5.1. Examining Resilience Among MS Care Partners.
Katherine Cardwell*(1), Odessa Mckenna (1), Afolasade Fakolade (2), Lara Pilutti (1)
(1) Faculty of Health Sciences, University of Ottawa, Ottawa, ON.
(2) School of Rehabilitation Therapy, Queen’s University, Kingston, ON
Background: Multiple sclerosis (MS) care partners face a host of difficulties related to the physical, mental and emotional demands of the caregiving role. Despite this, some care partners are able to avoid the negative health-related outcomes associated with caregiving. This may be attributable to resilience which can be defined as a process of adapting to stress or trauma, or ‘bouncing back’ from adversity. Factors contributing to resilience in MS care partners, however, have yet to be identified. Objective: This study aims to characterize the profile of resilient MS care partners considering factors at individual, community and societal levels as outlined in the Ecological Model of Resilience by Windle & Bennett (2012). Methods: A total of 613 informal MS care partners from across Canada completed an online survey using SurveyMonkey. Resilience was characterized using the 25-item Connor-Davidson Resilience scale (CD-25). Linear regression was used to compare care partner demographics, social support, and caregiving tasks to reported resilience levels. Results: The final sample of care partners (n=540) was an average of 39.4 years old (SD=8.62), predominantly male (59.1%), and comprised of mostly spouses (56.3%) or parents (37.9%) of the care recipients. Mean CD-25 score for the sample was 84.1 (SD=7.59). Linear regression showed that resilience was related to care partner sex (R2=0.106, p<0.001), age (R2=0.042, p<0.001) and relationship with their care recipient (R2=0.208, p<0.001). Reported caregiving tasks (R2=0.055, p<0.001) and social support (R2=0.168, p<0.001) were also significantly related to resilience. Conclusions: Key care partner characteristics are significantly related to their reported resilience levels. Identifying profiles of resilient MS care partners will guide future interventions aiming to enhance resilience and will allow for the identification of care partners who may be at risk for low resilience.
Keywords: Multiple Sclerosis, caregiving, care partners, resilience, social support.
5.2. The Effect of the First Wave of the COVID-19 Shutdown on Patients Engagement in a Virtual Preventative Care Clinic.
Zachary Levine (1), Aaron Rosenfeld* (2), Ruwaida Rehman (3), Tarnbir Aulakh (4), Ravi Bajaj (5), David A. Alter (5, 6, 7, 8)
Katherine Cardwell*(1), Odessa Mckenna (1), Afolasade Fakolade (2), Lara Pilutti (1)
(1) Arts & Science, McMaster University, Hamilton, ON;
(2) Faculty of Medicine, University of Ottawa, Ottawa, ON;
(3) Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, ON;
(4) School of Kinesiology & Health Studies, Queen’s University, Kingston, ON;
(5) Faculty of Medicine, University of Toronto, Toronto, ON;
(6) Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON;
(7) Rehabilitation Institute-University Health Network, University of Toronto, Toronto, ON;
(8) Institute for Clinical Evaluative Sciences, Toronto, ON.
Introduction: The COVID-19 shutdown has resulted in significant disruption to individuals’ lives and health. This disruption is expected to result in decreased engagement and attentiveness to preventative care, as demonstrated during previous natural disasters. However, there is little research to support this claim during the COVID-19 shutdown. Objectives: Our telemedicine exercise rehabilitation program remained intact during the COVID-19 shutdown from Feb 1, 2020 through April 30, 2020, thus allowing us to investigate the extent to which patients remained engaged in a preventative care program. Methods: Engagement as quantified by capacity, exercise volume, non-exercisers, and non-attendance were compared between the pre-COVID shutdown (Feb 1, 2020 to March 13, 2020) and during the COVID shutdown (March 14, 2020 to April 30, 2020). Results: There was a significant decrease in capacity (P<.001) and non-exercisers (P=.02) from pre-COVID to COVID, as to be expected. There was, however, no significant difference in non-attendance (P=.55) and exercise volume (P=.59). Conclusions: Capacity restrictions during the COVID-19 shutdown resulted in a reduced number of patients participating in prevention programs, however, in our telemedicine clinic, those who participated remained adherent and engaged in following their exercise prescriptions. These findings emphasize the need for further research and possibly the importance of maintaining preventive care during crises.
