Empowered management for pelvic pain: The experiences of women with persistent pelvic pain participating in an online self-directed self-management program while they wait for interprofessional care.

BACKGROUND: Persistent pelvic pain is pain sensed in or around the pelvis and is often associated with negative cognitive, behavioral, sexual, and emotional consequences. The lack of interprofessional persistent pelvic pain management programs that address the complex interplay of biopsychosocial factors result in lengthy wait times and negative health outcomes. Limited access to evidence informed self-management educational resources contributes to poor coping strategies. Evidence shows that self-management education and strategies support patients while they wait for care. However, very few studies explore the patient's lived experience of participating in an online educational program designed for persistent pelvic pain. OBJECTIVES: This study aims to understand the experience of women with persistent pelvic pain participating in an online, self-management education program ("Pelvic Pain Empowered Management" program) while awaiting care at an interprofessional pelvic pain clinic. DESIGN: A descriptive qualitative approach was used to explore the experiences of women participating in an online educational program designed for cis women with persistent pelvic pain. METHODS: We conducted semi-structured interviews with 11 women, transcribed the data verbatim using NVivo software (NVivo 12, QSR International Pty Ltd.), and analyzed inductively using previously established methods. RESULTS: We identified four main themes relevant to women's experiences of the program: (1) the program shaped expectations around upcoming pelvic pain appointments, (2) the program content is relevant and resonates with people with lived experience of persistent pelvic pain, (3) the program enhanced understanding of persistent pelvic pain, and (4) the program empowered people with skills and strategies to better manage their persistent pelvic pain. CONCLUSION: Our findings highlight how self-directed online patient education can be leveraged while persistent pelvic pain patients wait for care to support them in setting expectations around care and in engaging in pain self-management.

Changes in the prevalence of diabetes, prediabetes and associated risk factors in rural Baluchistan; a secondary analysis from repeated surveys (2002-2017).

To observe trends of diabetes and its associated risk factors from health surveys 2002-2017 in rural areas of Baluchistan-Pakistan and a secondary analysis based on community based health surveys of Baluchistan conducted between 2001-02, 2009-10, and 2016-17. A total of 4250 participants were included in this combined analysis, 2515 from 2001-2002, 1377 from 2009-2010 and 358 from 2016-2017 survey year. In each survey, detailed information of baseline parameters were noted on a predesigned questionnaire. Fasting plasma glucose (FPG) was used for diagnosis of diabetes for comparative purposes in this analysis. Cardiovascular (CVD) risk factors including hypertension, obesity, dyslipidaemia, tobacco use, alcohol consumption, and physical activity were compared. Most subjects were aged 30-50 years and males were found higher in 2016-17 compared to 2001-02 and 2009-10. Pronounced increases in BMI, waist circumference, blood pressure, and family history of diabetes were observed in 2016-17. Diabetes prevalence was 4.2 (3.4-4.9), 7.8 (6.6-9.2) and 31.9 (26.9-37.4), whilst pre-diabetes was 1.7 (1.3-2.2), 3.6 (2.8-4.6) and 10.7 (7.6-14.9) in years 2001-02, 2009-10, and 2016-17, respectively. Among those aged 20-39years, prevalence of diabetes was stable from 2001-10 yet increased considerably between the ages of 30-39years in 2016-17. Throughout the observed period, rapid increases were observed in hypertension, obesity, and dyslipidaemia, however, addiction to tobacco use and alcohol intake decreased. Adjusted odd ratios showed age, marital status, education, hypertension, and family history of diabetes as associated risk factors for glycaemic dysregulation. The rural Baluchistan population is confronted with increasing trends of early onset diabetes due to highly associated CVD risk factors, especially central obesity and dyslipidaemia, raising a major public health challenge.

Virtual care exercise interventions in multidisciplinary chronic pain clinics: a qualitative study of perspectives of adults living with chronic pain.

