"We're in this together": Attachment insecurities, dyadic coping strategies, and relationship satisfaction in couples involved in medically assisted reproduction.

Attachment is an important predictor of relationship satisfaction and attachment insecurities are a risk factor for couples under stress. Drawing from the Vulnerability-Stress-Adaptation model, we investigated whether dyadic coping strategies (DCS) would explain the links between attachment insecurities and relationship satisfaction in 97 couples involved in medically assisted reproduction (MAR). Path analyses revealed that for women and men, attachment insecurities (anxiety, avoidance) were associated with their own lower relationship satisfaction through their lower use of positive DCS. Attachment avoidance was also associated with participants' own lower relationship satisfaction through their own lower use of negative DCS. Men's attachment avoidance was also related to their partner's lower relationship satisfaction via their own and their partner's lower use of positive DCS. The findings suggest that promoting the use of positive DCS may be important to preserve relationship satisfaction in couples involved in MAR.

Relative Age Effect in Attention Deficit/Hyperactivity Disorder at Various Stages of the Medicalization Process.

Diagnosis and pharmacological treatment of ADHD are more common among the youngest children in a classroom, born in the months immediately preceding the school entry cutoff date. The mechanisms behind this phenomenon, called the relative age effect (RAE), are not yet well understood. Nearly all hypotheses involve the school system, various teachers' actions, and concern children's immaturity. However, most previous studies have been based on reports of health professionals' diagnoses and prescriptions found in official databases rather than on reports of teachers' behavior identification or suspicion of ADHD, despite their being at the first stages of the medicalization process. Our study overcomes this limitation by using reports of parents' and teachers' behavior identification or suspicion of ADHD within a three-level multilevel survey design, comprising 1294 children, 130 teachers, and 17 elementary public schools. The goal of our study was to investigate whether RAE stems (1) from adults' judgement of the child's expression of immaturity or (2) from the consequences associated with the child's double burden of being immature and exhibiting ADHD behaviors. Our multilevel analyses put forward the first hypothesis only, supporting the medicalization of immaturity. RAE in ADHD seems mostly initiated by teachers' pre-diagnostic actions toward younger children.

Relational Instability in Couples Seeking Therapy: The Contribution of Attachment, Caregiving and Sex.

Attachment theory postulates that three behavioral systems-attachment, caregiving, and sex-are essential for optimal relationship functioning in couples. We examined the contribution of attachment insecurities, perceived partner support, and sexual satisfaction to relational instability in 274 couples seeking relationship therapy. The results underscore the importance of all three systems for relationship stability, showing that for both men and women, avoidance of intimacy, low perceived partner support, and low sexual satisfaction were significant and concurrent predictors of relational instability. As such, intervening on factors associated with all three behavioral systems might help reduce relationship instability in couples experiencing relationship distress.

Perceptions of Educational Needs in an Era of Shifting Mental Health Care to Primary Care: Exploratory Pilot Study.

BACKGROUND: There is an unmet need for mental health care in Canada. Primary care providers such as general practitioners and family physicians are the essential part of mental health care services; however, mental health is often underestimated and underprioritized by family physicians. It is currently not known what is required to increase care providers' willingness, comfort, and skills to adequately provide care to patients who present with mental health issues. OBJECTIVE: The aim of this study was to understand the need of caregivers (family members overseeing care of an individual with a mental health diagnosis) and family physicians regarding the care and medical management of individuals with mental health conditions. METHODS: A needs assessment was designed to understand the educational needs of caregivers and family physicians regarding the provision of mental health care, specifically to seek advice on the format and delivery mode for an educational curriculum to be accessed by both stakeholder groups. Exploratory qualitative interviews were conducted, and data were collected and analyzed iteratively until thematic saturation was achieved. RESULTS: Caregivers of individuals with mental health conditions (n=24) and family physicians (n=10) were interviewed. Both the caregivers and the family physicians expressed dissatisfaction with the status quo regarding the provision of mental health care at the family physician's office. They stated that there was a need for more educational materials as well as additional support. The caregivers expressed a general lack of confidence in family physicians to manage their son's or daughter's mental health condition, while family physicians sought more networking opportunities to improve and facilitate the provision of mental health care. CONCLUSIONS: Robust qualitative studies are necessary to identify the educational and medical management needs of caregivers and family physicians. Understanding each other's perspectives is an essential first step to collaboratively designing, implementing, and subsequently evaluating community-based mental health care. Fortunately, there are initiatives underway to address these need areas (eg, websites such as the eMentalHealth, as well as the mentorship and collaborative care network), and information from this study can help inform the gaps in those existing initiatives.

Appearance Esteem Trajectory According to Three Different Sources of Support Among Adolescents Over a School Year.

Although social support has been linked to body satisfaction, there has been little research on the effect of differential sources of support on the trajectory of appearance esteem over time. To address this gap, this study explored changes in adolescents' appearance esteem to perceived social support over one year. Data were collected from 339 Canadian adolescents (54.57% females) in Grade 7 (Mage = 12.05) and Grade 10 (Mage = 15.14). Multilevel growth modeling revealed that perceived social support from fathers was not associated with appearance esteem, whereas mothers' support had the strongest effect on appearance esteem, consistently over time. Friends' support was also related to an increase in the appearance esteem trajectory, but only for older students. Overall, this prospective study provides a better understanding of the unique contribution of three different sources of social support during adolescence for preventing negative appearance esteem, beyond the effects of other related variables.

Evaluation of eMentalHealth.ca, a Canadian Mental Health Website Portal: Mixed Methods Assessment.