Keywords: Preventative Care; Exercise Rehabilitation; COVID-19; Capacity; Attendance;
5.3. A Meta-analysis of Parental Behaviors: Mothers show Higher Mind-mindedness than Fathers
Philip Trepiak* (1), Audrey-Ann Deneault (1), Thomas Trepiak (1)
(1) Faculty of Psychology, University of Ottawa, Ottawa, ON
Background: Mind-mindedness refers to a caregiver’s tendency to attribute mental states to their children (Meins, 1997). Although it is a relatively new and understudied construct within child developmental research, research has shown that mind-mindedness predicts positive development in children (McMahon & Bernier, 2017). Many studies have compared paternal and maternal mind-mindedness and have provided mixed findings, with some studies finding no difference between mothers and fathers (Barretto, 2016) and others finding that mothers display higher mind-mindedness (Planalp, 2016). Objective: To report on the available literature, this study uses meta-analytical techniques to systematically determine whether mothers and fathers exhibit similar levels of mind-mindedness towards their children. Methods: A systematic search for studies evaluating mind-mindedness and similar constructs (i.e., reflective functioning, mentalization; Zeegers et al., 2017) across 5 databases identified 33 studies. Results: The results show that mothers presented higher mind-mindedness than fathers (d = -0.26, p < 0.01). There was also a significant correlation in mind-mindedness between mothers and fathers of the same family (r = 0.17, p < 0.01). Conclusions: Fathers display lower levels of mind-mindedness in comparison to mothers. Given the association between mind-mindedness and reduced levels of parental stress (Camisasca et al., 2017; McMahon & Meins, 2012; Walker et al., 2012), and emerging research finding that mind-mindedness may be a protective factor against child behavior problems (Centifanti et al., 2016; Easterbrooks et al., 2017; Hughes et al., 2016), it is important that future parenting interventions focus on the promotion of fathers’ mind-mindedness, which can improve the well-being and mental health in both fathers and their children.
Keywords: Mind-mindedness, meta-analysis, fathers, mothers, mental health
5.4. IVR technology use by patients with health failure: Utilization patterns and compliance.
Esra Ben Ismail* (1), Mirou Jaana (1)
(1) Telfer School of Management, University of Ottawa, Ottawa, Ontario.
Introduction: Interactive voice response (IVR) is an automated telephony system that leverages existing telephone lines for monitoring patients post-discharge from a hospital, for early intervention. Limited evidence exists on the pattern of use and success of IVR technology among patients with heart failure (HF), and how IVR affects their compliance. Objectives: This study explores the pattern of IVR use by HF patients in the IVR program at the University of Ottawa Heart Institute (UOHI), describes their characteristics and IVR patterns of use in relation to compliance behavior (e.g., weighing themselves, medication compliance) and services utilization (i.e., hospital readmission). Methods: Secondary data collected by the IVR system at UOHI were used in this analysis. The system is based on an algorithm that triggers automated telephone calls to patients at a predetermined time for six months after discharge: Day 2, Weeks 1, 2, 4, 6, 8, 10, and 12. Calls consist of questions related to HF given in the same order a clinician would when assessing a patient. Results: A total of 902 HF patients were considered with a mean age of 70 years (59.4% male). The preliminary results show a peak of completed calls at Week 1 (78%), followed by a steady decline until Week 12 (54.9%). Week 12 showed the lowest rates of hospital readmissions (5.5%) whereas, week 4 had the highest rate (10.6%). More analysis will be done to further explore the characteristics and cluster of patients that IVR works best on. Conclusion: The increased use of IVR in remote patient monitoring will allow for a cheaper and more accessible form of at-home recovery. Leveraging IVR technology to support other conditions, especially during a pandemic, may be beneficial for patients to avoid unnecessary visits to the hospital and complications due to delay in seeking care.
Keywords: IVR technology, Heart-Failure, Remote monitoring.
5.5. Analysis of Challenges with Asynchronous Online Lectures in a First-Year Anatomy and Physiology Course.
Ishika Tripathi* (1), Jacqueline Carnegie (2)
(1) Faculty of Science, University of Ottawa, Ottawa, Ontario
(2) Faculty of Medicine, University of Ottawa, Ottawa, Ontario
Understanding the effects of asynchronous online learning has become increasingly important as courses resort to online learning during the COVID-19 pandemic. The goal of this project is to understand the challenges faced by students learning anatomy and physiology (ANP) using asynchronous lecture recordings during an obligatory shift to online education and the ability of this teaching approach to help students progress through an effective learning experience. This research project used survey and Echo360 data to evaluate student approaches to asynchronous online instruction. The survey data was anonymous, voluntary, and collected from 154 students enrolled in a first-year ANP course during fall, 2020. The Echo360 data pertained to the timing and frequency of student participation in recorded lectures. Survey results show that more students find asynchronous online lectures difficult rather than easy compared to synchronous in-person lectures. Most students were not affected by significant extrinsic or intrinsic cognitive load but lacked the ability to use the benefits of pre-recorded lectures, such as re-watching recordings, to their full advantage. Analysis of Echo360 data on lecture recordings provided information on the average view time per recording, timing of attendance to recorded lectures, and the frequency of repeat viewing, especially in relation to final exams. The average number of total views per lecture was 575. The average number of unique views was 270, meaning that 70.9% of students watched recorded lectures at least once. Higher views also correlated positively with note-taking events, suggesting that students re-watched and engaged more when faced with specific topics. The results of this project will guide healthcare educators to discover more effective ways to fully engage students when teaching ANP online, and will promote interest in developing more effective online learning tools for healthcare students.
