Introduction: This article aimed to evaluate pilot community paramedicine (CP) programs in northern Ontario from the perspectives of paramedics to gain program recommendations related to both rural and urban settings. Methods: An online questionnaire was created and distributed to 879 paramedics with and without CP experience employed at eight emergency medical services providers in northern Ontario. An explanatory sequential design was used to analyze and synthesize the results from the quantitative survey items and the open-ended responses. Results: Seventy-five (40.5%) respondents participated in a CP program, and the majority of 75 paramedics who indicated they participated in CP (n=41, 54.4%) were from rural areas. CP was generally well received by both paramedics currently practicing CP and those who were not practicing CP. The majority (86.3%) of paramedics stated paramedics should be practicing CP in the future. Paramedics identified developing professional relationships and improving health promotion as positive aspects of CP. Areas for CP program improvement included better organization and scheduling, improved training and a need for better patient tracking software. Conclusion: Engaging and consulting paramedics in the ongoing process of CP development and implementation is important to ensure they feel valued and are part of the change process.

Background/Purpose: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that can affect multiple organ systems and can vary in its manifestations between individuals. SLE can range in severity, resulting in some patients being unable to continue working while others can remain employed. The purpose of this study is to analyze and compare factors including SLE disease activity between work disabled and employed patients with SLE to elucidate variables associated with unemployment. Methods: This is a cross-sectional study focused on the status of last employment reported in the data on 1110 adult SLE patients followed at a single centre where 746 patients were categorized as “Employed” and 364 as “Unemployed” (work disability or Sick Leave). In the employed group, 478 patients were matched to 297 patients in the unemployed group by 2:1 matching. Patients were matched on gender, inception status (whether patient was first seen at clinic within 12 months of SLE diagnosis), disease duration at last visit (+/- 3 years), ethnicity (Caucasian or non-Caucasian) and highest education level obtained. Associations between variables and employment status were assessed using univariate and multivariate conditional logistic regressions in a nested case-control study. Greedy matching algorithm was used to assemble the cases and controls. Patients’ characteristics were compared by paired t-test and McNemar’s test in matched cohorts, and a conditional logistic regression was performed to examine patients’ demographics, last five years’ disease activity, organ damage, disease burdens and treatment to the last employment status. Step-down variable selection method was adopted in the multivariable model building with Akaike Information Criterion (AIC) used as the model fitting statistics. Results: The demographics of 775 patients were represented in Table 1. Patients in the unemployed group showed significantly greater disease activity (higher adjusted mean SLEDAI-2K and SLEDAI-K Glucocorticoid index (SLEDAI-2KG) in the past five years and greater damage by SDI). Patients were also found to have a significantly higher prevalence of myocardial infarction, stroke, fibromyalgia, hypertension, and higher daily and cumulative glucocorticoid use. In the multivariable analysis (Table 2), age at SLE diagnosis (OR, 95% CI: 1.04,1.02-1.06), adjusted mean SLEDAI-2KG in past five years (OR, 95% CI: 1.07, 1.03-1.12), SDI (OR, 95% CI: 1.59, 1.40-1.80) and prevalence of fibromyalgia (OR, 95% CI: 3.84, 2.52, 5.86) were associated with the increased risk of unemployment. We conducted additional modeling where adjusted mean SLEDAI-2KG was substituted by adjusted mean SLEDAI-2K and cumulative glucocorticoid dose in the past five years, and the results were similar to the previous model. Conclusion: High disease activity, damage and use of glucocorticoids were associated with an increased likelihood of patients being unemployed. Similarly, fibromyalgia was strongly associated with a patient being unemployed. Employment status may be improved by better control of SLE disease activity and management of fibromyalgia and other risk factors.