PURPOSE: Chronic pain affects 1 in 4 Canadians and is a leading contributor of disability. Although virtual care has become more prevalent, it is unclear how adults living with chronic pain perceive virtual delivery of exercise interventions within multidisciplinary chronic pain clinics (MCPC). This study explores the perspectives of adults living with chronic pain regarding their perceived barriers and facilitators and recommendations when implementing virtual care exercise interventions within MCPCs. METHODS: We conducted an interpretive description qualitative study based on semi-structured interviews with adults (age ≥18 years) living with chronic pain from a MCPC in Toronto, Canada, between March 1 and April 30, 2021. RESULTS: We completed fifteen (N = 15) interviews of adults living with chronic pain. We identified eight themes that addressed the study objectives: 1) virtual care supplements in-person care, 2) virtual care improves accessibility, 3) impact of technology on participation, 4) navigating the home environment, 5) impact of pain on participation, 6) impact of supervision and feedback, 7) the need for tailored care, and 8) the need for preparation and additional support. CONCLUSION: Our results reveal that adults living with chronic pain view virtual care exercise interventions positively however, the implementation of these interventions must be carefully considered within MCPCs. Specifically, virtual care was considered an excellent adjunct to in-person care but should not replace it completely.Implications for RehabilitationChronic pain is a leading contributor of disability.Exercise interventions are recommended component of comprehensive pain management.Virtual delivery of exercise interventions are becoming more prevalent.Adults living with chronic pain view virtual care exercise interventions positively as they can supplement in-person care and improve access to this type of care.

Defining Success in Transitions from Pediatric to Adult Chronic Pain Care: A Descriptive Qualitative Study of Perspectives of Young Adults Living with Chronic Pain.

OBJECTIVE: To explore how young adults with chronic pain define a successful transition from pediatric to adult chronic pain care and how they would like to be empowered to achieve a successful transition. DESIGN: A descriptive qualitative design. SETTING: Participants were recruited from a hospital-based chronic pain clinic in Toronto, Canada, and through social media. SUBJECTS: Young adults (18-25 years of age, inclusive) who received chronic pain care in a pediatric setting and continued to self-identify as having a need for chronic pain care in an adult chronic pain care setting. METHODS: Semistructured interviews were used to understand the perspectives of young adults with chronic pain. Interviews were audio-recorded, transcribed verbatim, and checked for accuracy. Qualitative inductive content analysis was used to analyze the interview data. RESULTS: Eight young adults with chronic pain were interviewed (all women; median age=19 years). Five themes that addressed the study objectives are described: 1) Young adults value skill-building and knowledge about the transition, 2) establishment of a strong therapeutic alliance with health care providers, 3) coordinated and planned transition, 4) social and environmental support, and 5) respect for young adults' independence and autonomy. CONCLUSION: Findings suggest the need for a collaborative and individualized approach to the successful transition of young adults across the continuum of chronic pain care that addresses their unique needs. To promote successful transition, clinicians should build relationships with young adults that facilitate choice and autonomy while enhancing skill-building and education on available resources.

Racial equity in the fight against COVID-19: a qualitative study examining the importance of collecting race-based data in the Canadian context.

BACKGROUND: A failure to ensure racial equity in response to the COVID-19 pandemic has caused Black communities in Canada to disproportionately be impacted. The aim of the current study was to determine the needs and concerns of Black communities in the Greater Toronto Area (GTA) and to highlight the importance of collecting race-based COVID-19 data early on to address these needs. METHODS: Six qualitative interviews were conducted with local community health centre leaders who serve a high population of racialized communities within the GTA. Content analysis was used to extract the main themes and concerns raised during the interviews. RESULTS: The findings from this study provide further evidence of the disproportionate impact COVID-19 has had on Black and other racialized communities. Difficulty self-isolating due to overcrowded housing, food insecurity, and less social support for seniors were concerns identified by community health leaders. Also, enhanced financial support for front-line workers, such as Personal Support Workers (PSWs), was an important concern raised. In order to lessen the impact of the pandemic on these communities, leaders noted the need for greater accessibility of testing centres in these areas and a greater investment in tailored health promotion approaches. CONCLUSIONS: Overall, our findings point to the importance of collecting race-based data to ensure an equitable response to the pandemic. The current "one size fits all" response is not effective for all individuals, especially Black communities. Not all populations have access to the same resources, nor do they live in the same conditions (Kantamneni, J Vocal Behav 119:103439, 2020). A deeper consideration of the social determinants of health are needed when implementing COVID-19 policies and responses. Also, a lack of attention to Black communities only continues to perpetuate the under-acknowledged issue of anti-Black racism prevalent in Canada.