Keywords: Anatomy and Physiology education, e-learning, asynchronous, recorded lectures, cognitive load.
5.6. Reduced Emotional Reactivity in Breast Cancer Survivors with Chronic Neuropathic Pain Following Mindfulness-Based Stress Reduction (MBSR): an fMRI Pilot Investigation
Diya Li *(1). Andra Smith (1)
(1) Faculty of Health Science, University of Ottawa, ON
Objectives: While chronic neuropathic pain (CNP) has been at the back of many cancer survivors’ minds, few non-pharmaceutical interventions are able to successfully erase CNP off their sensory perceptions. Therefore, this study’s objective was to determine the degree of the impact an 8-week mindfulness-based stress reduction (MBSR) program has on breast cancer survivors’ neuropathic pain perception. Method: With informed consent, twenty-one women (age ranges from 37 to 81 years old) who met the eligibility criteria were randomly assigned to either the MBSR group (n=11) or a control group (n=10). All participants were scanned by fMRI before and after the MBSR training or treatment as usual while being asked to complete an emotional Stroop task in an effort to measure their emotional reactivities. Pain severity and interference from the Brief Pain Inventory (BPI) were also assessed. Everyone involved in this research was blind to the group except for the research coordinator and the participants. Result: At post-treatment assessment, when challenged by emotional Stroop stimuli, MBSR practice contributed to reduced blood oxygen level-dependent (BOLD) activities in visual attention areas (left precuneus, left primary visual cortex), left somatosensory cortex, and the left dorsolateral prefrontal cortex (this area was often associated with increased neuropathic pain). The pain interference score on the BPI in the MBSR group was significantly decreased after the training in contrast to the control group in which no difference was observed. Conclusion: The preliminary findings demonstrated a positive impact of MBSR training on pain and attention processing in breast cancer survivors. Such evidence suggests that MBSR could be one of the viable non-pharmaceutical interventions available for breast cancer survivor with chronic neuropathic pain (CNP). However, further research with a larger sample should be considered.
Keywords: fMRI; MBSR; neuropathic pain; mindfulness; breast cancer; emotional Stroop.
5.7. Predictors of Sleep-disordered breathing in children with Down syndrome: A systematic review and meta-analysis.
Youstina Hanna (1,3) Nardin Hanna * (2, 3) Bokhaut J (3) Tsampalieros A (3) Blinder H (3) Sherri Katz (3,4,5)
(1) St. Michael’s Hospital, Department of Medicine, Toronto ON
(2) University of Ottawa, Faculty of Medicine, Ottawa ON
(3) Children’s Hospital of Eastern Ontario Research Institute, Ottawa ON
(4) Division of Respirology, Department of Pediatrics, Children’s Hospital of Eastern Ontario, Ottawa ON
(5)Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa ON
Introduction: Children with Down syndrome are at increased risk of sleep disordered breathing, (SDB), which is associated with significant morbidity including neurocognitive impairment, cardiometabolic disease and systemic inflammation. Polysomnography for sleep disordered breathing diagnosis is recommended by the age of 4 years, but due to limited resources this is often difficult to fulfill. The identification of clinical features that predict SDB is critical in identifying children with Down syndrome most likely to have SDB to facilitate early diagnosis with polysomnography and treatment, ultimately preventing life-threatening co-morbidities. Objectives: The objective was to identify clinical features in children with Down syndrome which are most predictive of sleep-disordered breathing through a systematic review of the literature. We hypothesized that adenotonsillar hypertrophy, BMI obesity and cardiac disease may be found to be associated with more severe SDB. Methods: This systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol (PRISMA-P) checklist. A comprehensive literature search was conducted using MEDLINE, Embase, CENTRAL, and CINAHL. Studies were included if they involved individuals with Down syndrome who were evaluated for SDB using overnight laboratory-based polysomnography (PSG) or overnight oximetry and identified predictors of SDB. Results: 437 articles were identified, and after articles were screened against inclusion and exclusion criteria, 21 articles were included in the final analysis. Our review of the literature identified the following features to be potential predictors of SDB in children with Down syndrome: older age, BMI, male sex, tonsil size, snoring, race and ethnicity, surgical history, decreased verbal IQ, desaturations in oximetry, congenital cardiac abnormalities, and gastrointestinal, psychiatric, and upper and lower respiratory comorbidities. The meta-analysis is ongoing. Conclusion: This study identified obesity, male sex, verbal IQ, tonsil size, abnormal overnight oximetry and presence of specific comorbidities as predictors of SDB which can necessitate earlier PSG.
Keywords: Down Syndrome, Sleep Disordered Breathing, Pediatric Respirology, Congenital Abnormalities, Respiratory