Isolde Daiski

Diabetes prevalence and income: Results of the Canadian Community Health Survey

UNLABELLED This paper contributes to a growing body of literature indicating the importance of income as a key socioeconomic status marker in accounting for the increased prevalence of type 2 diabetes (T2DM). METHODS We analyzed data from the Canadian Community Health Survey cycle 3.1 conducted by Statistics Canada. Descriptive statistics on the prevalence of self-reported diabetes were computed. Multiple logistic regression was used to examine the association between income and prevalence of T2DM. RESULTS In 2005 an estimated 1.3 million Canadians (4.9%) reported having diabetes. The prevalence of T2DM in the lowest income group is 4.14 times higher than in the highest income group. Prevalence of diabetes decreases steadily as income goes up. The likelihood of diabetes was significantly higher for low-income groups even after adjusting for socio-demographic status, housing, BMI and physical activity. There is a graded association between income and diabetes with odds ratios almost double for men (OR 1.94, 95% CI 1.57-2.39) and almost triple for women (OR 2.75 95% CI 2.24-3.37) in the lowest income compared to those in highest income. CONCLUSION These findings suggest that strategies for diabetes prevention should combine person-centered approaches generally recommended in the diabetes literature research with public policy approaches that acknowledge the role of socioeconomic position in shaping T2DM prevalence/incidence.

The dynamics of the relationship between diabetes incidence and low income: Longitudinal results from Canada's National Population Health Survey

UNLABELLED This paper sheds light on the dynamic relationship between peoples experiences of low income and the development of type 2 diabetes (T2DM) by moving beyond the static perspective provided by cross-sectional studies to a long-term approach informed by longitudinal analyses. METHODS We analyzed data from the Canadian National Population Health Survey (NPHS) conducted by Statistics Canada from 1994 to 2007. The longitudinal sample is composed of 17,276 respondents (8046 males, 9230 females) 12 years of age or older. We further developed an algorithm to distinguish T2DM from other types of diabetes. Proportional hazard models with time-varying predictors were used to explore the dynamics of the relationship between low income and T2DM. RESULTS The results suggest that living in low income and experiencing persistent low income are significant precursors of developing T2DM. Being in low income in the previous cycle of T2DM onset was associated with 77% higher risk of T2DM (hazard ratio 1.77; 95% CI: 1.48-2.12). The association between low income and diabetes incidence remains significant after adjusting for age, sex, health behaviors, and psychological distress (hazard ratio 1.24; 95% CI: 1.02-1.52). CONCLUSION This study contributes to the under-developed research examining longitudinally the relationship between socioeconomic status and diabetes incidence. Employing this long-term approach, this study calls attention to the primary effect of socioeconomic position on diabetes incidence that cannot be explained entirely by behavioral factors. Findings draw attention to the need to address the role played in T2DM by the inequitable distribution of the social determinants of health.

A toxic combination of poor social policies and programmes, unfair economic arrangements and bad politics: the experiences of poor Canadians with Type 2 diabetes

Type 2 diabetes (T2DM) is a serious life-threatening chronic disease whose prevalence is especially high among Canadians living in poverty. And these Canadians with T2DM in poverty are especially likely to experience serious consequences of the disease. Of special concern is Statistics Canada reporting an explosive increase in mortality rates from diabetes (of which 90% represent T2DM) in low-income urban neighbourhoods across Canada. We place findings from interviews with 60 Canadians with T2DM who live in poverty within the context of recent shifts in public policy that have affected the distribution of the social determinants of health. Findings of material deprivation among our participants indicate that it is almost impossible for these individuals to acquire the diet necessary to prevent the adverse outcomes associated with T2DM. These findings draw attention to consideration of the important role public policy plays in affecting the situation of people living in poverty who are afflicted with T2DM and other chronic diseases.

The Health Bus: Healthcare for Marginalized Populations

The Health Bus, an innovative outreach program, serves the marginalized population of a large Canadian city. In this article, a needs assessment/evaluation study of its services is discussed. Barriers to mainstream healthcare and solutions are examined. This study was qualitative, descriptive, and exploratory and surveyed 58 client volunteers of the program through semistructured interviews and focus groups. Thematic analysis of data was carried out. The Health Bus was found to provide basic healthcare and supplies effectively. Clients value respectful treatment, competency of healthcare professionals, and accessibility, whereas disrespectful treatments and lack of transportation are barriers to mainstream healthcare. A conclusion of this study is that Health Bus services should be expanded with clients’ input. Mainstream institutions need flexibility and a change in attitudes toward the marginalized.

The Road to Professionalism in Nursing: Case Management or Practice Based in Nursing Theory?

of the system. In this issue, Isolde Daiski presents some of these changes within the Canadian healthcare system with a growing focus on case management, critical pathways, and care maps. Daiski posits that these tools fail to take into account the uniqueness of the individual, and they do not truly meet pa tient needs. An important question to consider is the following: Will nurses again blindly move backward in the march toward purported progress? Case management clearly has decreasing the cost of patient care as a primary motive. This is a laudable goal, for resources have limits. But what human price is paid to meet the organization’s plan?

