Papers by Alicia J Polachek
BMC Health Services Research, 2022
Background Homeless and unstably housed individuals face barriers in accessing healthcare despite... more Background Homeless and unstably housed individuals face barriers in accessing healthcare despite experiencing greater health needs than the general population. Case management programs are effectively used to provide care for this population. However, little is known about the experiences of providers, their needs, and the ways they can be supported in their roles. Connect 2 Care (C2C) is a mobile outreach team that provides transitional case management for vulnerable individuals in a major Canadian city. Using an ethnographic approach, we aimed to describe the experiences of C2C team members and explore their perceptions and challenges. Methods We conducted participant observations and semi-structured interviews with C2C team members. Data analysis consisted of inductive thematic analysis to identify themes that were iteratively discussed. Results From 36 h of field observations with eight team members and 15 semi-structured interviews with 12 team members, we identified five over...
What patients notice about physicians’ wellness
<p>What patients notice about physicians’ wellness.</p
How patients’ perceptions of physician wellness impact patients’ views of their care, their feelings, and their actions
<p>How patients’ perceptions of physician wellness impact patients’ views of their care, th... more <p>How patients’ perceptions of physician wellness impact patients’ views of their care, their feelings, and their actions.</p
Table 6, Pooled absolute risk differences of antibiotic resistance for Enterobacteriaceae isolates in faecal samples
World Health Organization, Mar 1, 2017
Restriction in the use of antibiotics in food animals and antibiotic resistance in food animals and humans – a systematic review and meta-analysis (University of Calgary, Canada)
World Health Organization, Mar 1, 2017
An Analysis of the Implications for Mental and Physical Health
The Lancet. Planetary health, 2017
Antibiotic use in human medicine, veterinary medicine, and agriculture has been linked to the ris... more Antibiotic use in human medicine, veterinary medicine, and agriculture has been linked to the rise of antibiotic resistance globally. We did a systematic review and meta-analysis to summarise the effect that interventions to reduce antibiotic use in food-producing animals have on the presence of antibiotic-resistant bacteria in animals and in humans. On July 14, 2016, we searched electronic databases (Agricola, AGRIS, BIOSIS Previews, CAB Abstracts, MEDLINE, Embase, Global Index Medicus, ProQuest Dissertations, Science Citation Index) and the grey literature. The search was updated on Jan 27, 2017. Inclusion criteria were original studies that reported on interventions to reduce antibiotic use in food-producing animals and compared presence of antibiotic-resistant bacteria between intervention and comparator groups in animals or in human beings. We extracted data from included studies and did meta-analyses using random effects models. The main outcome assessed was the risk differenc...
Gender and the Division of Household Labour: An Analysis of the Implications for Mental and Physical Health
This thesis examines the relationships between the division of household labour and mental and ph... more This thesis examines the relationships between the division of household labour and mental and physical health using survey data from 1,193 male and female lawyers in Canada. Household labour is examined in terms of time spent in housework on work days and non-work days, relative contribution to housework, and perceptions of fairness about the division of household tasks. The results indicate that housework time and relative contributions are not particularly detrimental to mental and physical health. Rather, time spent in housework only appears to be harmful when it interferes with weekends or when individuals feel that the division of housework is unfair, particularly if it is unfair to one's spouse. Interestingly, these relationships do not differ for men and women. The results also suggest that work demands mediate the relationships between gender and health, as well as housework and health. Several avenues for further research are discussed.
Frontiers in Public Health, 2021
Introduction: Vulnerably housed individuals, especially those experiencing homelessness, have hig... more Introduction: Vulnerably housed individuals, especially those experiencing homelessness, have higher acute care use compared with the general population. Despite available primary care and social services, many face significant challenges accessing needed services. Connect 2 Care (C2C) is a novel transitional case management program that includes registered nurses and health navigators with complementary expertise in chronic disease management, mental health and addictions, social programs, community health, and housing, financial, transportation and legal resources. C2C bridges acute care and community services to improve care coordination.Methods and Analysis: We will perform a mixed-methods evaluation of the C2C program according to the Donabedian framework of structure, process and outcome, to understand how program structure and process, coupled with contextual factors, influence outcomes in a novel intervention. Eligible patients are homeless or unstably housed adults with com...