Predicting the risk of type 2 diabetes through anthropometric indices in Pakistani adults- A sub-analysis of second National diabetes survey of Pakistan 2016-2017 (NDSP-07).

BACKGROUND AND AIM: Excess adiposity is associated with an increased risk of diabetes. Amongst the various measures of adiposity, the most appropriate one to predict the risk of diabetes remains debatable. Therefore, the aim of this study was to compare the ability of body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR) in predicting type 2 diabetes mellitus (DM) among Pakistani adults. SUBJECTS AND METHODS: This was the sub-analysis of a large population based Second National Diabetes Survey of Pakistan (NDSP) 2016-2017. With this survey, 10834 individuals were recruited and 4788 individuals fulfilled the inclusion criteria for this sub-analysis (subjects with missing anthropometric details were excluded). Participants were categorized into two groups; subjects with type 2 DM and subjects without DM. Data of participants was collected via pre-designed detailed questionnaire. Clinical and anthropometric measurements were measured using standardized techniques. RESULTS: Out of 4788 individuals, 3085(64.4%) were non-DM subjects and 1703(35.6%) were type 2 DM subjects with mean age of 39.78 ±â€¯13.79 and 50.38 ±â€¯11.33 years, respectively. Logistic regression analysis revealed a significant association of WC with type 2 diabetes after adjustment for possible confounders. Area under the curve (AUC) of WC was found higher than AUC of BMI and WHR. CONCLUSION: The findings from second NDSP (2016-2017) demonstrated that WC is a better marker than WHR and BMI in predicting type 2 DM for Pakistani population.

Relationship between diabetic retinopathy and diabetic nephropathy; A longitudinal follow-up study from a tertiary care unit of Karachi, Pakistan.

OBJECTIVE: To determine the development and progression of diabetic retinopathy in subjects with diabetic nephropathy. METHODOLOGY: This retrospective longitudinal follow up study was conducted in outpatient department of Baqai Institute of Diabetology and Endocrinology (BIDE), a tertiary care diabetes unit of Karachi Pakistan, from January 2005 to December 2016. Type 2 diabetic subjects with newly diagnosed diabetic nephropathy (DN) and sex-age matched controls were identified from the electronic database of the institute, Health Management System (HMS). Subjects with type 1 diabetes, gestational diabetes and subjects with diabetic retinopathy (DR) at the baseline of both DN and non-DN group were excluded from the study. Statistical analyses were conducted by using SPSS version 20. RESULT: Out of 3056 type 2 diabetic subjects, 2389 were with DN and 667 were without DN. The incidence of retinopathy was found to be 21.7 per 1000 person years. The incidence rate ratio (IRR) of 2.57 (1.92-3.43) showed that retinopathy was significantly higher in subjects with DN as compared to subjects without DN. Kaplan-Meier survival plot confirmed that subjects with DN had a worse diabetic retinopathy-free survival than subjects without DN. CONCLUSION: Diabetic nephropathy is an independent risk factor for the development and progression of diabetic retinopathy.

The lived experiences of chronic pain among immigrant Indian-Canadian women: A phenomenological analysis.

