings will be disseminated through peer-reviewed publications, presentations and translated summary reports for our partners and participants.

Front-line clinicians and health-care workers need to be educated to provide care in critical situations such as large-scale catastrophes and pandemics. This narrative review is focused on investigating educational strategies in confrontation with coronavirus disease 2019 (COVID-19) pandemic. We conducted a literature search in December 2020 through LitCovid, PubMed, ERIC, and Cochrane Library in order to retrieve relevant studies regarding the role of education in prevention, diagnosis, and treatment of COVID-19. There were 12 reviewed studies related to this specific subject. The articles selected for this study demonstrated that education and training had a positive impact on the knowledge and attitude of the participants and also the educational interventions, whether they were simulation-based or other formats of training, would be deemed crucial for enhancing participants' level of perceptions and confidence. Therefore, it is highly recommended that public health policymakers consider this important issue.

In his weekly paper, Die Medizinische Reform, Rudolf Virchow termed physicians \"natural attorneys of the poor.\" In lay terms, advocacy involves an entity of greater power (which physicians with wealth, education and status represent) speaking out for one with lesser power, often for social justice. It's now a time-honoured role for physicians around the globe, including Canada. In 1996, the Royal College of Physicians and Surgeons of Canada recognized \"Advocate\" as one of seven essential physician roles. And in 2001, the Association of Faculties of Medicine of Canada adopted a social accountability vision. Advocacy efforts may promote the health of individuals, communities or populations, to incorporate broader health promotion activities on equity and socioeconomic issues including advocating changes in areas that affect patients directly, such as housing conditions or domestic violence.1

At the eleventh hour, following unprecedented activism by health care providers, editorials from national newspapers and letters from medical associations, refugees sponsored by the government and certain privately sponsored refugees were excluded from the cutbacks. In the succeeding 2 months, confusion has reigned among refugees and providers, with eligible refugees requiring urgent care being turned away from emergency departments while the government partially reverses course. Since the Immigration and Refugee Protection Act in 2002, refugees invited by the Government of Canada or some private groups typically arrive sicker and with less social capital to be self -sufficient than before the act, because of the priority placed on resettling vulnerable refugees who need urgent protection. These refugees receive residency status on arrival, have access to basic provincial health insurance programs, may also qualify for income support, and, thanks to the government's capitulation, will continue to receive extended health coverage. Most refugees sponsored by private groups and all refugee claimants - people who have found their way to Canada on their own and make a claim for refugee status - will be affected by the revised Interim Federal Health Program. In 2011, a total of 24 900 people made requests for asylum from within Canada.2 The government now divides refugee claimants into 2 categories: those from designated countries of origin (countries the government determines to be generally safe and should not be producing people in need of protection) and those from other countries. At the time of this article's publication, the list of designated countries of origin is still not available.

ObjectiveCanadian family medicine (FM) residency programmes are responding to the growing demand to provide global health (GH) education to their trainees; herein, we describe the various GH activities (GHAs) offered within Canadian FM programmes.DesignA bilingual online survey was sent out to all 17 Canadian FM program directors (PDs) and/or an appointed GH representative.SettingOnline survey via QualtricsParticipantsAll 17 Canadian FM PDs and/or an appointed GH representative.ResultsThe response rate was 100% and represented 3250 first-year and second-year FM residents across English and French Canada. All schools stated that they participate in some form of GHAs. There was variation in the level of organisation, participation and types of GHAs offered. Overall, most GHAs are optional, and there is a large amount of variation in terms of resident participation. Approximately one third of programmes receive dedicated funding for their GHAs, and two thirds wish to increase the scope/variety of GHAs.ConclusionThese results suggest nationwide interest in developing a workforce trained in GH, but show great discrepancies in training, implementation and education.