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Background The paper presents two-year findings from a study investigating the effectiveness of Housing First (HF) with assertive community treatment (ACT) in helping individuals with serious mental illness, who are homeless or precariously housed and living in a small city, to become stably housed. Methods The research design was a parallel group non-blinded RCT with participants randomly assigned after the baseline interview to receive HF with ACT ( N = 100) or treatment as usual (TAU; N = 101). Participants were interviewed every 3 months over 21/24 months to investigate changes on a range of housing and psychosocial outcomes. The primary outcomes were housing stability (as defined by a joint function of number of days housed and number of moves) and improvement in community functioning. Secondary predicted outcomes were improvements in self-rated physical and mental health status, substance use problems, quality of life, community integration, and recovery. Results An intent-to-treat analysis was conducted. Compared to TAU participants, HF participants who entered housing did so more quickly (23.30 versus 88.25 days, d = 1.02, 95% CI [0.50–1.53], p < 0.001), spent a greater proportion of time stably housed ( Z = 5.30, p < 0.001, OR = 3.12, 95% CI [1.96–4.27]), and rated the quality of their housing more positively ( Z = 4.59, p < 0.001, d = 0.43, 95% CI [0.25–0.62]). HF participants were also more likely to be housed continually in the final 6 months (i.e., 79.57% vs. 55.47%), χ 2 (2, n = 170) = 11.46, p = .003, Cramer’s V = 0.26, 95% CI [0.14–0.42]). HF participants showed greater gains in quality of life, ( Z = 3.83, p < 0.001, ASMD = 0.50, 95% CI [0.24–0.75]), psychological integration ( Z = 12.89, p < 0.001, pooled ASMD = 0.91, 95% CI [0.77–1.05]), and perceived recovery ( Z = 2.26, p = 0.03, ASMD = 0.39, 95% CI [0.05–0.74]) than TAU participants. Conclusions The study indicates that HF ends homelessness significantly more rapidly than TAU for a majority of individuals with serious mental illness who have a history of homelessness and live in a small city. In addition, compared to TAU, HF produces psychosocial benefits for its recipients that include an enhanced quality of life, a greater sense of belonging in the community, and greater improvements in perceived recovery from mental illness. Trial registration International Standard Randomized Control Trial Number Registe...

IntroductionDementia is on the rise in Canada and globally. Ensuring accessibility to diagnosis, treatment and management throughout the course of the disease is a very significant problem worldwide. In order to provide comprehensive care to patients and their caregivers, enhancing primary care-based dementia care is seen as the way forward. In many Canadian provinces various collaborative care models (collCMs) anchored in primary care to improve dementia care have been developed and implemented. The overall objective of our research programme is to identify key factors for the successful implementation of collCMs, and to facilitate dissemination and scale-up of dementia best practices.Methods and analysisWe will use a convergent mixed-methods design. An observational study using chart review (2014–2016) and questionnaires (2014–2018; repeated in 2020) will measure application of guidelines and implementation of collCMs. This study will be complemented with a qualitative descriptive study using interviews (2017–2020) conducted in parallel. Quantitative and qualitative results will be further integrated using a matrix representing sites and findings. An integrated knowledge exchange strategy will ensure uptake by principal stakeholders throughout the research.Ethics and disseminationOur study has been approved by all relevant ethics committees. Our dissemination plan follows an integrated knowledge transfer strategy using provincial, national and international councils. We will present the results individually to the clinical sites and then to these councils. Our research will be the first provincial and cross jurisdictional evaluation of primary care models for patients living with dementia, providing evidence on the ongoing debate on the respective role of clinicians in primary care and specialists in caring for patients with dementia.

Our study objective was to develop and validate a questionnaire assessing the knowledge, attitude, and practice (KAP) of family physicians regarding dementia care and dementia strategies in Canada. Using a multistage process with a panel of experts, we developed and distributed an 83-item questionnaire to 542 eligible family physicians in 42 interdisciplinary primary care teams participating in the Quebec Alzheimer Plan implementation. Altogether, 369 physicians (68%) returned questionnaires. Median item-specific non-response rate was 0.8 per cent (0.3%–8.1%). Exploratory factor analyses and scale correlation supported the questionnaire validity. The final questionnaire contained five factors and 31 items. The KAP questionnaire has proved to be a reliable instrument for assessing the KAP of family physicians regarding dementia care and dementia strategies. This questionnaire provides researchers, clinicians, managers, and decision-makers with a tool to assess an intervention, a program, or a policy change implemented in primary health care for patients with dementia.