BACKGROUND: Many Canadians have mental health needs, and it can be challenging not knowing where to go for mental health information, services, and support. The website eMentalHealth.ca was created to facilitate and assist Canadians to (1) learn about mental health, (2) screen for common mental health issues, and (3) find mental health services and support. OBJECTIVE: The aim of this study was to use multiple methods to learn about visitors of eMentalHealth.ca, their perceptions, and their satisfaction with the website. METHODS: Website analytics (Google Analytics) provided information about the number of unique visits to the website and how the site was used. Web-based self-administered surveys were used to gather additional information on users' characteristics and to assess their perception of the website and satisfaction with the website. RESULTS: Web analytic results showed that from January 1 to December 31, 2017, there were 651,107 users, with 1.97 million page views. Users were more often female than male, and the majority of users were aged 35 years and older. Most users were located in Canada (612,806/651,107, 94.12%), and the most common city of origin of users was Toronto (101,473/651,107, 15.58%), followed by Ottawa (76,692/651,107, 11.78%), and Montreal (26,621/651,107, 4.09%). Web-based surveys were completed by a total of 370 respondents from June to December 2017. Overall, the majority of users were satisfied with the website (93.0%, 320 out of 344 responses). Positive feedback was related to the content of the website as a helpful resource, and negative feedback was related to technical difficulties as well as the design of the main page. This analysis will be used to help the team with ongoing improvements to the website, for example, improving technical issues and homepage usability. CONCLUSIONS: Most visitors reported satisfaction with their use of eMentalHealth.ca to learn about mental health as well as where to find help. Mental health websites such as eMentalHealth.ca are a low-cost way to increase public awareness about mental health.

Perioperative Pain and Addiction Interdisciplinary Network (PAIN) clinical practice advisory for perioperative management of buprenorphine: results of a modified Delphi process.

Until recently, the belief that adequate pain management was not achievable while patients remained on buprenorphine was the impetus for the perioperative discontinuation of buprenorphine. We aimed to use an expert consensus Delphi-based survey technique to 1) specify the need for perioperative guidelines in this context and 2) offer a set of recommendations for the perioperative management of these patients. The major recommendation of this practice advisory is to continue buprenorphine therapy in the perioperative period. It is rarely appropriate to reduce the buprenorphine dose irrespective of indication or formulation. If analgesia is inadequate after optimisation of adjunct analgesic therapies, we recommend initiating a full mu agonist while continuing buprenorphine at some dose. The panel believes that before operation, physicians must distinguish between buprenorphine use for chronic pain (weaning/conversion from long-term high-dose opioids) and opioid use disorder (OUD) as the primary indication for buprenorphine therapy. Patients should ideally be discharged on buprenorphine, although not necessarily at their preoperative dose. Depending on analgesic requirements, they may be discharged on a full mu agonist. Overall, long-term buprenorphine treatment retention and harm reduction must be considered during the perioperative period when OUD is a primary diagnosis. The authors recognise that inter-patient variability will require some individualisation of clinical practice advisories. Clinical practice advisories are largely based on lower classes of evidence (level 4, level 5). Further research is required in order to implement meaningful changes in practitioner behaviour for this patient group.

The implementation and evaluation of an e-Learning training module for objective structured clinical examination raters in Canada.

Improving the reliability and consistency of objective structured clinical examination (OSCE) raters' marking poses a continual challenge in medical education. The purpose of this study was to evaluate an e-Learning training module for OSCE raters who participated in the assessment of third-year medical students at the University of Ottawa, Canada. The effects of online training and those of traditional in-person (face-to-face) orientation were compared. Of the 90 physicians recruited as raters for this OSCE, 60 consented to participate (67.7%) in the study in March 2017. Of the 60 participants, 55 rated students during the OSCE, while the remaining 5 were back-up raters. The number of raters in the online training group was 41, while that in the traditional in-person training group was 19. Of those with prior OSCE experience (n= 18) who participated in the online group, 13 (68%) reported that they preferred this format to the in-person orientation. The total average time needed to complete the online module was 15 minutes. Furthermore, 89% of the participants felt the module provided clarity in the rater training process. There was no significant difference in the number of missing ratings based on the type of orientation that raters received. Our study indicates that online OSCE rater training is comparable to traditional face-to-face orientation.

Building capacity for medical education research in family medicine: the Program for Innovation in Medical Education (PIME).

BACKGROUND: Despite the apparent benefits to teaching, many faculty members are reluctant to participate in medical education research (MER) for a variety of reasons. In addition to the further demand on their time, physicians often lack the confidence to initiate MER projects and require more support in the form of funding, structure and guidance. These obstacles have contributed to a decline in physician participation in MER as well as to a perceived decay in its quality. As a countermeasure to encourage physicians to undertake research, the Department of Family Medicine at the University of Ottawa implemented a programme in which physicians receive the funding, coaching and support staff necessary to complete a 2-year research project. The programme is intended primarily for first-time researchers and is meant to serve as a gateway to a research career funded by external grants. Since its inception in 2010, the Program for Innovation in Medical Education (PIME) has supported 16 new clinician investigators across 14 projects. METHODS: We performed a programme evaluation 3 years after the programme launched to assess its utility to participants. This evaluation employed semi-structured interviews with physicians who performed a research project within the programme. RESULTS: Programme participants stated that their confidence in conducting research had improved and that they felt well supported throughout their project. They appreciated the collaborative nature of the programme and remarked that it had improved their willingness to solicit the expertise of others. Finally, the programme allowed participants to develop in the scholarly role expected by family physicians in Canada. CONCLUSION: The PIME may serve as a helpful model for institutions seeking to engage faculty physicians in Medical Education Research and to thereby enhance the teaching received by their medical learners.