Higher psychosocial work demands in veterinary and academic professions are associated with decreased occupational, physical, and mental well-being. COVID-19 introduced far-reaching challenges that may have increased the psychosocial work demands for these populations, thereby impacting individual- and institutional-level well-being. Our objective was to investigate the psychosocial work demands, health and well-being, and perceived needs of faculty, staff, residents and interns at the Ontario Veterinary College, in Ontario, Canada, during COVID-19. A total of 157 respondents completed a questionnaire between November 2020 and January 2021, that included the Third Version of the Copenhagen Psychosocial Questionnaire (COPSOQ-III) and open-text questions on perceived needs for well-being. Results showed that COPSOQ-III dimensions of quantitative demands, recognition, sense of community, burnout, stress, and depressive symptoms, were significantly worse in our study population than the Canadian norm. Quantitative and emotional demands, health and well-being (including depressive symptoms, stress, cognitive stress, somatic stress, and burnout), and work-life conflict were also reported to have worsened since the COVID-19 restrictions for most respondents. Females and caregivers had higher odds of experiencing increased work demands, and decreased health and well-being, compared to males and non-caregivers. However, male caregivers experienced worsened supervisor relations, compared to female caregivers. Social capital also worsened for clinical and part-time employees, compared to full-time and non-clinical employees. Respondents identified increased workload support, community-building, recognition of employees' capacities and personal needs, flexible work schedules, and consistent communication, as strategies to increase well-being during COVID-19 and generally. Overall, our findings suggest that COVID-19 has increased occupational demands, work-life conflicts, and decreased well-being in veterinary academia. Institutional-level interventions are discussed and recommended to aid individual and institutional well-being.

Background: Sickness absenteeism is an area of concern in nursing and is more concerning given the recent impacts of the COVID-19 pandemic on healthcare. This study is one of two meta-analyses that examined sickness absenteeism in nursing. In this study, we examined demographic, lifestyle, and physical health predictors. Methods: We reviewed five databases (CINAHL, ProQuest Allied, ProQuest database theses, PsycINFO, and PubMed) for our search. We registered the systematic review (CRD de-identified) and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Additionally, we used the Population/Intervention/Comparison/Outcome Tool to improve our searches. Results: Following quality testing, 17 articles were used for quantitative synthesis. Female employees were at higher risks of sickness absenteeism than their male counterparts (OR = 1.73; 95% CI: 1.33-2.25). Nursing staff who rated their health as poor had a greater likelihood of experiencing sickness absence (OR = 1.38; 95% CI: 1.19-1.60). Also, previous sick leave predicted future leaves (OR = 3.35; 95% CI: 1.37-8.19). Moreover, experiencing musculoskeletal pain (OR = 2.41 95% CI: 1.77-3.27) increased the likelihood of sickness absence with greater odds when it is a back pain (OR = 3.05; 95% CI: 1.66-5.62). Increased age, physical activity, and sleep were not associated with sick leave. Conclusion: Several variables were statistically associated with the occurrence of sickness absenteeism. One primary concern is the limited research in this area despite alarming rates of sick leave in healthcare. More research is required to identify predictors of sickness absence, and thereby, implement preventative measures.

Background: Mental health issues are on the rise which may impede university students' abilities to perform daily functions and interact with other community members. The objectives of the current study are to explore (1) the characteristics of university students' mental health and engagement in activities, (2) how students use their smartphones to support their mental health and engagement in activities, (3) student preferences for important features and functions of a smartphone application (app) that promote engagement in activities and (4) student perspectives about what data an app should collect as indicators of change in their mental health and engagement in activities. Methods: We designed a pilot study and an online questionnaire with open and closed-ended questions to collect data exploring the association between student mental health and engagement in activities. The questionnaire included four sections: demographics, mental health and activity status and management, general smartphone use, and smartphone use to support mental health and engagement in activities. The data were analysed using descriptive statistics. Results: A total of 56 participants were recruited to complete the online survey, with an average completion rate of 77% (n = 43). The majority of participants were 24 years of age or older (n = 34, 65.4%), and less than half were between the ages of 18 and 23 (n = 18, 34.6%). The results of participants' engagement in self-care, productivity and leisure/play activities are reported. As well, participants' use of smartphones to support their mental health is described. Conclusions: This study provides a greater understanding of what features and functions to include and what data to collect when developing a novel app to support students' mental health and engagement in activities. Moreover, it clarifies the bidirectional relationship between mental health changes and self-care engagement, productivity/work and leisure/play domains.

Systemic lupus erythematosus (SLE) is a chronic relapsing-remitting autoimmune disease that attacks different organ systems and results in substantial disability and mortality. For SLE patients, work disability is related to personal challenges, including limitations in functioning, decreased income, activity participation restrictions, and diminished health-related quality of life. In order to address these challenges, work disability in patients with SLE should be evaluated through a biopsychosocial framework that is patient-centric and grounded in disability management. Work disability resides at the confluence of the physical, psychosocial, and cultural factors embedded in the International Classification of Functioning and the Work Disability Prevention Framework. This chapter highlights the importance of measuring and assessing work disability through biopsychosocial lens through patient-reported outcomes of work disability and functioning and clinician-administered evaluations. Emphasis is placed on using a holistic and preventative approach in supporting SLE patients in their participation and engagement in work.