An expanded model of diabetes care based in an analysis and critique of current approaches

AIMS AND OBJECTIVES To examine and critique various models guiding the care and education of people with diabetes, to develop more helpful and effective approaches to care. The focus is on relationships and communication between patients and healthcare providers. BACKGROUND Many patients are not adhering to the recommended treatments, hence it seems that effective diabetes care is difficult to achieve, particularly for patients of lower socio-economic status, who are disproportionately afflicted. The results are usually devastating, and lead to serious health complications that incisively diminish quality of life for patients with diabetes, frustrate healthcare providers and increase healthcare costs. DESIGN Critical review. METHOD This paper represents a critical review of various approaches to diabetes care and education. A CINAHL search with relevant key words was carried out and selected exemplary research studies and articles describing and/or evaluating the various approaches to diabetes care and management were examined. Particular attention was paid to how the paradigmatic underpinnings of these approaches construct patient - healthcare provider relationships. CONCLUSION The literature revealed that the traditional top-down approaches to care were largely ineffective, while collaborative approaches, based in respect and taking the whole persons and their unique situations into account, were found to be central to good care. Further, an integration of the different kinds of knowledge contained in the various approaches can complement and extend one another. RELEVANCE TO CLINICAL PRACTICE Avoiding devastating complications by improving the management of diabetes and overall quality of life of patients is a worthwhile goal. Therefore expanding diabetes care beyond the traditional bio-medical model to develop more effective approaches to care is of interest to all healthcare professionals working in this area.

Book Review: Philosophy of Science for Nursing Practice: Concepts and Applications. Michael D. Dahnke & H. Michael Dreher, (2nd Ed.) (2016). New York: Springer.

This book introduces the reader to Western philosophy from historical origins to contemporary thought. The authors, Dahnke (PhD, Philosophy) and Dreher (RN, PhD, Nursing Science), state that it was written primarily for students of the Doctor of Nursing Practice (DNP) but might equally be used by students in PhD nursing programs. Nursing in this text is described as a young practice discipline that only developed over the last 100 years and currently remains intently focused on reproduction of evidence-based practice (EBP). Meanwhile, the authors maintain that inquiry and critical thinking are left somewhat on the back burner or at the very least remain in the domain of the PhD programs. There is currently a plethora of avenues to educational preparation into the nursing profession in the United States, including diploma programs outside the university. The authors argue that, as a result of this varying educational preparation, nursing seems somewhat mired in the concrete and many nurses feel alienated from more abstract levels of thinking, knowledge development, and academic research. Yet in order to be recognized as a discipline and a science, a discipline-specific knowledge base is essential. The authors make a convincing argument that all practitioners prepared at the doctoral level should be familiar with philosophy of science to be able to carry out knowledge development in order to ground and legitimize stewardship of their own disciplinary practice. After reading this book, the authors hope this text will facilitate a shift of students’ thinking from the concrete to the abstract, as “doctoral education is about debate and discourse, and not merely acquiescence to another scholar’s ideas” (Dahnke & Dreher, 2016, p. xvii). Furthermore, students should be able to answer the question of whether nursing is a science. Lastly, the authors anticipate that the gap between the two professional nursing communities, one of researchers and the other of practitioners, will be narrowed by using this text as a starting point for discussion (p. xix). The first two chapters deal with what it means to be a practice discipline, particularly its interpersonal aspects. The authors elaborate on concepts such as practice, discipline, profession, the role of ethics, and who should be able to generate knowledge within a discipline. In chapter 3, the authors deliberate on the role of philosophy of science in the practice discipline of nursing. Questions are raised about how much philosophy is needed in the DNP curriculum, as opposed to the more academically oriented PHD programs. There is also discussion about what should be a requirement for graduation from a DNP program. Should DNP students produce more practical types of projects, or should theses or dissertations be an expectation? Various types of research with practical knowledge and application research are proposed (Dahnke & Dreher, 2016), preferably conducted in the students’ own practice environments to ensure usefulness and relevancy for the practitioner. This type of actionable research could further expand and enrich the knowledge base of the discipline. Chapters 4 to 14 introduce the student to Western philosophy and philosophizing beginning with the ancient world philosophers, like Socrates and Plato, and ending with contemporary social sciences and post-modernism. The basic concepts of philosophy are discussed in chapter 4 and the concepts of science in chapter 5. Chapter 6 focuses on the last 100 years, when philosophy of science became a clearly identifiable branch. Various presumptive theories are introduced here and further elaborated on in the following chapters. The purposes and functions of theory in describing, sometimes predicting, and other times explaining the world and its phenomena are discussed. Science, scientific method, and deductive and inductive logic in scientific investigation are also explored. Lastly, the reader is introduced to feminist 661117 NSQXXX10.1177/0894318416661117Nursing Science QuarterlyDaiski book-review2016

Women Living with Homelessness: They Are (Almost) Invisible

Introduction: In this paper I present and discuss the stories told by women living with extreme poverty and homelessness. Consigned to the margins of society they are barely noticed, almost invisible.