Background: Chronic pain is a growing public health concern affecting 1.5 million people in Canada. In particular, it is a concern among the expanding immigrant population, because immigrant groups report higher pain intensity than non-immigrants. In 2011, the Indian population became the largest visible minority group and continues to be the fastest growing. Though the prevalence of chronic pain among Canadian Indians is unknown, research has found a higher prevalence among Indian women than men in India, Malaysia, Singapore, and the United Kingdom, with women reporting more severe pain. An understanding of how pain is experienced by this particular group is therefore important for providing culturally sensitive care. AIMS: This study explores the lived experiences of chronic pain among immigrant Indian women in Canada. METHODS: Thirteen immigrant Indian women participated in one-on-one interviews exploring daily experiences of chronic pain. RESULTS: Using thematic analysis informed by van Manen's phenomenology of practice, four themes emerged: (1) the body in pain, (2) pain in the context of lived and felt space, (3) pain and relationships, and (4) pain and time. Women revealed that their experiences were shaped by gender roles and expectations enforced through culture. Specifically, a dual gender role was identified after immigration, in which women had to balance traditional household responsibilities of family labor and care alongside employment outside the home, exacerbating pain. CONCLUSIONS: This research uncovers the multifaceted nature of chronic pain and identifies factors within the sociocultural context that may place particular groups of women at greater risk of living with pain.

Contexte: La douleur chronique est un problème de santé publique croissant qui touche 1,5 million de personnes au Canada. Elle est particulièrement préoccupante au sein de la population immigrante en expansion, car les groupes d'immigrants signalent une intensité de douleur plus élevée que les non-immigrants. En 2011, la population indienne est devenue le plus grand groupe de minorités visibles et continue d'être celui qui connaît la croissance la plus rapide. Bien que la prévalence de la douleur chronique chez les Indo-Canadiens soit inconnue, des études ont montré que la prévalence de cette maladie chez les femmes indiennes était supérieure à celle des hommes en Inde, en Malaisie, à Singapour et au Royaume-Uni, les femmes faisant état de douleurs plus intenses. Une compréhension de la manière dont la douleur est ressentie par ce groupe particulier est donc importante pour fournir des soins adaptés à la culture.Objectifs: Cette étude se penche sur les expériences de douleur chronique vécues par les immigrantes indiennes au Canada.Méthodes: Treize immigrantes indiennes ont participé à des entretiens individuels portant sur leurs expériences de douleur chronique quotidiennes.Résultats: Grâce à une analyse thématique fondée sur la phénoménologie de la pratique de van Manen, quatre thèmes ont émergé : (1) le corps douloureux, (2) la douleur dans le contexte de l'espace vécu et ressenti, (3) la douleur et les relations, et (4) la douleur et le temps. Les femmes ont révélé que leur expérience était façonnée par les rôles sexo-spécifiques et les attentes étaient imposées par la culture. Plus précisément, un double rôle sexo-spécifique a été découvert après l'immigration, dans laquelle les femmes doivent équilibrer les responsabilités traditionnelles du travail familial et des soins parallèlement à l'emploi en dehors du domicile, ce qui exacerbe la douleur.Conclusions: Cette étude révèle la nature multidimensionnelle de la douleur chronique et recense les facteurs propres au contexte socioculturel qui peuvent placer des groupes particuliers de femmes à plus grand risque de vivre avec la douleur.

Insulin-associated Weight Gain in Type 2 Diabetes and Its Relation with Caloric Intake.

Objective The aim of this study was to observe the weight change in a patient with type 2 diabetes initiated on insulin therapy and the relation of weight gain with caloric intake. Methods This retrospective longitudinal follow-up study was conducted at the Baqai Institute of Diabetology and Endocrinology (BIDE), a tertiary care hospital of Karachi, Pakistan. Records of 917 patients attending the tertiary care diabetic clinic were retrieved from January 2009 to May 2016 from the Hospital Management System (HMS). Subjects were divided into two groups: group A consisted of subjects on oral hypoglycemic agents (OHA), while group B consisted of subjects on insulin therapy with OHA. Change in weight, change in HbA1c, and change in calories intake were calculated by examining data at baseline and end-line visit of the study. Results Group B showed significantly higher weight gain than group A (48.3% vs 24.8%). Insulin therapy with OHA (OR (95% CI = 1.78(1.05-3.02)), increased caloric intake (OR [95% CI = 1.98(1.093.60)]) and decreased HbA1c (OR [95% CI = 0.44(0.24-0.79)]) were the only factors identified as significant predictors of weight gain. Conclusion It is concluded that type 2 diabetic subjects, especially on insulin treatment, gain weight due to increase or unadvised caloric intake. Long-term multicenter studies are needed to ascertain the findings of this study.