Prevalence of antimicrobial resistance genes and its association with restricted antimicrobial use in food-producing animals: a systematic review and meta-analysis
Journal of Antimicrobial Chemotherapy, Nov 4, 2020
Background There is ongoing debate regarding potential associations between restrictions of antim... more Background There is ongoing debate regarding potential associations between restrictions of antimicrobial use and prevalence of antimicrobial resistance (AMR) in bacteria. Objectives To summarize the effects of interventions reducing antimicrobial use in food-producing animals on the prevalence of AMR genes (ARGs) in bacteria from animals and humans. Methods We published a full systematic review of restrictions of antimicrobials in food-producing animals and their associations with AMR in bacteria. Herein, we focus on studies reporting on the association between restricted antimicrobial use and prevalence of ARGs. We used multilevel mixed-effects models and a semi-quantitative approach based on forest plots to summarize findings from studies. Results A positive effect of intervention [reduction in prevalence or number of ARGs in group(s) with restricted antimicrobial use] was reported from 29 studies for at least one ARG. We detected significant associations between a ban on avoparcin and diminished presence of the vanA gene in samples from animals and humans, whereas for the mecA gene, studies agreed on a positive effect of intervention in samples only from animals. Comparisons involving mcr-1, blaCTX-M, aadA2, vat(E), sul2, dfrA5, dfrA13, tet(E) and tet(P) indicated a reduced prevalence of genes in intervention groups. Conversely, no effects were detected for β-lactamases other than blaCTX-M and the remaining tet genes. Conclusions The available body of scientific evidence supported that restricted use of antimicrobials in food animals was associated with an either lower or equal presence of ARGs in bacteria, with effects dependent on ARG, host species and restricted drug.
Alberta Academic Review, Oct 31, 2019
Certain kinds of housing instability, such as foreclosure and homelessness, have been associated ... more Certain kinds of housing instability, such as foreclosure and homelessness, have been associated with poorer physical and mental health. The Connect 2 Care (C2C) program targets medically complex individuals who are unstably housed, primarily aimed at reducing acute care utilization and connecting clients to appropriate community-based care. However, because
Background We have previously reported, in a systematic review of 181 studies, that restriction o... more Background We have previously reported, in a systematic review of 181 studies, that restriction of antibiotic use in food-producing animals is associated with a reduction in antibiotic-resistant bacterial isolates. While informative, that report did not concretely specify whether different types of restriction are associated with differential effectiveness in reducing resistance. We undertook a sub-analysis of the systematic review to address this question. Methods We created a classification scheme of different approaches to antibiotic restriction: (1) complete restriction; (2) single antibiotic-class restriction; (3) single antibiotic restriction; (4) all non-therapeutic use restriction; (5) growth promoter and prophylaxis restriction; (6) growth promoter restriction and (7) other/undetermined. All studies in the original systematic review that were amenable to meta-analysis were included into this substudy and coded by intervention type. Meta-analyses were conducted using random ...
The paradox of compassionate work: a mixed-methods study of satisfying and fatiguing experiences of animal health care providers
Background and objectives: Compassionate work appears paradoxical as it may provide great rewards... more Background and objectives: Compassionate work appears paradoxical as it may provide great rewards, but may also come at great costs to care providers. This paper explores the paradox of compassionate work by examining what interactions contribute to compassion satisfaction and what interactions contribute to compassion fatigue. Design: This mixed-methods, cross-sectional study uses qualitative interview data from animal health care providers (N = 20) to identify work interactions that they find satisfying or stressful. Quantitative survey data (N = 572) are used to test hypotheses generated from the interviews regarding predictors of compassion satisfaction and compassion fatigue. Methods: Interview transcripts were analyzed using a directed content analysis approach. Survey data were analyzed using ordinary least squares regression. Results: The results highlight the complex nature of compassionate work. As hypothesized, making a difference to animals and building relationships wit...
