Exercise and leisure activities provide physical and psychosocial benefits to people with multiple sclerosis (MS) and can enhance their quality of life. In Winnipeg, Manitoba, Canada, people with MS have reported barriers to their participation in local MS-specific aquafitness (AF) programs. Therefore, a formal exploration of the accessibility of local AF programs for people with MS was undertaken. The purpose of this phenomenological study was to identify factors that facilitate or impede participation in AF programs by individuals with MS living in Winnipeg. Qualitative data were collected from a total of eight participants through one focus group (n = 7) and one in-depth interview (n = 1). The sample consisted of individuals with MS who were currently participating in AF programming as well as those who were not. Data were audio-recorded and transcribed verbatim, and thematic analysis was completed. Seven themes emerged regarding factors affecting participation in local AF programs. Barriers to participation included inadequate transportation, lack of one-on-one support, environmental inaccessibility, and fears associated with participation in the programs. Facilitators of participation included a knowledgeable instructor and experiencing physical and psychosocial benefits from the program. Information from this study was used locally to advocate for people with MS in order to increase participation in local AF programming. Int J MS Care. 2012;14:132-141.A quafitness (AF) programs provide a variety of physical and psychosocial benefits to people with multiple sclerosis (MS).1-3 Aquafitness programs consist of exercises performed in water, and are sometimes classified as aquatic therapy. 4 In Winnipeg, Manitoba, Canada, AF programs tailored to people with MS are offered through the City of Winnipeg. Although this specialized program has been offered regularly for over 10 years, class sizes have remained small, and anecdotal reports from people with MS have indicated difficulty attending the programs. In order to validate the reports of people with MS in this community and further understand the difficulties associated with participation in these programs, a formal exploration of the accessibility of local AF programs was undertaken. Benefits of AF Programs for People with MSMany advantages of water-based exercise have been identified for individuals with MS. Literature suggests that it can lead to reduced muscle stress, decreased pain, less guarded movement associated with the fear of falling, and improved performance in physical activity due to the properties of water. 5,6 The water supports the body through its density and buoyancy, allowing the individual with MS to move more easily.4,7 Aquatic exercise also limits exercise-induced increases in body temperature, a factor associated with worsening MS-related fatigue symptoms. 6,7 Many physical benefits are associated with AF programs for people with MS, including increased strength,

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Trends in extant literature suggest that more relational and identity-based leadership approaches are necessary for leadership that can harness the benefits of the diverse and globalized workforces of today and the future. In this study, we compared general leadership development programs (GLDPs) and women’s leadership development programs (WLDPs) to understand to what extent program descriptions addressed inclusive leadership—leadership that draws on relational skills to value both the uniqueness and belonging needs of diverse identities to create business effectiveness for the long term. GLDPs predominantly reflected pedagogical assumptions of separate knowing, development of the autonomous self, and masculine leadership approaches of agentic and transactional leadership. In contrast, pedagogical assumptions of connected knowing, development of the relational self, and relational and identity-based leadership approaches were more prevalent in WLDPs. These findings suggest that WLDPs continue to offer significant value to supporting women leaders in their advancement, yet both WLDPs and GLDPs can do more to be inclusive of additional diverse identities to better develop leaders of the future who can lead with inclusive behaviors. We suggest a pedagogical framework for inclusive leadership development that may better balance and promote synergies between achieving business priorities and relating to others and their diverse identities.

Integrated care is a promising approach for improving care transitions for older adults, but this concept is inconsistently defined and applied. This scoping review describes the size and nature of literature on integrated care initiatives for transitions from hospital to community care for older adults (aged 65 and older) and how this literature conceptualizes integrated care. A systematic search of literature from the past 10 years yielded 899 documents that were screened for inclusion by two reviewers. Of the 48 included documents, there were 26 journal articles and 22 grey literature documents. Analysis included descriptive statistics and a content analysis approach to summarize features of the integrated care initiatives. Results suggest that clinical and service delivery integration is being targeted rather than integration of funding, administration, and/or organization. To promote international comparison of integrated care initiatives aiming to improve care transitions, detailed descriptions of organizational context are also needed.

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High users of health care services were identifiable prior to hospital admission, supporting the use of community-based integrated care approaches.

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