Incidence of microvascular complications of type 2 diabetes: A 12 year longitudinal study from Karachi-Pakistan.

OBJECTIVES: To estimate the incidence of microvascular complications among subjects with type 2 diabetes at a tertiary care hospital. METHODS: This retrospective longitudinal follow-up study assessed the data records of type 2 diabetic subjects who visited the outpatient department of Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, from January 2005 to April 2016. Subjects with gestational diabetes, type 1 diabetes and with history of any microvascular complication were excluded. Medical records were obtained through electronic database (Health Management System). Statistical analyses were conducted using STATA version 14 and SPSS version 20. RESULTS: The incidence of microvascular complications was 92.8, 106.2, and 130.2 per 1000 person per years for retinopathy, neuropathy and nephropathy respectively. Retinopathy, neuropathy and nephropathy were significantly high among diabetic patients with duration of diabetes >10 years followed by 5-10 years. Incidence of retinopathy and nephropathy was significantly higher in patients who had HbA1c>7% than patients with HbA1c≤7% (p-value<0.05). Higher incidence rate of all three microvascular complications were seen in subjects with hypertension than subjects without hypertension. CONCLUSION: A high incidence of microvascular complications is found in subjects with type 2 diabetes. Poor glycaemic control, longer duration of diabetes and hypertension was found to be associated with the occurrence of these complications.

Access Barriers to Services by Immigrant Mothers of Children with Autism in Canada.

Equal access for autism services remains suboptimal for diverse groups. In Canada, little is known about the barriers immigrant mothers face accessing services and support for their children with developmental disabilities. In this qualitative study, 21 immigrant mothers of children with Autism, from a diverse ethno cultural background, were interviewed in Toronto, Canada. We apply House's (1981) four domains of social support to analyze findings. Structural support challenges, such as delays in diagnosis, fragmented and dispersed services were common, followed by instrumental challenges due to loss of social ties and stigma. Lack of expected support from partners, and negative perceptions of services, were identified as emotional and perceptive challenges. Focused attention is required to address inequalities within the context of current access pathways for autism.

Mothering children with developmental disabilities: A critical perspective on health promotion.

We present findings of a qualitative study exploring what constitutes relevant health promotion initiatives for immigrant mothers of children with developmental disabilities. We apply a social ecological approach, with a focus on gender-specific and transformative health promotion, to examine factors impacting mothers' health and wellbeing. Twenty-eight semi-structured and open-ended interviews were conducted with immigrant mothers in the greater Toronto area, Canada. Mothers identified facilitators, challenges, and strategies for their health promotion, providing relevant insights for meaningful intervention. Our findings show that immigrant mothers' health is influenced by intersecting social determinants of health, including migration status, gender, and disability.

Stressors and Barriers to Services for Immigrant Fathers Raising Children with Developmental Disabilities.

This narrative review examines research on the experiences of immigrant fathers raising children with developmental disabilities, and considers the findings within the Canadian context. Applying Green, Johnson & Adams' (Journal of Chiropractic Medicine, 5(3), 101-117, 2006) methodology, a step-by-step process was followed to conduct the review. Four databases (PsychINFO, PubMed, CINAHL and Sociological Abstracts) were used for the search. A total of 39 articles were found to be relevant after applying the inclusion/exclusion criteria. Also 20 articles from published reference lists and peer-reviewed journal articles, located through Google Scholar, complimented the initial search. Along with House's (1981) four dimensions of social support, an intersectional approach underpinned the analysis of findings. Four themes were identified which included: economic challenges, social influences, cultural influences, and the changing gender roles of fathers. Stressors and barriers to accessing health services in the post-migration setting were examined. Based on the review's findings, the paper recommends 1) addressing income inequality, 2) improving access to health care, social and developmental services, 3) improving cultural-sensitivity of health care, social and developmental services, and 4) increasing participation of fathers. Overall, a more systemic understanding of immigrant fathers' experiences is called for, taking into account their multiple social locations.