BMJ Global Health
BackgroundWe have previously reported, in a systematic review of 181 studies, that restriction of... more BackgroundWe have previously reported, in a systematic review of 181 studies, that restriction of antibiotic use in food-producing animals is associated with a reduction in antibiotic-resistant bacterial isolates. While informative, that report did not concretely specify whether different types of restriction are associated with differential effectiveness in reducing resistance. We undertook a sub-analysis of the systematic review to address this question.MethodsWe created a classification scheme of different approaches to antibiotic restriction: (1) complete restriction; (2) single antibiotic-class restriction; (3) single antibiotic restriction; (4) all non-therapeutic use restriction; (5) growth promoter and prophylaxis restriction; (6) growth promoter restriction and (7) other/undetermined. All studies in the original systematic review that were amenable to meta-analysis were included into this substudy and coded by intervention type. Meta-analyses were conducted using random eff...
Journal of General Internal Medicine
BACKGROUND: Attending physician preceptors are accountable to many stakeholder groups, yet stakeh... more BACKGROUND: Attending physician preceptors are accountable to many stakeholder groups, yet stakeholders' views about what the preceptor role entails have not been sufficiently considered. OBJECTIVE: To explore stakeholder groups' unique perspectives of the preceptor role. DESIGN: Qualitative study with a constructivist orientation. PARTICIPANTS: Semi-structured interviews were conducted with 73 participants from two university teaching hospitals between October 2012 and March 2014. Participants included representatives from seven stakeholder groups: patients and their families, allied healthcare providers, bedside nurses, nurse managers, medical students, internal medicine residents, and preceptors. APPROACH: An inductive thematic analysis was conducted where researchers coded transcripts, abstracted codes into themes, and then mapped themes onto six focus areas: role dimensions, role performance, stressors and rewards, mastery, fulfillment, and impact on others. Two authors then identified Brecurrent themes^(emerging in two or more focus areas) and compared them across groups to identify Bunique themes^(emerging from a maximum of two stakeholder groups). BUnique thematic emphases^(unique themes that would not have emerged if a stakeholder group was not interviewed) are described. KEY RESULTS: Patients and their families emphasized preceptors' ultimate authority. Allied healthcare providers described preceptors as engaged collaborators involved in discharge planning and requiring a sense of humor. Bedside nurses highlighted the need for role standardization. Nurse managers stressed preceptors' need for humanism. Medical students highlighted preceptors' emotional labor and their influence on learners' emotional well-being. Residents emphasized preceptors' responsibilities to multiple stakeholders. Preceptors described lifelong learning and exercising control over one's environment. CONCLUSIONS: Various stakeholder groups hold unique and nuanced views of the attending physician preceptor role. These views could broaden formal role guidance for medical education and patient care. This study generated real-world, practical examples of what stakeholders feel are important preceptor skills. These skills should be practiced, taught, and role modeled in this clinical setting.
PloS one, 2018
Despite increased interest in physician wellness, little is known about patients' views on th... more Despite increased interest in physician wellness, little is known about patients' views on the topic. We explore patients' perceptions of physician wellness and how it links to patient care. This exploratory, qualitative study employed semi-structured interviews with a convenience sample of 20 patients from outpatient care settings in a western Canadian city. Using inductive thematic analysis, interview transcripts were independently coded by two authors and then discussed to ensure consensus and to abstract into higher-level themes. Three overarching premises were identified. First, patients notice cues that they interpret as signs of physician wellness. These include overt indicators, such as a physician's demeanor or physical appearance, along with a general impression about a physician's wellness. Second, patients form judgments based on what they notice, and these judgments affect patients' views about their care; feelings, such as trust, in their interactio...
