Roles and usages of neuro service dogs for caregivers living at home with persons with dementia: An exploratory comparative case study.

The goal of the present study was to examine how canine assistance may support family caregivers and persons with dementia and to document and compare two modalities of home care support. An exploratory comparative case study research design was conducted. Three cases correspond of dyads of a caregiver, a person with mild to moderate dementia, and either a neuro service dog (NSD), a companion dog or no dog. Hypotheses are formulated to capture differences between cases. Recruitment was done in a service dog organisation, through Canadian Alzheimer associations and in records of a hospital. Data were collected through 45-60 minutes telephone interviews that included completion of the Caregiver's Burden Scale and sociodemographic questions. We used an inductive approach with qualitative data. There were five caregivers (mean age 54.8 years) who had an NSD, 28 caregivers (63.6 years) who had a companion dog, and 23 caregivers (63.8 years) without dog. In the category of roles and usages of the dog, 'Socialisation' and 'Help with a sense of direction' were the most addressed roles for dyads with the NSD. For dyads with companion dog and without dog, 'Engagement-and-meaning of life' as well as 'Physical activity with the dog' were the most discussed roles. The 'Sleep or wake up' role was the least discussed role across three cases. In the other categories, they were seven advantages and 10 inconvenients that were mentioned for canine assistance. For home care support, the presence of NSD has more positive impacts on both the person with dementia and their caregiver compared to the presence of a companion dog; the presence of a NSD results in the person with dementia accessing more indoor and outdoor public sites than with a companion dog; and dyads with a dog are informally socially engaged more frequently than those with no dog.

Neuro Service Dogs Impacts on Community-Dwelling Persons with Mild to Moderate Dementia and Their Caregiver.

Since there were no research data on the use of neuro service dogs (NSD) in 2018, a comparative case study research design was done. The cases comprised of a caregiver with a person with mild to moderate dementia, and either an NSD (n=5), a companion dog (n=28), or no dog (n=23). Monitor activity and online questionnaires were administrated. Interesting qualitative data on the roles of a NSD, advantages and inconvenients were fully described and published. Quantitative data could not confirm that NSD is benefit-cost, neither that it increases quality of sleep or level of exercise, compared to companion dogs.

Nursing home aversion post-pandemic: Implications for savings and long-term care policy.

COVID-19 outbreaks at nursing homes during the recent pandemic have received ample media coverage and may have lasting negative impacts on individuals' perception of nursing homes. We argue that this could have sizable and persistent implications for savings and long-term care policies. Our theoretical model predicts that higher nursing home aversion should induce higher savings and stronger support for policies subsidizing home care. Based on a survey of Canadians aged 50 to 69, we document that higher nursing home aversion is widespread: 72% of respondents are less inclined to enter a nursing home because of the pandemic. Consistent with our model, we find that these respondents are more likely to have higher intended savings for old age because of the pandemic. We also find that they are more likely to strongly support home care subsidies.

Health-Related Quality of Life of Patients Presenting to the Emergency Department with a Musculoskeletal Disorder.

BACKGROUND: Musculoskeletal disorders (MSKDs) are among the most disabling and costly non-fatal health conditions. They may lead to long-term consequences such as chronic pain, physical limitations, and poorer quality of life. They also account for a significant proportion of emergency department visits, representing between 18% and 25% of all visits, depending on country. PURPOSE: To assess the health-related quality of life of patients presenting to the emergency department with a MSKD, to convert their answers to utility scores and to explore the association between diverse socio-demographic and clinical variables and patients' health-related quality of life. PATIENTS AND METHODS: This is an analysis of cross-sectional data obtained during the baseline assessment performed as part of a 6-month pragmatic randomized controlled trial conducted in an academic emergency department. We included patients aged 18-80 years with a minor MSKD. The main outcome measures were health-related quality of life (five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) and utility scores (-0.148 - worse than death, 0 - dead, 0.949 - perfect health) measured with the EQ-5D-5L. Possible associations were explored by comparing scores across subgroups based on certain socio-demographic (eg, age, gender, triage score) and clinical factors (eg, pain interference on function, pain intensity) and with reference values using descriptive statistics (mean, median), rankFD ANOVAs, and χ 2 tests. RESULTS: Sixty-nine participants completed the EQ-5D-5L. Mean and median utility scores were, respectively, 0.536 (95% CI: 0.479-0.594) and 0.531 (IQR: 0.356-0.760). Participants with higher levels of pain (<4/10: 0.741, 95% CI: 0.501-0.980; 4-7/10: 0.572, 0.500-0.644; >7/10: 0.433, 0.347-0.518) or pain interference on function (<4/10: 0.685, 95% CI: 0.605-0.764; 4-7/10: 0.463, 0.394-0.533; >7/10: 0.294, 0.126-0.463) presented significantly lower utility scores. No significant differences were found for other socio-demographic characteristics. CONCLUSION: In patients with MSKDs who present to the emergency department, higher levels of pain or pain interference are associated with decreased health-related quality of life. These findings need to be confirmed on a larger scale.