The At Home / Chez Soi demonstration project was conducted to investigate the effectiveness of the Housing First model in 5 Canadian cities. Using a randomized controlled trial design, this study evaluates the impact of this project on the use of health services by people with severe and persistent mental health problems and a history of homelessness in the greater Moncton area. The sample comprised 193 homeless persons, 95 in the control group and 98 in the treatment group. The results show a significant difference between the 2 groups only in the number of days of hospitalization, particularly in the psychiatric unit. Factors associated with the use of health services by people who are homeless and who have severe mental health problems need to be further investigated.Keywords: homelessness, health services, severe mental illness, mental health RÉSUMÉLe projet At Home / Chez Soi fut conçu afin d'évaluer l'efficacité du modèle Logement d'abord dans 5 villes canadiennes. Utilisant un devis expérimental, la présente étude examine l'effet du programme d'intervention At Home / Chez Soi sur le recours aux services de santé par des personnes itinérantes de la région de Moncton qui ont des troubles psychiatriques sévères et persistants. L'échantillon comprend 193 personnes itinérantes, soit 95 dans le groupe témoin et 98 dans le groupe intervention. Les résultats démontrent une différence significative entre les 2 groupes seulement en ce qui concerne le nombre de jours d'hospitalisation, en particulier à l'unité psychiatrique. Les facteurs associés au recours aux services de santé mentale par les personnes itinérantes ayant des problèmes sévères de santé mentale doivent être étudiés plus à fond. Mots clés : personnes itinérantes, services de santé, problèmes sévères de santé mentaleChronic homelessness is often associated with physical and mental health conditions such as psychiatric, somatic, physical, and comorbid disorders, resulting in an increased mortality rate in this vulnerable population Nusselder et al., 2013). In response to attempts to reduce chronic homelessness in Canada for people with mental health problems, the Mental Health Commission of Canada launched the At Home / Chez Soi demonstration project . The purpose of this national initiative is to examine the impact of a Housing First strategy for homeless people with severe and persistent mental health problems in five cities across Canada: Moncton, Montreal, Toronto, Winnipeg, and Vancouver. This study attempts to describe the effects of the At Home / Chez Soi demonstration project's Housing First-style intervention on the use of health services by homeless people in the Moncton area. The Moncton site was chosen because the city of 139,000 is the only officially bilingual Canadian urban centre. Moreover, although this site has proportionally fewer homeless people than other large Canadian sites, access to health services for this population is particularly difficult.In general, homeless people use health services at much higher rates than the ...

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Purpose – The aim of this study was to evaluate the individual effect of sumac (S), Turkish coffee (C) and yerba mate tea (Y) on the postprandial glycemic response to Lebanese mankoucheh, a common breakfast item in the Lebanese culture, and to determine the glycemic index (GI) of this food. S, C and Y are typical constituents of Lebanese meals. They may influence the postprandial glycemic response to carbohydrate-rich foods, but this has not been studied to date. Design/methodology/approach – Twelve healthy normoglycemic adults consumed on separate days the following test meals: mankoucheh without S (M) with water (control meal); M prepared with single or double doses of S (S1 and S2) with water; M with 60 or 120 mL of unsweetened C; or M with 100 or 200 mL of unsweetened Y. Meals were prepared according to standardized recipes containing 50 g of available carbohydrates. Capillary blood glucose measures were taken at fast and six times after meal ingestion over a two hour period. The GI of mankoucheh was determined using a standard protocol. Findings – The glycemic responses, evaluated at each time following meal ingestion, did not differ significantly among the seven meals, and neither did the incremental area under the glycemic response curves. The GI of mankoucheh was 61 ± 6, with no significant difference between M, M with S1 and M with S2. Originality/value – This study contributes to better characterize the glycemic properties of S, C, Y and mankoucheh in conditions that closely resemble how these dietary items are used and consumed by some cultural groups.

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