Prevalence of Antimicrobial Resistance Genes in Listeria monocytogenes Isolated from Dairy Farms
Foodborne Pathogens and Disease, 2005
Antimicrobial resistance of Listeria monocytogenes (n = 38) isolated from the four dairy farms to... more Antimicrobial resistance of Listeria monocytogenes (n = 38) isolated from the four dairy farms to 15 antimicrobial agents was evaluated. All 38 L. monocytogenes isolates from the four farms evaluated were resistant to more than one antimicrobial in different combinations. All L. monocytogenes isolates evaluated were resistant to cephalosporin C (minimum inhibitory concentration [MIC] &amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 512 microg/mL), streptomycin (MIC &amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 32) and trimethoprim (MIC &amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 512). Most L. monocytogenes isolates were resistant to ampicillin (92%, MIC &amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 2), rifampicin (84%, MIC &amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 4), rifamycin (84%, MIC &amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 4), and florfenicol (66%, MIC &amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 32) and some were resistant to tetracycline (45%, MIC &amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 16), penicillin G (40%, MIC &amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 2) and chloramphenicol (32%, MIC &amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 32). All L. monocytogenes isolates were susceptible to amoxicillin, erythromycin, gentamicin, kanamycin and vancomycin. Susceptibility of L. monocytogenes to the antimicrobials evaluated was quite consistent among the dairy farms evaluated. However, some variability in antimicrobial susceptibility among dairy farms was noted. Nineteen of 38 L. monocytogenes isolates contained more than one antimicrobial resistance gene sequence. A high frequency of floR (66%) was found in L. monocytogenes followed by penA (37%), strA (34%), tetA (32%), and sulI (16%). Other tetracycline resistance genes (tetB, tetC, tetD, tetE, and tetG) and other antimicrobial resistance genes (cmlA, strB, aadA, sulI, vanA, vanB, ampC, ermB, ereA, and ereB) were not found in any of the L. monocytogenes isolates from the four dairy farms. Results of the present study demonstrated that L. monocytogenes isolated from the dairy farm environment were resistant to many antimicrobials and contained one or more antimicrobial resistance genes.
Examination of unintended consequences of antibiotic use restrictions in food-producing animals: Sub-analysis of a systematic review
One Health
Antimicrobial resistance is considered one of the greatest threats to global and public health to... more Antimicrobial resistance is considered one of the greatest threats to global and public health today. The World Health Organization, the Food and Agriculture Organization, and the World Organisation for Animal Health, known as the Tripartite Collaboration, have called for urgent action. We have previously published a systematic review of 181 studies, demonstrating that interventions that restrict antibiotic use in food-producing animals are associated with a reduction in antibiotic resistant bacterial isolates in both animals and humans. What remains unknown, however, are whether (and what) unintended consequences may arise from such interventions. We therefore undertook a sub-analysis of the original review to address this research question. A total of 47 studies described potential consequences of antibiotic restrictions. There were no consistent trends to suggest clear harm. There may be increased bacterial contamination of food products, the clinical significance of which remains unclear. There is a need for rigorous evaluation of the unintended consequences of antibiotic restrictions in human health, food availability, and economics, given their possible widespread implications.
The paradox of compassionate work: a mixed-methods study of satisfying and fatiguing experiences of animal health care providers
Anxiety, stress, and coping, Jan 24, 2017
Compassionate work appears paradoxical as it may provide great rewards, but may also come at grea... more Compassionate work appears paradoxical as it may provide great rewards, but may also come at great costs to care providers. This paper explores the paradox of compassionate work by examining what interactions contribute to compassion satisfaction and what interactions contribute to compassion fatigue. This mixed-methods, cross-sectional study uses qualitative interview data from animal health care providers (N = 20) to identify work interactions that they find satisfying or stressful. Quantitative survey data (N = 572) are used to test hypotheses generated from the interviews regarding predictors of compassion satisfaction and compassion fatigue. Interview transcripts were analyzed using a directed content analysis approach. Survey data were analyzed using ordinary least squares regression. The results highlight the complex nature of compassionate work. As hypothesized, making a difference to animals and building relationships with animal patients and human clients relate to greater...
The look and feel of resilience: A qualitative study of physicians’ perspectives
Journal of Hospital Administration, 2016
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Papers by Alicia J Polachek