Direct-access physiotherapy to help manage patients with musculoskeletal disorders in an emergency department: Results of a randomized controlled trial.

OBJECTIVES: The objective was to evaluate the effects of direct-access physiotherapy on patients presenting with a musculoskeletal disorder (MSKD) to the emergency department (ED) on clinical outcomes and use of health care resources. METHODS: We conducted a randomized controlled trial in an academic ED in Québec City, Canada. We included patients aged 18 to 80 years with minor MSKD. The intervention group had direct access to a physiotherapist (PT) in the ED immediately after triage and prior to physician assessment, and the control group received usual care by the emergency physician without PT intervention. The key variables included clinical outcomes (pain, interference of pain on function) and resources use (ED return visit, medications, diagnostic tests, additional consultations). They were analyzed using descriptive statistics and compared between groups using two-way analyses of variance, log-linear analysis, and chi-square tests. RESULTS: Seventy-eight patients suffering from MSKDs were included (40.2 ± 17.6 years old; 44% women). For the primary clinical outcome, participants in the PT group (n = 40) had statistically lower levels of pain and pain interference at 1 and 3 months. In terms of resource use, participants in the PT group returned significantly less often to the ED. At baseline and 1 month, less prescription medication was used, including opioids, but there were no differences at 3 months. Although over-the-counter medication was recommended more at baseline in the PT group, there were no differences in use at 1 month, and the PT group had used them less at 3 months. There were no differences between groups at follow-up for imaging tests, other professionals consulted, and hospitalization rates. CONCLUSION: Patients presenting with a MSKD to the ED with direct access to a PT had better clinical outcomes and used less services and resources than those in the usual care group after ED discharge and up to 3 months after discharge.

Early Impact of the COVID-19 Pandemic on Household Finances in Quebec.

The coronavirus disease 2019 (COVID-19) pandemic surged in early March 2020, with unemployment reaching historic levels in April 2020. This study paints an early portrait of the pandemic's impact on the finances of households in Quebec, one of the hardest-hit provinces in terms of COVID-19 cases as well as unemployment levels. The article also provides an understanding of how government emergency benefit programs may have helped households get by during the early period of the pandemic. Finally, we draw on expectations data collected in a survey of 3,009 respondents living in Quebec to illustrate what households can expect for the rest of 2020.

La pandémie de maladie à coronavirus 2019 (COVID­19) a fait son apparition au début de mars 2020, le chômage ayant atteint des niveaux sans précédent en avril 2020. Les auteurs tracent un premier portrait des répercussions de la pandémie sur la situation financière des ménages du Québec, l'une des provinces les plus durement touchées par la COVID­19 quant au nombre de cas et au taux de chômage. Ils tentent également d'expliquer en quoi les programmes gouvernementaux de prestations d'urgence ont pu aider les ménages à surmonter leurs difficultés au cours de la phase initiale de la pandémie. Enfin, les auteurs s'appuient sur les données relatives aux attentes qu'ils tirent de leur sondage pour illustrer ce à quoi les ménages peuvent s'attendre pour le reste de 2020.